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Xiong F, Jetson J, Park C, Delcher C. Federal Impacts on Buprenorphine Prescribing in Washington State, 2012 to 2022. Am J Public Health 2024; 114:696-704. [PMID: 38696736 PMCID: PMC11153960 DOI: 10.2105/ajph.2024.307649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/04/2024]
Abstract
Objectives. To evaluate changes in monthly buprenorphine dispensation associated with federal prescribing policies in Washington State from 2012 to 2022. Methods. We conducted an interrupted time series analysis comparing monthly buprenorphine prescriptions dispensed per 1000 population after the Comprehensive Addiction and Recovery Act (CARA), Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and new prescribing rules during the COVID-19 pandemic. Buprenorphine formulated for opioid use disorder was included from the Washington State Prescription Monitoring Program. A log-linear autoregressive model measured linear trend changes. Results. Physician prescribing increased by 1.63% (95% confidence interval [CI] = 1.41%, 1.85%) per month after CARA with sustained declines after SUPPORT. Nurse practitioner (NP) prescribing increased by 19.48% (95% CI = 18.8%, 20.16%) per month after CARA with physician assistants (PAs) showing similar trends. Following the implementation of SUPPORT, NP and PA trends continued to increase at a reduced growth rate of 3.96% (95% CI = 2.01%, 5.94%) and 1.87% (95% CI = 0.56%, 3.19%), respectively. No prescribers experienced increases during the COVID-19 pandemic. Conclusions. CARA nearly tripled the buprenorphine prescribing rate. The SUPPORT Act initiated sustained declines for physician prescribing, and the COVID-19 period reversed gains for PAs and NPs. The current opioid crisis requires expanded efforts in Washington State. (Am J Public Health. 2024;114(7):696-704. https://doi.org/10.2105/AJPH.2024.307649).
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Affiliation(s)
- Fan Xiong
- Fan Xiong and Jillian Jetson are with the Washington State Department of Health, Tumwater, Washington. Cheolwoo Park is with the Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of South Korea. Chris Delcher is with the Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington
| | - Jillian Jetson
- Fan Xiong and Jillian Jetson are with the Washington State Department of Health, Tumwater, Washington. Cheolwoo Park is with the Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of South Korea. Chris Delcher is with the Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington
| | - Cheolwoo Park
- Fan Xiong and Jillian Jetson are with the Washington State Department of Health, Tumwater, Washington. Cheolwoo Park is with the Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of South Korea. Chris Delcher is with the Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington
| | - Chris Delcher
- Fan Xiong and Jillian Jetson are with the Washington State Department of Health, Tumwater, Washington. Cheolwoo Park is with the Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of South Korea. Chris Delcher is with the Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington
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Uscher-Pines L, Sousa J, Raja P, Mehrotra A, Busch AB, Huskamp HA. Perceptions of stimulant and buprenorphine diversion and strategies to address it. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae074. [PMID: 38934014 PMCID: PMC11199907 DOI: 10.1093/haschl/qxae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
There is ongoing policy debate on the prescribing of controlled substances such as buprenorphine and stimulants via telemedicine. The goal of federal and state policymakers is to ensure access to care while limiting diversion risk. However, there is little evidence on how clinicians view and address diversion and on telemedicine's role in diversion. From December 2023 to January 2024, we conducted semi-structured interviews with 21 psychiatrists and primary care physicians engaged in hybrid (telemedicine and in-person) care models in which we explored perceptions of diversion and strategies used to monitor for diversion. Most physicians reported monitoring for diversion, but there was little consistency on how monitoring was done and reported strategies did not differ between telemedicine vs in-person care. When physicians suspected diversion, there was also wide variation in responses: some clinicians did not immediately take any action while others imposed more requirements on patients (e.g., more frequent visits), no longer prescribed the controlled substance, or terminated the patient from their practice. Few physicians had ever reported a case of suspected diversion to law enforcement. Our findings suggest that the Drug Enforcement Administration could clarify reporting requirements and professional societies could provide additional guidance on how to respond to suspected diversion, given the current variation in practice across clinicians could be exploited by individuals who want to divert.
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Affiliation(s)
| | | | - Pushpa Raja
- Department of Mental Health, Greater Los Angeles VA Medical Center, Los Angeles, CA 90073, United States
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
- Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
- Department- Psychiatry, McLean Hospital, Belmont, MA 02478, United States
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
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Stopka TJ, Babineau DC, Gibson EB, Knott CE, Cheng DM, Villani J, Wai JM, Blevins D, David JL, Goddard-Eckrich DA, Lofwall MR, Massatti R, DeFiore-Hyrmer J, Lyons MS, Fanucchi LC, Harris DR, Talbert J, Hammerslag L, Oller D, Balise RR, Feaster DJ, Soares W, Zarkin GA, Glasgow L, Oga E, McCarthy J, D’Costa L, Chahine R, Gomori S, Dalvi N, Shrestha S, Garner C, Shadwick A, Salsberry P, Konstan MW, Freisthler B, Winhusen J, El-Bassel N, Samet JH, Walsh SL. Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240132. [PMID: 38386322 PMCID: PMC10884876 DOI: 10.1001/jamanetworkopen.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Importance Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration ClinicalTrials.gov Identifier: NCT04111939.
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Affiliation(s)
- Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Erin B. Gibson
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Charles E. Knott
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Debbie M. Cheng
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jonathan M. Wai
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Derek Blevins
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - James L. David
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Dawn A. Goddard-Eckrich
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Michelle R. Lofwall
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, Columbus
| | | | | | - Laura C. Fanucchi
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | | | | | - Lindsey Hammerslag
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Devin Oller
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
| | - Raymond R. Balise
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - William Soares
- UMass Chan Medical School–Baystate, Springfield, Massachusetts
| | - Gary A. Zarkin
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - LaShawn Glasgow
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Emmanuel Oga
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - John McCarthy
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Lauren D’Costa
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Rouba Chahine
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Steve Gomori
- Research Triangle Institute, Research Triangle Park, North Carolina
| | - Netrali Dalvi
- Office of Prescription Monitoring and Drug Control, Massachusetts Department of Public Health, Boston
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Aimee Shadwick
- RecoveryOhio, Office of Ohio Governor Mike DeWine, Columbus
| | - Pamela Salsberry
- Health Behavior and Health Promotion, Ohio State University, Columbus
| | | | | | - John Winhusen
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University; Division on Substance Use Disorders, New York State Psychiatric Institute, New York
| | - Jeffrey H. Samet
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Sharon L. Walsh
- College of Medicine, University of Kentucky Center on Drug and Alcohol Research, Lexington
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Wang Y, Chan A, Beuttler R, Fleming ML, Schneberk T, Nichol M, Lu H. Real-World Dispensing of Buprenorphine in California during Prepandemic and Pandemic Periods. Healthcare (Basel) 2024; 12:241. [PMID: 38255128 PMCID: PMC10815450 DOI: 10.3390/healthcare12020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The opioid overdose crisis in the United States has become a significant national emergency. Buprenorphine, a primary medication for individuals coping with opioid use disorder (OUD), presents promising pharmacokinetic properties for use in primary care settings, and is often delivered as a take-home therapy. The COVID-19 pandemic exacerbated the scarcity of access to buprenorphine, leading to dire consequences for those with OUD. Most existing studies, primarily focused on the immediate aftermath of the COVID-19 outbreak, highlight the challenges in accessing medications for opioid use disorder (MOUDs), particularly buprenorphine. However, these studies only cover a relatively short timeframe. METHODS To bridge this research gap, in our study, we utilized 33 months of California's prescription drug monitoring program (PDMP) data to provide insights into real-world buprenorphine dispensing trends since the onset of the pandemic from 2018 to 2021, focusing on outcomes such as patient counts, prescription volumes, prescriber involvement, days' supply, and dosage. Statistical analysis employed interrupted time series analysis to measure changes in trends before and during the pandemic. RESULTS We found no significant impact on patient counts or prescription volumes during the pandemic, although it impeded the upward trajectory of prescriber numbers that was evident prior to the onset of the pandemic. An immediate increase in days' supply per prescription was observed post-pandemic. CONCLUSION Our findings differ in comparison to previous data regarding the raw monthly count of patients and prescriptions. The analysis encompassed uninsured patients, offering a comprehensive perspective on buprenorphine prescribing in California. Our study's insights contribute to understanding the impact of COVID-19 on buprenorphine access, emphasizing the need for policy adjustments.
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Affiliation(s)
- Yun Wang
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA; (R.B.); (M.L.F.)
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA 92697, USA;
| | - Richard Beuttler
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA; (R.B.); (M.L.F.)
| | - Marc L. Fleming
- School of Pharmacy, Chapman University, Irvine, CA 92618, USA; (R.B.); (M.L.F.)
| | - Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Michael Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA 90089, USA;
| | - Haibing Lu
- Leavey School of Business, Santa Clara University, Santa Clara, CA 95053, USA;
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Tormohlen KN, Eisenberg MD, Fingerhood MI, Yu J, McCourt AD, Stuart EA, Rutkow L, Quintero L, White SA, McGinty EE. Trends in Opioid Use Disorder Outpatient Treatment and Telehealth Utilization Before and During the COVID-19 Pandemic. Psychiatr Serv 2024; 75:72-75. [PMID: 37461819 PMCID: PMC11034749 DOI: 10.1176/appi.ps.20230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVE The authors examined trends in opioid use disorder treatment and in-person and telehealth modalities before and after COVID-19 pandemic onset among patients who had received treatment prepandemic. METHODS The sample included 13,113 adults with commercial insurance or Medicare Advantage and receiving opioid use disorder treatment between March 2018 and February 2019. Trends in opioid use disorder outpatient treatment, treatment with medications for opioid use disorder (MOUD), and in-person and telehealth modalities were examined 1 year before pandemic onset and 2 years after (March 2019-February 2022). RESULTS From March 2019 to February 2022, the proportion of patients with opioid use disorder outpatient and MOUD visits declined by 2.8 and 0.3 percentage points, respectively. Prepandemic, 98.6% of outpatient visits were in person; after pandemic onset, at least 34.9% of patients received outpatient care via telehealth. CONCLUSIONS Disruptions in opioid use disorder outpatient and MOUD treatments were marginal during the pandemic, possibly because of increased telehealth utilization.
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Affiliation(s)
- Kayla N Tormohlen
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Matthew D Eisenberg
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Michael I Fingerhood
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Jiani Yu
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Alexander D McCourt
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Elizabeth A Stuart
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Lainie Rutkow
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Luis Quintero
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Sarah A White
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
| | - Emma E McGinty
- Departments of Health Policy and Management (Tormohlen, Eisenberg, McCourt, Stuart, Rutkow, White) and Mental Health (Fingerhood, Stuart), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medicine, New York City (Yu, McGinty); Johns Hopkins Carey Business School, Washington, D.C. (Quintero)
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Andraka-Christou B, Golan O, Totaram R, Ohama M, Saloner B, Gordon AJ, Stein BD. Prior authorization restrictions on medications for opioid use disorder: trends in state laws from 2005 to 2019. Ann Med 2023; 55:514-520. [PMID: 36724766 PMCID: PMC9897778 DOI: 10.1080/07853890.2023.2171107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RESEARCH OBJECTIVE Medications for opioid use disorder (MOUDs) - including methadone, buprenorphine, and naltrexone - are the most effective treatments for opioid use disorder (OUD). Historically, insurers have required prior authorization for MOUD, but prior authorization is often reported as a key barrier to MOUD prescribing. Some states have passed laws prohibiting MOUD prior authorization requirements. We sought to identify the frequency of MOUD prior authorization prohibitions in state laws and to categorize types of prohibitions. METHODS We searched for regulations and statutes present in all U.S. states and Washington DC between 2005 and 2019 using MOUD-related terms in Westlaw legal software. In qualitative software, we coded laws discussing MOUD prior authorization using template analysis - a mixed deductive/inductive approach. Finally, we used coded laws to identify frequencies of states with prior authorization prohibitions, including changes over time. RESULTS No states had laws prohibiting MOUD prior authorization between 2005 and 2015, with the first prohibition appearing in 2016. By 2019, fifteen states had MOUD prior authorization prohibitions. States varied significantly in their approach to prohibiting MOUD prior authorization. In 2019, it was more common for states to have MOUD prior authorization prohibitions applying to all insurers (n = 10 states) than to only Medicaid (n = 7 states) or only non-Medicaid insurers (n = 1 state). In 2019, general prior authorization prohibitions (n = 10 states) were more common than prohibitions only applicable to medications on the formulary, prohibitions only applicable to medications on the preferred drug list, prohibitions only applicable during the first 5 days of treatment, and prohibitions only applicable during the first 30 days of treatment. CONCLUSIONS The number of states with an MOUD prior authorization law prohibition increased in recent years. Such laws could help expand access to life-saving OUD treatments by making it easier for clinicians to prescribe MOUD.KEY MESSAGESNo states had MOUD prior authorization prohibitions between 2005 and 2015 in state statutes or regulations, and only one state had such a prohibition in 2016.By 2019, fifteen states had an MOUD prior authorization prohibition law.States varied significantly in their approach to prohibiting MOUD prior authorization, including with respect to the insurer type, duration of the prohibition, and applicable medication.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA
- CONTACT Barbara Andraka-Christou School of Global Health Management and Informatics, University of Central Florida, 525 W Livingston Street, Suite 401, Orlando, 32801FL, USA
| | - Olivia Golan
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Rachel Totaram
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Maggie Ohama
- The Cardiac and Vascular Institute, Gainesville, FL, USA
| | - Brendan Saloner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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O'Donoghue AL, Reichheld A, Anderson TS, Zera CA, Dechen T, Stevens JP. Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States. J Addict Med 2023; 17:e399-e402. [PMID: 37934549 DOI: 10.1097/adm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVES Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers. To quantify these changes, we examined trends in the number of individuals filling buprenorphine/naloxone prescriptions during the COVID-19 pandemic. METHODS We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from prepandemic (May 2019 to February 2020) to the pandemic period (April 2020 to December 2020). We estimated changes in the growth rate in the monthly number of individuals filling buprenorphine/naloxone prescriptions in the 6 months preceding a delivery claim, per 100,000 pregnancies, during the COVID-19 pandemic. RESULTS We identified 2947 pregnant individuals filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling buprenorphine/naloxone prescriptions (4.83%; 95% confidence interval [CI], 3.82-5.84%). During the pandemic, this monthly growth rate declined for both individuals on commercial insurance and individuals on Medicaid (all payers: -5.53% [95% CI, -6.65% to -4.41%]; Medicaid: -7.66% [95% CI, -10.14% to -5.18%]; Commercial: -3.59% [95% CI, -5.32% to -1.87%]). CONCLUSION The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing, but this growth has been lost during the pandemic.
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Affiliation(s)
- Ashley L O'Donoghue
- From the Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA (ALO, AR, TSA, TD, JPS); Harvard Medical School, Boston, MA (ALO, TSA, CAZ, JPS); Tufts University School of Medicine, Boston, MA (AR); Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA (TSA); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (CAZ); and Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (JPS)
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Austin AE, Tang L, Kim JY, Allen L, Barnes AJ, Chang CCH, Clark S, Cole ES, Durrance CP, Donohue JM, Gordon AJ, Huskamp HA, McDuffie MJ, Mehrotra A, Mohamoud S, Talbert J, Ahrens KA, Applegate M, Hammerslag LR, Lanier P, Tossone K, Zivin K, Burns ME. Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs. JAMA HEALTH FORUM 2023; 4:e231422. [PMID: 37327009 PMCID: PMC10276306 DOI: 10.1001/jamahealthforum.2023.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results Among a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth.
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Affiliation(s)
- Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | - Lu Tang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joo Yeon Kim
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lindsay Allen
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Chung-Chou H. Chang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Clark
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor
| | - Evan S. Cole
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Julie M. Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J. Gordon
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Mary Joan McDuffie
- Center for Community Research and Service, Joseph R. Biden, Jr. School of Public Policy and Administration, University of Delaware, Newark
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland, Baltimore County, Baltimore
| | - Jeffery Talbert
- Institute for Biomedical Informatics, University of Kentucky, Lexington
| | - Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland
| | | | | | - Paul Lanier
- School of Social Work, The University of North Carolina at Chapel Hill
| | - Krystel Tossone
- The Ohio Colleges of Medicine, Government Resource Center, College of Medicine, The Ohio State University, Columbus
| | - Kara Zivin
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor
| | - Marguerite E. Burns
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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Roy PJ, Callaway Kim K, Suda K, Luo J, Wang X, Olejniczak D, Liebschutz JM. Impact of COVID-19-related regulatory changes on nationwide access to buprenorphine: An interrupted time series design. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100135. [PMID: 36694665 PMCID: PMC9851915 DOI: 10.1016/j.dadr.2023.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Background The impact of COVID-19-related healthcare changes on access to buprenorphine (BUP) nationwide in the US is unknown. Methods We conducted an interrupted time series with the IQVIA LRx database. The study timeline included BUP prescriptions from 52 weeks before (2/23/19-2/21/20) to 52 weeks after (4/4/20-4/2/21) the initial pandemic period (2/22/20-4/3/20). Segmented regression estimated relative changes in total milligrams (MG) of BUP available per week nationwide at 1, 26, and 52 weeks post-initial-pandemic. We evaluated treatment disruptions in previously stable patients, defined as ≥6 months of BUP prescriptions. Results A total of 31 617 849 prescriptions were included. Total MG BUP dispensed increased at 1 and 26 weeks and then returned to baseline trends at 52 weeks post-initial pandemic period (4.1% [95% CI: 3.7,4.5], 2.1% [1.5,2.6], 0.1% [-0.6,0.9]). Stably-treated patients saw a decrease in 7-, 14-, and 28-day treatment disruptions at 52 weeks post-initial-pandemic period (-21.6% [-25.6,-17.7]; -10.8% [-16.3,-5.3]; -27.3% [-33.0,-21.6]). Men retained an increase in MG BUP compared to women at 52 weeks (0.7% [0.01,1.4] versus -0.6% [-1.5,0.2]). Younger age groups (18-29 years and 30-39 years) had a decrease in MG BUP at 52 weeks compared to expected baseline trend (-16.6 [-24.2, -9.0]; -1.6 [-3.0, -0.1). Patients with Medicaid demonstrated an increase in MG BUP at 52 weeks (8.3% [6.3,10.3]). MG BUP prescribed by APP prescribing increased by over 140 000 mg per week prior to the pandemic and continued to increase. Conclusions Regulatory changes around buprenorphine prescribing facilitated patient access to buprenorphine during the pandemic.
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Affiliation(s)
- Payel Jhoom Roy
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine Callaway Kim
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katie Suda
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Jing Luo
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Xiaoming Wang
- National Institute on Drug Abuse, Bethesda, MD, United States
| | - Donna Olejniczak
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
| | - Jane M Liebschutz
- Department of Medicine, UPMC/University of Pittsburgh, Pittsburgh, PA, United States
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10
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Stein BD, Landis RK, Sheng F, Saloner B, Gordon AJ, Sorbero M, Dick AW. Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention. J Gen Intern Med 2023; 38:733-737. [PMID: 36474004 PMCID: PMC9734477 DOI: 10.1007/s11606-022-07891-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND During the COVID pandemic, overall buprenorphine treatment appeared to remain relatively stable, despite some studies suggesting a decrease in patients starting buprenorphine. There is a paucity of empirical information regarding patterns of buprenorphine treatment during the pandemic. OBJECTIVE To better understand the patterns of buprenorphine episodes during the pandemic and how those patterns compared to pre-pandemic patterns. DESIGN Pharmacy claims representing approximately 92% of all prescriptions filled at retail pharmacies in all 50 US states and the District of Columbia. PARTICIPANTS Individuals filling buprenorphine prescriptions indicated for treatment of opioid use disorder. MAIN MEASURES The number of active, starting, and ending buprenorphine treatment episodes March 13 to December 1, 2020, and the expected number of such episodes in 2020 based on the growth in treatment episodes from March 13 to December 1, 2019. KEY RESULTS The observed number of active buprenorphine episodes in December 2020 was comparable to the expected number, but new treatment episodes starting between March 13 and December 1, 2020, were 17.2% fewer than expected based on the 2019 experience. Similarly, the number of episodes that ended between March 13 and December 1, 2020, was 16.0% fewer than expected. Decreases from expected episode starts and ends occurred throughout the period but were greatest in the 2 months after the declaration of the public health emergency. CONCLUSIONS AND RELEVANCE Beneath the apparent stability of buprenorphine patient numbers during the pandemic, the flow of individuals receiving buprenorphine treatment changed substantially. Our findings shed light on how policy changes meant to support buprenorphine prescribing influenced prescribing dynamics during that period, suggesting that while policy efforts may have been successful in maintaining existing patients in treatment, that success did not extend to individuals not yet in treatment.
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Affiliation(s)
- Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Rachel K Landis
- George Washington University Trachtenberg School of Public Policy, Washington, DC, USA.,RAND Corporation, Arlington, VA, USA
| | | | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mark Sorbero
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
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11
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National trends in buprenorphine prescribing before and during the COVID-19 pandemic. J Subst Abuse Treat 2023; 144:108923. [PMID: 36334383 PMCID: PMC9617630 DOI: 10.1016/j.jsat.2022.108923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/30/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent studies have shown that early in the COVID-19 pandemic, rates of buprenorphine prescription dispensing for opioid use disorder (OUD) were relatively stable. However, whether that pattern continued later in the pandemic is unclear. This study examines the monthly rate of dispensed buprenorphine prescriptions during the early period and the later period of the pandemic. METHODS The study uses interrupted time series analysis to examine buprenorphine prescription dispensed, average day's supply, payment source, and the number of patients with a dispensed buprenorphine prescription. The study utilized January 2019-April 2021 data from IQVIA National Prescription Audit, PayerTrack and Total Patient Tracker databases. RESULTS After an initial increase in the number of patients prescribed buprenorphine in the early period of the pandemic, the monthly rate of patients prescribed buprenorphine increased at a lower rate compared to the pre-pandemic period (6100 vs 4600/month). The study observed a decline in the number of buprenorphine prescriptions dispensed both in levels and growth rate during the pandemic, but an increase occurred in the average day's supply of buprenorphine prescriptions (17 days pre-pandemic vs 18.6 day during the pandemic). Medicaid became the primary payer of buprenorphine prescriptions as the pandemic continued, while buprenorphine prescriptions paid for by private insurance declined. DISCUSSION Expanding and maintaining access to treatment for OUD were key priorities in federal and state responses to the COVID-19 pandemic. The results of our study underscore the importance of policy efforts to help increase buprenorphine prescribing for OUD.
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Frost MC, Zhang L, Kim HM, Lin L(A. Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2236298. [PMID: 36223118 PMCID: PMC9557869 DOI: 10.1001/jamanetworkopen.2022.36298] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention-a key indicator of care quality. OBJECTIVES To compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19-related policy changes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19-related changes; prior to COVID-19-related changes). EXPOSURES Patient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person). MAIN OUTCOMES AND MEASURES Treatment modality; 90-day retention. RESULTS Among 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non-service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non-service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19-related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19-related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71). CONCLUSIONS AND RELEVANCE In this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.
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Affiliation(s)
- Madeline C. Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington
| | - Lan Zhang
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor
| | - H. Myra Kim
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor
| | - Lewei (Allison) Lin
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor
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13
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Lin L(A, Zhang L, Kim HM, Frost MC. Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder. Am J Psychiatry 2022; 179:740-747. [PMID: 35899380 PMCID: PMC9529783 DOI: 10.1176/appi.ajp.21111141] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the impact of COVID-19-related policies reducing barriers to telehealth delivery of buprenorphine treatment for opioid use disorder (OUD) on buprenorphine treatment across different modalities (telephone, video, and in-person visits). METHODS This was a national retrospective cohort study with interrupted time-series analyses to examine the impact of policy changes in March 2020 on buprenorphine treatment for OUD in the Veterans Health Administration, during the year before the start of the COVID-19 pandemic (March 2019 to February 2020) and during the first year of the pandemic (March 2020 to February 2021). The authors also examined trends in the use of telephone, video, and in-person visits for buprenorphine treatment and compared patient demographic characteristics and retention in buprenorphine treatment across the two periods. RESULTS The number of patients receiving buprenorphine increased from 13,415 in March 2019 to 15,339 in February 2021. By February 2021, telephone visits were used by the most patients (50.2%; 4,456 visits), followed by video visits (32.4%; 2,870 visits) and in-person visits (17.4%; 1,544 visits). During the pre-pandemic period, the number of patients receiving buprenorphine increased significantly by 103 patients per month. After the COVID-19 policy changes, there was an immediate increase of 265 patients in the first month, and the number continued to increase significantly, at a rate of 47 patients per month. The demographic characteristics of patients receiving buprenorphine during the pandemic period were similar to those during the pre-pandemic period, but the proportion of patients reaching 90-day retention on buprenorphine treatment decreased significantly from 49.6% to 47.7%, while days on buprenorphine increased significantly from 203.8 to 208.7. CONCLUSIONS The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits, suggesting that any reversal of COVID-19 policies must be carefully considered.
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Affiliation(s)
- Lewei (Allison) Lin
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI
- University of Michigan Injury Prevention Center, Ann Arbor, MI
| | - Lan Zhang
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI
| | - Madeline C. Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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Treatment of Opioid Use Disorder With Buprenorphine Among US Adolescents and Young Adults During the Early COVID-19 Pandemic. J Adolesc Health 2022; 71:239-241. [PMID: 35595609 PMCID: PMC9110275 DOI: 10.1016/j.jadohealth.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE The COVID-19 pandemic's impact on buprenorphine treatment for opioid use disorder among adolescents and young adults (AYAs) is unknown. METHODS We used IQVIA Longitudinal Prescription Claims, including US AYAs aged 12-29 with at least 1 buprenorphine fill between January 2018 and August 2020, stratifying by age group and insurance. We compared buprenorphine prescriptions in March-August 2019 to March-August 2020. RESULTS The monthly buprenorphine prescription rate increased 8.3% among AYAs aged 12-17 but decreased 7.5% among 18- to 24-year-olds and decreased 5.1% among 25- to 29-year-olds. In these age groups, Medicaid prescriptions did not significantly change, whereas commercial insurance prescriptions decreased 12.9% among 18- to 24-year-olds and 11.8% in 25- to 29-year-olds, and cash/other prescriptions decreased 18.7% among 18- to 24-year-olds and 19.9% in 25- to 29-year-olds (p < .001 for all). DISCUSSION Buprenorphine prescriptions paid with commercial insurance or cash among young adults significantly decreased early in the pandemic, suggesting a possible unmet treatment need among this group.
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Vo AT, Patton T, Peacock A, Larney S, Borquez A. Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148883. [PMID: 35886734 PMCID: PMC9317093 DOI: 10.3390/ijerph19148883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
We carried out a scoping review to characterize the primary quantitative evidence addressing changes in key individual/structural determinants of substance use risks and health outcomes over the first two waves of the COVID-19 pandemic in the United States (US). We systematically queried the LitCovid database for US-only studies without date restrictions (up to 6 August 2021). We extracted quantitative data from articles addressing changes in: (a) illicit substance use frequency/contexts/behaviors, (b) illicit drug market dynamics, (c) access to treatment and harm reduction services, and (d) illicit substance use-related health outcomes/harms. The majority of 37 selected articles were conducted within metropolitan locations and leveraged historical timeseries medical records data. Limited available evidence supported changes in frequency/behaviors/contexts of substance use. Few studies point to increases in fentanyl and reductions in heroin availability. Policy-driven interventions to lower drug use treatment thresholds conferred increased access within localized settings but did not seem to significantly prevent broader disruptions nationwide. Substance use-related emergency medical services’ presentations and fatal overdose data showed a worsening situation. Improved study designs/data sources, backed by enhanced routine monitoring of illicit substance use trends, are needed to characterize substance use-related risks and inform effective responses during public health emergencies.
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Affiliation(s)
- Anh Truc Vo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Thomas Patton
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
| | - Amy Peacock
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC H3C 3J7, Canada;
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
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Nguyen T, Ziedan E, Simon K, Miles J, Crystal S, Samples H, Gupta S. Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2214765. [PMID: 35648400 PMCID: PMC9161014 DOI: 10.1001/jamanetworkopen.2022.14765] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Importance COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown. Objective To investigate whether disruptions in filled buprenorphine and naltrexone prescriptions differed by race and ethnicity and insurance status or payer type. Design, Setting, and Participants This cross-sectional study used retail pharmacy claims from May 2019 to June 2021 from the Symphony Health database, which includes 92% of US retail pharmacy claims, with race and ethnicity data spanning all insurance status and payer categories. Interrupted time series were used to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. Included individuals were those who filled buprenorphine and extended-release naltrexone prescriptions. Data were analyzed from July 2021 through March 2022. Main Outcomes and Measures Weekly rates of dispensed buprenorphine and extended-release naltrexone prescription fills per 1000 patients and proportion of longer (ie, ≥14 days' supply) buprenorphine prescription fills were calculated. Analyses were stratified by patient race and ethnicity and further by insurance status and payer type for White and Black patients. Results A total of 1 556 860 individuals who filled buprenorphine prescriptions (4359 Asian [0.3%], 94 657 Black [6.1%], 55 369 Hispanic [3.6%], and 664 779 White [42.7%]) and 127 506 individuals who filled extended-release naltrexone prescriptions (344 Asian [0.3%], 8186 Black [6.4%], 5343 Hispanic [4.2%], and 53 068 White [41.6%]) from May 6, 2019, to June 5, 2021, were analyzed. Prepandemic increases in buprenorphine fill rate flattened for all groups after COVID-19 onset (30.5 percentage point difference in trend; P < .001) compared with prepandemic trends. Significant level decreases in buprenorphine fills (ranging from 2.5% for Black patients; P = .009 to 4.0% for Hispanic patients; P = .009) at pandemic onset were observed for members of racial and ethnic minority groups but not White patients. At pandemic onset, rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare: 10.0%; P < .001; cash: 20.0%; P < .001) than White patients (Medicare: 3.5%; P = .004; cash: 15.0%; P < .001). No decreases were found among Medicaid patients. Unlike buprenorphine, extended-release naltrexone had uniform level (from 10.0% for White patients with private insurance; P < .001 to 23.3% for Black patients with Medicare; P < .001) and trend (from 15.5 percentage points for White patients with Medicaid; P = .001 to 52.0 percentage points for Black patients with private insurance; P < .001) decreases across groups. Conclusions and Relevance This study found that the COVID-19 pandemic was associated with immediate decreases in filled buprenorphine prescriptions by members of racial and ethnic minority groups but not White individuals. These findings suggest that members of racial and ethnic minority groups had larger losses in buprenorphine access during the pandemic across payer types.
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Affiliation(s)
- Thuy Nguyen
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Engy Ziedan
- Department of Economics, Tulane University, New Orleans, Louisiana
| | - Kosali Simon
- O'Neil School of Public and Environmental Affairs, Indiana University, Bloomington
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Jennifer Miles
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, New Brunswick, New Jersey
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health Rutgers University, New Brunswick, New Jersey
| | - Sumedha Gupta
- Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis
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17
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Saloner B, Landis RK, Jayakrishnan R, Stein BD, Barry CL. A bridge too far? Distance to waivered physicians and utilization of buprenorphine treatment for opioid use disorder in West Virginia Medicaid. Subst Abus 2022; 43:682-690. [PMID: 35099362 PMCID: PMC10105979 DOI: 10.1080/08897077.2021.1986882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Travel distance to medication treatment for opioid use disorder (OUD) is a challenge for many patients, but little is known about how distance is associated with medication treatment utilization. This study examines the association between distance to the nearest physician waivered to prescribe buprenorphine and patient-level buprenorphine treatment among West Virginia Medicaid expansion enrollees with diagnosed OUD. Methods: We conducted a cross-sectional spatial analysis with 2016 Medicaid claims data, separately examining individuals living in metropolitan and non-metropolitan areas. We calculated the driving distance from the centroid of patients' residential ZIP codes to the street address of the nearest waivered physician derived from the 2015 Drug Enforcement Administration listing. Regression models examined the association between distance and initiation and duration of buprenorphine (among those initiating). Results: We focused on 8,008 individuals with OUD in 2016. The nearest waivered prescriber in metropolitan areas was an average of 7.13 miles away from patients' residential ZIP codes and 14.54 miles in non-metropolitan areas. The providers they actually visited were a mean of 33.63 miles away in metro areas and 46.36 in non-metropolitan areas. In multivariable analyses, compared to those living <10 miles from a waivered physician, living >20 miles from a waivered physician was associated with -32.13 fewer days of treatment (95% CI: -57.86, -6.40) in metro areas and -16.70 fewer days in non-metro areas (95% CI: -32.32, -1.08). Conclusions: Longer travel distance to buprenorphine treatment is associated with a shorter duration of care that is likely to be clinically meaningful.
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Affiliation(s)
- Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel K Landis
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District Columbia, USA.,RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Ritujith Jayakrishnan
- Herbert Wertheim College of Medicine, Florida International University, Orlando, Florida, USA
| | | | - Colleen L Barry
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
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18
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Nguyen T, Muench U, Andraka-Christou B, Simon K, Bradford WD, Spetz J. The Association Between Scope of Practice Regulations and Nurse Practitioner Prescribing of Buprenorphine After the 2016 Opioid Bill. Med Care Res Rev 2022; 79:290-298. [PMID: 33792414 PMCID: PMC8594929 DOI: 10.1177/10775587211004311] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This article examines the relationship between federal regulations, state scope-of-practice regulations on nurse practitioners (NPs), and buprenorphine prescribing patterns using pharmacy claims data from Optum's deidentified Clinformatics Data Mart between January 2015 and September 2018. The county-level proportion of patients filling prescriptions written by NPs was low even after the 2016 Comprehensive Addiction and Recovery Act (CARA), 2.7% in states that did not require physician oversight of NPs, and 1.1% in states that did. While analyses in rural counties showed higher rates of buprenorphine prescriptions written by NPs, rates were still considerably low: 3.7% in states with less restrictive regulations and 1.1% in other states. These results indicate that less restrictive scope-of-practice regulations are associated with greater NP prescribing following CARA. The small magnitude of the changes indicates that federal attempts to expand treatment access through CARA have been limited.
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Affiliation(s)
| | | | | | - Kosali Simon
- Indiana University, Bloomington, IN, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | | | - Joanne Spetz
- University of California, San Francisco, CA, USA
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19
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Tilhou AS, Dague L, Saloner B, Beemon D, Burns M. Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic. JAMA HEALTH FORUM 2022; 3:e220093. [PMID: 35977284 PMCID: PMC8917419 DOI: 10.1001/jamahealthforum.2022.0093] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/18/2022] [Indexed: 01/04/2023] Open
Abstract
Question During the COVID-19 public health emergency, did patients with opioid use disorder experience decreased access to opioid use disorder treatment? Findings In this cohort study of 6453 Medicaid beneficiaries with opioid use disorder in Wisconsin, buprenorphine possession remained stable at the onset and for the first 6 months of the public health emergency. In contrast, completion of urine drug tests and receipt of opioid treatment program services declined with the onset of the public health emergency and recovered partially 6 months into the public health emergency. Meaning The findings of this study suggest that the COVID-19 public health emergency did not disrupt access to buprenorphine but did disrupt urine drug testing and access to opioid treatment program services. Importance Disruptions in care during the COVID-19 pandemic may have decreased access to care for patients with opioid use disorder. Objective To examine trends in opioid use disorder treatment including buprenorphine possession, urine drug testing, and opioid treatment program services during the COVID-19 public health emergency. Design, Setting, and Participants This cohort study included 6453 parent and childless adult Medicaid beneficiaries, aged 18 to 64 years, with opioid use disorder and continuous enrollment from December 1, 2018, to September 30, 2020, in Wisconsin. Logistic regression compared differences in study outcomes before, early, and later in the COVID-19 public health emergency. Analyses were conducted from January 2021 to October 2021. Exposures Early (March 16, 2020, to May 15, 2020) and later (May 16, 2020, to September 30, 2020) in the public health emergency. Main Outcomes and Measures Person-week outcomes included possession of buprenorphine, completion of outpatient urine drug testing, and receipt of opioid treatment program services. Results The final cohort of 6453 participants included 3986 (61.8%) childless adults; 5741 (89%) were younger than 50 years, 3435 (53.2%) were women, 5036 (78.0%) White, and 22.0% were racial and ethnic minority groups (American Indian, 269 [4.2%]; Asian, 26 [0.4%]; Black, 458 [7.1%]; Hispanic, 292 [4.5%]; Pacific Islander, 1 [.02%]; Multiracial, 238 [3.7%]). Overall, 2858 (44.3%), 5074 (78.6%), and 2928 (45.4%) received buprenorphine, urine drug testing, or opioid treatment program services during the study period, respectively. Probability of buprenorphine possession did not change in the early or later part of the public health emergency. Probability of urine drug testing initially decreased (marginal effect [ME], –0.04; 95% CI, –0.04 to –0.03; P < .001) and then partially recovered in the later public health emergency (ME, –0.02; 95% CI, –0.03 to –0.02; P < .001). Probability of opioid treatment program services followed a similar pattern, with an early decrease (ME, –0.05; 95% CI, –0.05 to –0.04; P < .001) followed by partial recovery (ME, –0.02; 95% CI, –0.03 to –0.02; P < .001). Conclusions and Relevance In a sample of continuously enrolled adult Medicaid beneficiaries, the COVID-19 public health emergency was not associated with decreased probability of buprenorphine possession, but was associated with decreased probability of urine drug testing and opioid treatment program services. These findings suggest patients in office-based settings retained access to buprenorphine despite decreased on-site services like urine drug tests, whereas patients at opioid treatment programs experienced greater disruption in care. Given the importance of medications for opioid use disorder in preventing overdose, policy makers should consider permanent policy changes based on lessons learned from the public health emergency to enable ongoing enhanced access to these medications.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Laura Dague
- Department of Public Service and Administration, Texas A&M University, College Station, Texas
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Daniel Beemon
- Department of Economics, University of Wisconsin-Madison, Madison
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison
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20
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Dowd WN, Mark TL. Changes in Buprenorphine Prescribing to Medicaid Beneficiaries During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e224058. [PMID: 35323952 PMCID: PMC8948527 DOI: 10.1001/jamanetworkopen.2022.4058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This cross-sectional study compares trends in prescribing buprenorphine to all Medicaid beneficiaries before and after the start of the COVID-19 pandemic.
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Affiliation(s)
- William N. Dowd
- Community Health Research Division, RTI International, Research Triangle Park, North Carolina
| | - Tami L. Mark
- Community Health Research Division, RTI International, Research Triangle Park, North Carolina
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21
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Chua KP, Dahlem CHY, Nguyen TD, Brummett CM, Conti RM, Bohnert AS, Dora-Laskey AD, Kocher KE. Naloxone and Buprenorphine Prescribing Following US Emergency Department Visits for Suspected Opioid Overdose: August 2019 to April 2021. Ann Emerg Med 2022; 79:225-236. [PMID: 34802772 PMCID: PMC8860890 DOI: 10.1016/j.annemergmed.2021.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE Nonfatal emergency department (ED) visits for opioid overdose are important opportunities to prescribe naloxone and buprenorphine, both of which can prevent future overdose-related mortality. We assessed the rate of this prescribing using national data from August 2019 to April 2021, a period during which US opioid overdose deaths reached record levels. METHODS We conducted a retrospective cohort analysis using Symphony Health's Integrated Dataverse, which includes data from 5,800 hospitals and 70,000 pharmacies. Of ED visits for opioid overdose between August 4, 2019, and April 3, 2021, we calculated the proportion with at least 1 naloxone prescription within 30 days and repeated this analysis for buprenorphine. To contextualize the naloxone prescribing rate, we calculated the proportion of ED visits for anaphylaxis with at least 1 prescription for epinephrine-another life-saving rescue medication-within 30 days. RESULTS Analyses included 148,966 ED visits for opioid overdose. Mean weekly visits increased 23.6% during the period between April 26, 2020 and October 3, 2020 compared with the period between August 4, 2019 to April 25, 2020. Visits declined to prepandemic levels between October 4, 2020 and March 13, 2021, after which visits began to rise. Naloxone and buprenorphine were prescribed within 30 days at 7.4% and 8.5% of the 148,966 visits, respectively. The naloxone prescribing rate (7.4%) was substantially lower than the epinephrine prescribing rate (48.9%) after ED visits for anaphylaxis. CONCLUSION Between August 4, 2019, and April 3, 2021, naloxone and buprenorphine were only prescribed after 1 in 13 and 1 in 12 ED visits for opioid overdose, respectively. Findings suggest that clinicians are missing critical opportunities to prevent opioid overdose-related mortality.
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Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
| | - Chin Hwa Y Dahlem
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI
| | - Thuy D Nguyen
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Institute for Health System Innovation and Policy, Questrom School of Business, Boston University, Boston, MA
| | - Amy S Bohnert
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI
| | - Aaron D Dora-Laskey
- Department of Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, MI
| | - Keith E Kocher
- Department of Emergency Medicine and Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI
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22
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Knudsen HK, Hartman J, Walsh SL. The effect of Medicaid expansion on state-level utilization of buprenorphine for opioid use disorder in the United States. Drug Alcohol Depend 2022; 232:109336. [PMID: 35123365 PMCID: PMC8885876 DOI: 10.1016/j.drugalcdep.2022.109336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Research on the impact of Medicaid expansion on buprenorphine utilization has largely focused on the Medicaid program. Less is known about its associations with total buprenorphine utilization and non-Medicaid payers. METHODS Monthly prescription data (June 2013-May 2018) for proprietary and generic sublingual as well as buccal buprenorphine products were purchased from IQVIA®. Population-adjusted state-level utilization measures were constructed for Medicaid, commercial insurance, Medicare, cash, and total utilization. A difference-in-differences (DID) approach with population weights estimated the association between Medicaid expansion and buprenorphine utilization, while controlling for treatment capacity. RESULTS Monthly total buprenorphine prescriptions increased by 68% overall and increased 283% for Medicaid, 30% for commercial insurance, and 143% for Medicare. Cash prescriptions decreased by 10%. The DID estimate for Medicaid expansion was not statistically significant for total utilization (-19.780, 95% CI = -45.118, 5.558, p = .123). For Medicaid buprenorphine utilization, there was a significant increase of 27.120 prescriptions per 100,000 total state residents (95% CI = 9.458, 44.782, p = .003) in expansion states versus non-expansion states post-Medicaid expansion. Medicaid expansion had a negative effect on commercial insurance (DID estimate = -37.745, 95% CI = -62.946, -12.544, p = .004), cash utilization (DID estimate = -6.675, 95% CI = -12.627, -0.723, p = .029), and Medicare utilization (DID estimate = -1.855, 95% CI = -3.697, -0.013, p = .048). DISCUSSION The associations between Medicaid expansion and buprenorphine utilization varied across different types of payers, such that the overall impact of Medicaid expansion on buprenorphine utilization was not significant.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA.
| | - Jeanie Hartman
- Substance Use Research Priority Area, University of Kentucky, 845 Angliana Avenue, Room 121, Lexington, KY 40508, USA.
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA.
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23
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Lee B, Yang KC, Kaminski P, Peng S, Odabas M, Gupta S, Green HD, Ahn YY, Perry BL. Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2138453. [PMID: 34889946 PMCID: PMC8665369 DOI: 10.1001/jamanetworkopen.2021.38453] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/17/2021] [Indexed: 11/14/2022] Open
Abstract
Importance During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. Objective To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. Design, Setting, and Participants This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. Main Outcomes and Measures The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. Results A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Conclusions and Relevance Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.
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Affiliation(s)
- Byungkyu Lee
- Department of Sociology, Indiana University Bloomington, Bloomington
| | - Kai-Cheng Yang
- Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, Bloomington
| | - Patrick Kaminski
- Luddy School of Informatics, Computing, and Engineering, Department of Sociology, Indiana University Bloomington, Bloomington
| | - Siyun Peng
- Department of Sociology, Indiana University Bloomington, Bloomington
| | - Meltem Odabas
- Department of Sociology, Indiana University Bloomington, Bloomington
| | - Sumedha Gupta
- Department of Economics, Indiana University–Purdue University, Indianapolis
| | - Harold D. Green
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington
| | - Yong-Yeol Ahn
- Center for Complex Networks and Systems Research, Luddy School of Informatics, Computing and Engineering, Indiana University Bloomington, Bloomington
- Network Science Institute, Indiana University Bloomington, Bloomington
- Connection Science, Massachusetts Institute of Technology, Cambridge
| | - Brea L. Perry
- Department of Sociology, Network Science Institute, Indiana University Bloomington, Bloomington
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24
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de Dios C, Fernandes BS, Whalen K, Bandewar S, Suchting R, Weaver MF, Selvaraj S. Prescription fill patterns for benzodiazepine and opioid drugs during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2021; 229:109176. [PMID: 34808468 PMCID: PMC8595244 DOI: 10.1016/j.drugalcdep.2021.109176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 and resulting mitigation measures in the United States (US) brought about limited access to medical care that has been linked to increases in mental health problems, excessive substance use, and drug overdoses. The increase in co-prescription of benzodiazepines and opioids may indicate population-level changes in health behaviors that can be exacerbated by limited access, hence necessitating the tracking of these drugs during COVID-19. We evaluated the impact of the declaration of COVID-19 as a US national emergency on prescription patterns in 2020. METHODS Prescriptions of benzodiazepines and opioids were analyzed using data aggregated on a weekly basis across 38 states over the January 2019-December 2020 period. Data were from Bamboo Health Prescription Drug Monitoring Program and covered all individuals regardless of insurance status. Generalized additive models estimated the effects of the March 13, 2020 declaration on proportion of prescriptions to all controlled substances by comparing volumes before to after the week of March 13 in 2020 (range: January 27-May 24) and comparing this trend to its 2019 counterpart. RESULTS When comparing the January 27-March 9 period to the March 16-May 24 period in 2020, there was a statistically significant 2.0% increase in the proportion of benzodiazepine dispensations to all controlled substances, and a significant 1.7% mean decrease in proportion of opioid dispensations to all controlled substances. A significant return approaching pre-declaration levels was observed only for opioids (beginning week of May 18, 2020). CONCLUSIONS The results suggest significant impacts of the COVID-19 pandemic on dispensations of benzodiazepines and opioids across the US. Continued monitoring of prescription trends and maintenance of adequate and accessible access to mental healthcare are important for understanding public health crises related to substance use.
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Affiliation(s)
- Constanza de Dios
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Brisa S. Fernandes
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | | | | | - Robert Suchting
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Michael F. Weaver
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
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25
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Chalasani R, Shinabery JM, Goetz CT, Chang CCH, Yang Q, Suda KJ, Gellad WF. Buprenorphine Dispensing in Pennsylvania During the COVID-19 Pandemic, January to October 2020. J Gen Intern Med 2021; 36:3915-3917. [PMID: 34378112 PMCID: PMC8354093 DOI: 10.1007/s11606-021-07083-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Rohan Chalasani
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared M Shinabery
- Drug Surveillance and Misuse Prevention Office, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Carrie Thomas Goetz
- Drug Surveillance and Misuse Prevention Office, Pennsylvania Department of Health, Harrisburg, PA, USA
| | - Chung-Chou H Chang
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qingnan Yang
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katie J Suda
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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26
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Experiences with substance use disorder treatment during the COVID-19 pandemic: Findings from a multistate survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103537. [PMID: 34871945 PMCID: PMC8602971 DOI: 10.1016/j.drugpo.2021.103537] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
Background Drug overdoses surged during the COVID-19 pandemic, underscoring the need for expanded and accessible substance use disorder (SUD) treatment. Relatively little is known about the experiences of patients receiving treatment during the pandemic. Methods We worked with 21 harm reduction and drug treatment programs in nine states and the District of Columbia from August 2020 to January 2021. Programs distributed study recruitment cards to clients. Clients responded to the survey by calling a study hotline and providing a unique study identification number. Our survey included detailed questions about use of SUD treatment prior to and since the COVID-19 pandemic. We identified settings where individuals received treatment and, for those treated for opioid use disorder, we examined use of medications for opioid use disorder. Individuals also reported whether they had received telehealth treatment and pandemic related treatment changes (e.g., more take-home methadone). We calculated p-values for differences pre and since COVID-19. Results We interviewed 587 individuals of whom 316 (53.8%) were in drug treatment both before and during the COVID-19 pandemic. Individuals in treatment reported substantial reductions in in-person service use since the start of the pandemic, including a 27 percentage point reduction (p<.001) in group counseling sessions and 28 percentage point reduction in mutual aid group participation (p<.001). By contrast, individuals reported a 21 percentage point increase in receipt of overdose education (p<.001). Most people receiving medications for opioid use disorder reported taking methadone and had high continuity of treatment (86.1% received methadone pre-COVID and 87.1% since-COVID, p=.71). Almost all reported taking advantage of new policy changes such as counseling by video/phone, increased take-home medication, or fewer urine drug screens. Overall, respondents reported relatively high satisfaction with their treatment and with telehealth adaptations (e.g., 80.2% reported “I'm able to get all the treatment that I need”). Conclusions Accommodations to treatment made under the federal public health emergency appear to have sustained access to treatment in the early months of the pandemic. Since these changes are set to expire after the official public health emergency declaration, further action is needed to meet the ongoing need.
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27
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Pessar SC, Boustead A, Ge Y, Smart R, Pacula RL. Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond. JAMA HEALTH FORUM 2021; 2:e213833. [PMID: 35647581 PMCID: PMC9138185 DOI: 10.1001/jamahealthforum.2021.3833] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
IMPORTANCE Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care. OBJECTIVE To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies. EVIDENCE REVIEW We summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021. FINDINGS This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCE With considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.
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Affiliation(s)
- Seema Choksy Pessar
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Anne Boustead
- School of Government and Public Policy, University of Arizona, Tucson
| | - Yimin Ge
- Sol Price School of Public Policy, University of Southern California, Los Angeles
| | | | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
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Saloner B, Whitley P, LaRue L, Dawson E, Huskey A. Polysubstance Use Among Patients Treated With Buprenorphine From a National Urine Drug Test Database. JAMA Netw Open 2021; 4:e2123019. [PMID: 34505888 PMCID: PMC8433604 DOI: 10.1001/jamanetworkopen.2021.23019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Polysubstance use is a concern for patients treated for opioid use disorder (OUD). While buprenorphine can curtail harmful opioid use, co-occurring use of nonprescribed substances, such as cocaine, methamphetamine, and other opioids, may negatively affect treatment outcomes. OBJECTIVE To characterize factors associated with urine drug positivity for nonprescribed substances among patients prescribed buprenorphine. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included patients who had been prescribed buprenorphine and who provided urine specimens for urine drug testing (UDT), as ordered by clinicians in primary care or behavioral health or at substance use disorder treatment centers, from 2013 to 2019. Specimens were analyzed by liquid chromatography-tandem mass spectrometry to assess positivity for several commonly used substances. EXPOSURES Buprenorphine prescription. MAIN OUTCOMES AND MEASURES Positivity for buprenorphine and several nonprescribed substances. Unadjusted trends in positivity for each nonprescribed substance were compared between specimens that did and did not test positive for buprenorphine. Multivariable logistic regression was used to examine factors associated with positivity; factors included patient age, sex, setting of care, payer, collection year, and census division. RESULTS The study included first UDT specimens from 150 000 patients, of whom 82 107 (54.74%) were men and 77 300 (51.53%) were aged 18 to 34 years. Across all specimens, 128 240 (85.49%) were positive for buprenorphine, and 71 373 (47.58%) were positive for 1 or more nonprescribed substances. From 2013 to 2019, positivity rates increased for most substances (eg, fentanyl: from 131 of 21 412 [0.61%] to 1464 of 13 597 [10.77%]). Factors associated with positivity varied widely by substance; for example, fentanyl positivity was highest for men (OR, 1.13; 95% CI, 1.06-1.21), patients aged 18 to 24 years (OR for patients ≥55 years, 0.46; 95% CI, 0.39-0.54), patients living in New England (OR, 1.19; 95% CI, 1.07-1.33), and patients with Medicaid (OR, 1.20; 95% CI, 1.11-1.31), whereas oxycodone positivity was greatest for women (OR for men, 0.84; 95% CI, 0.79-0.89), patients older than 55 years (OR, 1.42; 95% CI, 1.22-1.64), patients living in the South Atlantic (OR, 1.45, 95% CI, 1.33-1.58), and patients with private insurance (OR for Medicaid, 0.78; 95% CI, 0.73-0.84). Patients whose specimens were positive for buprenorphine were significantly less likely to be positive for other opioids (eg, fentanyl: OR for buprenorphine-negative samples, 6.71; 95% CI, 6.29-7.16; heroin: OR for buprenorphine-negative samples, 9.93; 95% CI, 9.31-10.59). CONCLUSIONS AND RELEVANCE In this cross-sectional study, patterns of nonprescribed substance positivity among patients prescribed buprenorphine varied widely. This study highlights the utility of UDT in public health surveillance efforts related to patients treated with buprenorphine for OUD.
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Affiliation(s)
- Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Leah LaRue
- Millennium Health, San Diego, California
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Cantor J, Kravitz D, Sorbero M, Andraka-Christou B, Whaley C, Bouskill K, Stein BD. Trends in visits to substance use disorder treatment facilities in 2020. J Subst Abuse Treat 2021; 127:108462. [PMID: 34134879 PMCID: PMC8217724 DOI: 10.1016/j.jsat.2021.108462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/26/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe weekly changes in the number of substance use disorder treatment (SUDT) facility visits in 2020 compared to 2019 using cell phone location data. METHODS We calculated the percentage weekly change in visits to SUDT facilities from the week of January 5 through the week of October 11, 2020, relative to the week of January 6 through the week of October 13, 2019. We stratified facilities by county COVID-19 incidence per 10,000 residents in each week and by 2018 fatal drug overdose rate. Finally, we conducted a multivariable linear regression analysis examining percent change in visits per week as a function of county-level COVID-19 tercile, a series of calendar month indicators, and the interaction of county-level COVID-19 tercile and month. We repeated the regression analysis replacing COVID-19 tercile with overdose tercile. RESULTS Beginning the eleventh week of 2020, the number of visits to SUDT facilities declined substantially, reaching a nadir of 48% of 2019 visits in early July. In contrast to January, there were significantly fewer visits in 2020 compared to 2019 in all subsequent months (p < 0.01 in all months). Multivariable regression results found that facilities in the tercile of counties experiencing the most COVID-19 cases had a significantly greater reduction in the number of SUDT visits in 2020 for the months of June through August than facilities in counties with the fewest COVID-19 rates (p < 0.05). The study found no statistically significant difference in the change in the number of visits by facilities in counties with historically different overdose rates. DISCUSSION Our findings support the hypothesis that a reduction has occurred in the average weekly number of visits to SUDT facilities. The size of the effect differs based on the number of COVID-19 cases but not on historical overdose rate.
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Affiliation(s)
| | | | | | - Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, Orlando, FL, USA; Department of Internal Medicine, University of Central Florida, Orlando, FL, USA
| | | | | | - Bradley D Stein
- RAND Corporation, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, USA.
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Chua KP, Volerman A, Conti RM. Prescription Drug Dispensing to US Children During the COVID-19 Pandemic. Pediatrics 2021; 148:peds.2021-049972. [PMID: 34285080 PMCID: PMC8344340 DOI: 10.1542/peds.2021-049972] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND After the US coronavirus disease 2019 outbreak, overall prescription dispensing declined but then rebounded. Whether these same trends occurred for children is unknown. METHODS Using the IQVIA National Prescription Audit, which contains monthly dispensing counts from 92% of US retail pharmacies, we assessed changes in the monthly number of prescriptions dispensed to US children aged 0 to 19 years during 2018-2020. We compared dispensing totals in April to December 2020 and April to December 2019 overall, by drug class, and among drug classes that typically treat acute infections (eg, antibiotics) or chronic diseases (eg, antidepressants). RESULTS Between January 2018 and February 2020, the median monthly number of prescriptions dispensed to children was 25 744 758. Dispensing totals declined from 25 684 219 to 16 742 568 between March and April 2020, increased to 19 657 289 during October 2020, and decreased to 15 821 914 during December 2020. Dispensing totals during April to December 2020 (160 630 406) were 27.1% lower compared with April to December 2019 (220 284 613). Among the 3 drug classes accounting for the most prescriptions in 2019, the corresponding percentage changes were -55.6% for antibiotics, -11.8% for attention-deficit/hyperactivity disorder medications, and 0.1% for antidepressants. Among drug classes that typically treat acute infections and chronic diseases, percentage changes were -51.3% and -17.4%, respectively. CONCLUSIONS Prescription dispensing to children declined by one-quarter in April to December 2020 compared with April to December 2019. Declines were greater for infection-related drugs than for chronic disease drugs. Decreased dispensing of the latter is potentially concerning and warrants further investigation. Whether reductions in dispensing of infection-related drugs are temporary or sustained will be important to monitor going forward.
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Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics and Susan B. Meister Child Health Evaluation and Research Center, Medical School .,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Anna Volerman
- Section of General Internal Medicine, Department of Medicine,Section of Academic Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Questrom School of Business and Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts
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Spetz J, Chapman S, Tierney M, Phoenix B, Hailer L. Barriers and Facilitators of Advanced Practice Registered Nurse Participation in Medication Treatment for Opioid Use Disorder: A Mixed Methods Study. JOURNAL OF NURSING REGULATION 2021. [DOI: 10.1016/s2155-8256(21)00052-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Treitler PC, Bowden CF, Lloyd J, Enich M, Nyaku AN, Crystal S. Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms. J Subst Abuse Treat 2021; 132:108514. [PMID: 34098210 PMCID: PMC8630075 DOI: 10.1016/j.jsat.2021.108514] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Objective The COVID-19 pandemic led to unprecedented temporary federal and state regulatory flexibilities that rapidly transformed medication for opioid use disorder (MOUD) treatment delivery. This study aimed to understand changes in treatment providers' care during COVID-19, provider experiences with the adaptations, and perceptions of which changes should be sustained long-term. Methods We conducted in-depth, semi-structured interviews with 20 New Jersey MOUD providers, purposively sampled to reflect diversity in provider setting, specialty, and other characteristics. Using a rapid analysis approach, we summarized content within interview domains and analyzed domains across participants for recurring concepts and themes. Results MOUD treatment practice changes taking place during the COVID-19 pandemic included a rapid shift from in-person care to telehealth, reduction in frequency of toxicology testing and psychosocial/counseling services, and modifications to prescription durations and take-home methadone supplies. Modifications to practice were positively received and reinforced a sense of autonomy for providers as well as enhancing the ability to provide patient-centered care. All respondents expressed support for making temporary regulatory flexibilities permanent, but differed in their implementation of the flexibilities and the extent to which they planned to modify their own practices long-term. Conclusion Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic.
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Affiliation(s)
- Peter C Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America.
| | - Cadence F Bowden
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America
| | - James Lloyd
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America
| | - Michael Enich
- Center for Prevention Science, School of Social Work, Rutgers, the State University of New Jersey, 390 George St., 5th Floor, New Brunswick, NJ 08901, United States of America
| | - Amesika N Nyaku
- Rutgers New Jersey Medical School, 185 South Orange Avenue Room I 689, Newark, NJ 07101, United States of America
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America
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Letter to the Editor regarding: Buprenorphine for opioid use disorder: The role of public funding in its development (by Barenie and Kesselheim, 2020). Drug Alcohol Depend 2021; 221:108644. [PMID: 33640197 DOI: 10.1016/j.drugalcdep.2021.108644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/20/2022]
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Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med 2021; 47:208-221. [PMID: 33528595 PMCID: PMC7851810 DOI: 10.1007/s00134-020-06331-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/04/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19). METHODS We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO2/FiO2 < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model. RESULTS Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41-58), 137 (72.1%) were men, and the median PaO2/FiO2 prior to ECMO initiation was 72 (IQR 61-90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41-0.74). Results were similar in a secondary analysis limited to patients with PaO2/FiO2 < 80 (HR 0.55; 95% CI 0.40-0.77). CONCLUSION In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.
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