About

Zachary F Meisel, MD, MPH, MSHP, is the William G. Baxt Professor in Emergency Medicine at the University of Pennsylvania Perelman School of Medicine. He serves as an attending physician in the Department of Emergency Medicine and is a senior fellow at the Leonard Davis Institute of Health Economics. Dr. Meisel is the director of the Policy and Dissemination Core at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, which is funded by NIDA. He also directs the Outreach Core of the Penn Injury Science Center, a CDC-funded National Center for Injury Prevention and Control, and is the vice chair of research in the Department of Emergency Medicine. His educational background includes a BA in History from Columbia College, MPH in Public Health in Health Policy and Management from Johns Hopkins University, MD from Johns Hopkins University School of Medicine, and MS in Health Policy Research from the University of Pennsylvania. Dr. Meisel's research expertise encompasses narrative medicine, health services research, emergency care access and utilization, patient safety, emergency medical services, medical journalism, medical writing, communication, dissemination and translation of health services research results, and comparative effectiveness research funding and federal policy. His clinical expertise is in emergency medicine, quality assurance, and prehospital care.

Research topics

• Obstetrics
• Pediatrics
• Emergency medicine
• Medicine
• Surgery

Selected publications

• Telemedicine Use and Outcomes Following Discharge From the Emergency Department, 2020-2022

  Annals of Emergency Medicine · 2026-03-12

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Inside CORE Talks: The New Forum Shaping Emergency Medicine Policy Thinking

  Emergency Medicine News · 2026-04-01

  articleSenior author
  PublisherDOI

• Postpartum Persistent Opioid Use After Opioid Exposure for Childbirth

  Obstetrics and Gynecology · 2025-11-20

  articleSenior author

  OBJECTIVE: To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure. METHODS: Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population. RESULTS: Of 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43). CONCLUSION: Opioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.

  PublisherDOI

• The Financial Sustainability of Programs to Initiate Medications for Opioid Use Disorder in Emergency Department Settings

  Academic Emergency Medicine · 2025-11-05

  articleOpen access

  BACKGROUND: The US is experiencing an epidemic of opioid misuse and mortality. Effective treatments are available, including medications for opioid use disorders (MOUD), but they are greatly underused due to a variety of barriers. In response, some US hospitals have established programs to identify emergency department (ED) patients with opioid use disorders (OUD) and begin treatment with MOUD ("ED induction"). For this model to be widely adopted, financial sustainability for hospitals is critical. Little is known about the financial aspects of ED-based treatment models, including insurance billing and reimbursement. OBJECTIVES: Our study addressed the following questions about ED-based induction of OUD treatment: (1) Which components of this model are billable to insurers? (2) How do hospitals fund the components that are not billable? (3) Does ED-based induction generate savings that could help fund that service? METHODS: We conducted a qualitative study, involving semi-structured interviews with officials at selected US hospitals. Potential interviewees were identified using a snowball sampling approach. We conducted 12 interviews across 10 states, mostly with urban teaching hospitals. RESULTS: Key findings include, (1) medication costs are often billable to insurers, but costs of key para-professional staff like peer navigators are not, requiring the hospital to absorb their salaries. Even some billable costs are reimbursed at low rates which challenge sustainability. (2) To fund non-billable components, hospitals typically rely on time-limited grant funding, including the federal 340B drug rebate program. (3) Several interviewees anticipated cost savings to their hospitals from reduced use of ED services by patients who had no (or low-paying) insurance. DISCUSSION: These findings indicate that some hospitals are able to sustain ED-based induction of MOUD using time-limited grant funding. However, wider dissemination of this model will likely require more stable funding streams, such as Medicaid reimbursement, paying adequate rates, and coverage of personnel.

  PublisherOA PDFDOI

• Racial Disparities in Unmet Pain Treatment Preference, Pain Treatment Satisfaction and Subsequent Opioid Misuse: A Secondary Analysis of a National Multisite RCT

  Journal of General Internal Medicine · 2025-06-25 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: Racial disparities in opioid prescriptions for pain are well documented. Evidence shows undertreated acute pain increases the risk of developing chronic pain, which puts patients at risk of long-term opioid use and misuse. We sought to determine the association between satisfaction with analgesia, unmet opioid preference, and opioid misuse risk by race in a diverse, longitudinal cohort. METHODS: We conducted a secondary analysis of participants with complete data in an RCT of 1301 patients who presented to the emergency department (E.D.) for acute kidney or back pain. Our primary outcome was opioid misuse risk quantified by the current opioid misuse measure (COMM), a self-report 17-item measure of risk of aberrant medication-related behavior among persons prescribed opioids for chronic pain, measured 90 days after the index E.D. visit. We used descriptive statistics and linear regressions to determine associations between satisfaction with analgesia (1-10, measured 1-day post-visit), unmet opioid preference, and opioid misuse risk by race, adjusting for age and sex. RESULTS: We analyzed 735 participants. The mean (SD) age was 39.6 (13.6), 58.9% (n = 432) were female, 46.4%(n = 341) were White, and 36.9%(n = 271) were Black. Unmet preference was more common among Black (21.8%, n = 59) vs. White (15%, n = 51) participants. Black (vs White) participants had a higher median (IQR) COMM (4 (1 - 12) vs 3 (1 - 6), P < 0.001, and lower median satisfaction (7 (4-10) vs 8 (5 - 10), P = 0.002). Adjusting for unmet preference and satisfaction, Black (vs. White) participants had higher COMM (β = 3.4, 95% CI 1.6-5.3, P = 0.01). Unmet preference was associated with higher COMM (β = 2.3, 95% CI 1.3-3.2, P < 0.001). Satisfaction was associated with lower COMM (β = - 0.5 pp, 95% CI - 0.7, - 0.2, P < 0.01). In a model with a triple interaction between satisfaction, unmet preference, and race, satisfaction was associated with lower COMM (- 0.3 pp, 95% CI - 0.5, - 0.1, P = 0.03) and mitigated the effect of unmet preference on Black participants' COMM (marginal effect β = - 1.3 pp, 95% CI - 1.9, - 0.7, P = 0.01). CONCLUSION: Satisfaction with analgesia was protective against opioid misuse risk, especially among Black participants whose opioid preference was unmet. Addressing unmet preferences and understanding factors that shape patient satisfaction with analgesia could help reduce racial disparities in opioid misuse.

  PublisherOA PDFDOI

• Firearm Violence and Health in Policymaker Discourse: Mixed Methods Social Media Analysis

  JMIR Formative Research · 2025-11-11

  articleOpen accessSenior author

  Background: Since 2019, firearm violence has remained the leading cause of death for US children and adolescents aged 1-19 years. This crisis has spurred action from policymakers, health professionals, and advocates. However, political polarization has contributed to divergent views on the causes and appropriate responses to firearm violence. Communication by elected officials, especially on social media, plays a critical role in shaping public opinion and policy agendas. Understanding how state policymakers discuss firearm violence, including the use of causal blame, calls to action, and health-related narratives, can inform more effective public health strategies. Objective: This study aimed to examine how Pennsylvania state legislators discuss firearms and firearm violence on social media and assess the extent to which their messaging aligns with public health perspectives. Methods: We conducted a 2-phase mixed methods analysis of X (formerly known as Twitter; X Corp) posts by Pennsylvania state legislators from May 27, 2017, to July 26, 2022. Posts were grouped into 3 time periods surrounding the Tree of Life Synagogue mass shooting in Pittsburgh. Using a Boolean search strategy, we identified 4573 posts related to firearms and firearm violence. After removing reposts and non-English content, we randomly sampled 1491 (32.6%) original posts authored by 152 unique legislators. Posts were coded using a structured codebook based on the Multiple Streams Framework to capture rhetorical framing, causal blame, and policy content. Interrater reliability was high (Holsti coefficient >0.8). We used chi-square tests and multivariable logistic regression to assess associations between rhetorical elements and policy mentions, adjusting for time period. Results: Mass shootings were the most frequently referenced category of firearm violence, peaking after the Tree of Life shooting (22/43, 51% vs 91/118, 77.1% vs 140/220, 63.6%; P=.004), while firearm suicide was rarely discussed. Posts using advocacy frames were nearly 5 times more likely to mention policy (adjusted odds ratio [aOR] 4.67, 95% CI 3.55-6.16), whereas those referencing mass shootings (aOR 0.54, 95% CI 0.37-0.77) or emotional appeals (aOR 0.53, 95% CI 0.40-0.69) were significantly less likely to do so. Most posts used general advocacy (aOR 2.97, 95% CI 2.13-4.13) and vague blame (aOR 8.26, 95% CI 6.02-11.35), resulting in nonspecific policy suggestions. Posts that attributed blame to firearm access were strongly associated with specific policy proposals (aOR 6.37, 95% CI 4.29-9.47) and inversely associated with general policy mentions (aOR 0.26, 95% CI 0.17-0.42). Only 9.4% (133/1422) of posts used health frames; when present, they more often referenced physical consequences (58/133, 43.6% vs 216/1358, 15.9%; P<.001). Conclusions: Pennsylvania legislators primarily focused on mass shootings and relied on emotional or symbolic language without proposing specific policies. Health frames were rare and typically focused on consequences rather than prevention. Findings highlight an opportunity to support policymakers with health-informed messaging strategies to promote actionable firearm violence prevention policies, particularly those addressing prevention.

  PublisherDOI

• Firearm Violence and Health in Policymaker Discourse: A Mixed-Methods Social Media Analysis (Preprint)

  2025-07-09

  preprintSenior author

  <sec> <title>BACKGROUND</title> Since 2019, firearm violence has remained the leading cause of death for U.S. children and adolescents ages 1–19. This crisis has spurred action from policymakers, health professionals, and advocates. However, political polarization has contributed to divergent views on the causes and appropriate responses to firearm violence. Communication by elected officials, especially on social media, plays a critical role in shaping public opinion and policy agendas. Understanding how state policymakers discuss firearm violence, including the use of causal blame, calls to action, and health-related narratives, can inform more effective public health strategies. </sec> <sec> <title>OBJECTIVE</title> To examine how Pennsylvania state legislators discuss firearms and firearm violence on social media and assess the extent to which their messaging aligns with public health perspectives. </sec> <sec> <title>METHODS</title> We conducted a two-phase mixed-methods analysis of X (formerly Twitter) posts by Pennsylvania state legislators from 05/27/2017 to 07/26/2022. Posts were grouped into three time periods surrounding the Tree of Life Synagogue mass shooting in Pittsburgh. Using a Boolean search strategy, we identified 4,573 posts related to firearms and firearm violence. After removing reposts and non-English content, we randomly sampled 1,491 original posts (32.6%) authored by 152 unique legislators. Posts were coded using a structured codebook based on the Multiple Streams Framework to capture rhetorical framing, causal blame, and policy content. Interrater reliability was high (Holsti’s coefficient &gt; 0.8). We used chi-squared tests and multivariable logistic regression to assess associations between rhetorical elements and policy mentions, adjusting for time period. </sec> <sec> <title>RESULTS</title> Mass shootings were the most frequently referenced category of firearm violence, peaking after the Tree of Life shooting (51% vs 77.1% vs 63.6%, P=.004), while firearm suicide was rarely discussed. Posts using advocacy frames were nearly five times more likely to mention policy (aOR 4.67, 95% CI: 3.55–6.16), whereas those referencing mass shootings (aOR 0.54, CI: 0.37–0.77) or emotional appeals (aOR 0.53, CI: 0.40–0.69) were significantly less likely to do so. Most posts employed general advocacy (aOR 2.97) and vague blame (aOR 8.26), resulting in non-specific policy suggestions. Posts that attributed blame to firearm access were strongly associated with specific policy proposals (aOR 6.37) and inversely associated with general policy mentions (aOR 0.26). Only 9.4% of posts used health frames; when present, they more often referenced physical consequences (43.6% vs 15.9%, P&lt;.001). </sec> <sec> <title>CONCLUSIONS</title> Pennsylvania legislators primarily focused on mass shootings and relied on emotional or symbolic language without proposing specific policies. Health frames were rare and typically focused on consequences rather than prevention. Findings highlight an opportunity to support policymakers with health-informed messaging strategies to promote actionable firearm violence prevention policies, particularly those addressing suicide. </sec>

  PublisherDOI

• Incidence of food allergic reactions among adolescents engaged in food allergy management

  Annals of Allergy Asthma & Immunology · 2025-03-09 · 2 citations

  article
  PublisherDOI

• Impact of telemental health on suicide prevention care in <scp>U.S.</scp> emergency departments

  Academic Emergency Medicine · 2025-05-07

  articleOpen access

  BACKGROUND: Mental health concerns are the reason for 7% of U.S. emergency department (ED) visits, and telehealth is increasingly used to provide emergency mental health care. Rural, critical-access hospitals have limited access to in-person mental health care. We sought to describe telemental health care programs in U.S. EDs and test whether access to telemental health care affects use of suicide prevention practices. METHODS: We conducted a cross-sectional survey of telemental health care and suicide prevention practices at a nationally representative sample of all U.S. EDs associated with acute care general medical hospitals. We used proportionate allocation and nonresponse weighting to generate national estimates. We used weighted adjusted logistic regression models to measure associations between an ED's access to telemental health care and use of six recommended suicide-prevention practices. RESULTS: A total of 606 of 977 eligible EDs completed the survey (62% response rate), weighted to represent 4321 EDs nationally. Telemental health care was used in 68% of EDs, and rural, smaller-volume, and critical-access EDs were more likely to use telemental health care. Critical-access hospitals were more likely to use telemental health care 24/7 and less likely to have access to a telehealth psychiatrist or electronic health record (EHR)-based information sharing. With structural differences being adjusted for, EDs with telemental health care were more likely to assess patients' suicidal intent or plans (adjusted risk ratio [ARR] 1.07, 95% confidence interval [CI] 1.10-1.14) and access to lethal means (ARR 1.13, 95% CI 1.01-1.26). Critical-access EDs with telemental health care were also more likely to provide lethal means safety counseling (ARR 2.11, 95% CI 1.14-3.89). CONCLUSIONS: Telemental health care is widely used across all types of EDs, and EDs with telemental health care are more likely to use suicide prevention practices. Critical-access hospitals rely on telemental health care to a great extent and need better access to telehealth psychiatry and EHR information sharing.

  PublisherOA PDFDOI

• The impact of opioid use associated with curative‐intent cancer surgery on safe opioid prescribing practice among veterans: An observational study

  Cancer · 2025-09-08 · 1 citations

  articleOpen access

  BACKGROUND: Opioid exposure during cancer therapy may increase long-term unsafe opioid prescribing. This study sought to determine the rates of coprescription of benzodiazepine and opioid medications and new persistent opioid use after surgical treatment of early-stage cancer. METHODS: A retrospective cohort study was conducted among a US veteran population via the Veterans Affairs Corporate Data Warehouse database. Participants were opioid-naive persons aged ≥21 years with a new diagnosis of stage 0-III cancer between January 1, 2015, and December 31, 2016. Outcomes were days of coprescription of benzodiazepines and opioids in the 13 months posttreatment and new persistent opioid use. The exposure was total morphine milligram equivalents (MMEs) attributed to treatment and prescribed from 30 days before through 14 days after the index surgical procedure. RESULTS: Among 9213 veterans, coprescription of benzodiazepines and opioids occurred in 366 patients (4.0%) and new persistent opioid use in 981 patients (10.6%). In a linear model adjusting for patient, clinical, and geographic factors, persons in the highest quartile compared to no opioid exposure had increased days with coprescription of benzodiazepines and opioids (mean difference, 1.0; 95% CI, 0.3-1.7). In a discrete time survival analysis, persons in the highest quartile of MME exposure compared to none had a greater risk of new persistent opioid use (hazard ratio, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS: More than one of 10 opioid-naive veterans undergoing curative-intent surgical treatment for cancer developed new persistent opioid use. Optimizing cancer treatment pain management strategies to mitigate long-term opioid-related health risks is crucial.

  PublisherOA PDFDOI

Recent grants

• The SPIN Trial (Stories to Promote Information through Narrative): A RCT testing

  NIH · $273k · 2013–2016

• CE19-001, The Penn Injury Science Center

  NIH · $4.4M · 2019–2024

• Health Economics of Substance Use Disorder, HCV, and HIV Treatment: Supporting Financial Sustainability, Advanced Methods, and Knowledge Translation

  NIH · $17.3M · 2015–2030

Frequent coauthors

• C. Crawford Mechem

  72 shared

• Frances S. Shofer

  Hospital of the University of Pennsylvania

  71 shared

• Jesse M. Pines

  CARE USA

  68 shared

• Charles V. Pollack

  67 shared

• Erik P. Hess

  Vanderbilt University

  56 shared

• Gerald C. Wydro

  49 shared

• Rex Mathew

  Thomas Jefferson University

  49 shared

• Adora Ozumba

  Pennsylvania Hospital

  49 shared

Labs

• Zachary F Meisel LabPI

Education

• Masters in Health Policy Research

  University of Pennsylvania

  2010

• MD

  Johns Hopkins University School of Medicine

  1999

• BA, History

  Columbia College, Columbia University

  1993

Awards & honors

• William G. Baxt Professor in Emergency Medicine