Shantel Hebert-Magee, MD, MPH

2018-2019

CLIA Laboratory Director, Louisiana Department of Public Health, Baton Rouge, LA

Dr. Shantel Hebert-Magee is a Cytopathologist and Associate Professor of Pathology, Affiliated Faculty at the University of Central Florida College of Medicine.  As the founding Director of Academic Pathology at the Center for Interventional Endoscopy, Florida Hospital, Orlando, FL she brought a vision of academic medicine to community practice. She has focused her clinical-effectiveness and device-development research on addressing early detection and diagnosis of pancreaticobiliary malignancy working collaboratively with academic, community, and industry partners. Her global health initiatives focused on early detection of pancreatic cancer have been conducted in Asia, Europe, and South America.  Prior to joining the faculty at UCF, Dr. Hebert-Magee was an Assistant Professor at the University of Alabama at Birmingham and Associate Scientist in the UAB Comprehensive Cancer Center.  She was a 2011 Charles Barkley Health Disparities Research Awardee and Minority Health Disparities Research Training Scholar. She has authored more than 50 peer-reviewed publications, editorials, white papers, and book chapters. In 2015, she launched Under the Scope Foundation, a 501c3 using microscopy and pathology to mitigate the sociobehavioral and environmental factors associated with pancreatic cancer in underserved communities. Dr. Hebert-Magee’s calling to public health dates back to her teen years in her hometown of New Orleans, where she worked on initiatives around the city’s teen HIV incidence rate. A future project would combine her interest in cultural consumption patterns, chronic diseases, and cancer as a result of socioeconomic inequalities.  Dr. Hebert-Magee received her medical degree from Georgetown University School of Medicine in 2005.  She also completed her Anatomic and Clinical Pathology residency as Chief Resident at Georgetown in 2009.  She completed a Translational Research Fellowship in Pathology at the National Cancer Institute in 2010 and Cytopathology Fellowship at UAB in 2011.

Neighborhood Segregation and Access to Buprenorphine for Opioid Use Disorder in Pregnant Women in Camden County, New Jersey

Background:

The opioid crisis has been declared a public health emergency by the US Department of Health and Human Services (HHS). A crucial component of the HHS proposed 5-point strategy is access to treatment. Hence, the need for the exploration of the therapeutic barriers and possible solutions to the opioid crisis in systems that have racial disparities.  Increasing evidence suggests that racial, ethnic, and economic residential clustering patterns determine access to novel opioid therapies for opiate use disorder.  Residential locations with high minority and low-income dwellers are less likely to have access to buprenorphine therapy for opioid use disorder compared to predominantly white, more affluent residential locations. 

Since the passage of New Jersey Senate Bill 3, signed on February 15, 2017 by Governor Chris Christie, New Jersey has aimed to examine minority and/or pregnant patients’ access to opioid agonist therapy. The bill outlines the state initiative to address the opioid epidemic by increasing restriction on opioid prescribing and requiring state-regulated health plans to cover benefits for both inpatient and outpatient treatment for persons diagnosed with a substance use disorder. New Jersey has contemporaneously invested in a comprehensive approach to confront the opioid crisis through - increasing access to medication-assisted treatment in low income residential areas, increasing access to pregnant women, and expanding the number of waivered providers.

The purpose of this project is to evaluate the impact of these policies on pregnant women, given residential clustering patterns.

Objectives:

1.  The objective of this study is to determine the contributory role of neighborhood clustering and urban residential segregation to buprenorphine treatment access in pregnant women in Camden County, New Jersey. 
2.  To determine the effectiveness of recent opioid access state policies for low-income and racial minority dwellers in high cluster neighborhoods in Camden County, New Jersey.

Methods:

1. Assembled and systematically analyzed existing peer-reviewed and grey literature.
2. Selected the geographic “social” areas and providers based upon residential racial/ethnic and income clustering patterns for the pilot phone survey.
3.  Defined the call script and fielded phone surveys with selected providers.
4.  Analyzed and summarized the findings from the pilot study to determine salient policy directives.

Results:

Across social areas, buprenorphine treatment rate (p=.012), buprenorphine access to pregnant women (p<.0001), and wait-time (p<.0001) were negatively correlated with high Black, high Latinx, and high poverty clustering.

Conclusion: 

The dissemination of new, lower risk opioid agonist treatment in Camden County is unequal.  Buprenorphine, as a therapeutic option, may disproportionately widen chasms in neighborhoods segregated by race, ethnicity, and income.

Preceptorship Team: Lisa Clemans-Cope, Emma Winiski, Marni Epstein, Urban Institute, Health Policy Center, Washington, DC