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Johnson CE, Chrischilles EA, Arndt S, Carnahan RM. State-level factors associated with implementation of prescription drug monitoring program integration and mandatory use policies, United States, 2009-2020. J Am Med Inform Assoc 2024; 31:2337-2346. [PMID: 38905012 DOI: 10.1093/jamia/ocae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/04/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) have been widely adopted as a tool to address the prescription opioid epidemic in the United States. PDMP integration and mandatory use policies are 2 approaches states have implemented to increase use of PDMPs by prescribers. While the effectiveness of these approaches is mixed, it is unclear what factors motivated states to implement them. This study examines whether opioid dispensing, adverse health outcomes, or other non-health-related factors motivated implementation of these PDMP approaches. METHODS Time-to-event analysis was performed using lagged state-year covariates to reflect values from the year prior. Extended Cox regression estimated the association of states' rates of opioid dispensing, prescription opioid overdose deaths, and neonatal opioid withdrawal syndrome with implementation of PDMP integration and mandatory use policies from 2009 to 2020, controlling for demographic and economic factors, state government and political factors, and prior opioid policies. RESULTS In our main model, prior opioid dispensing (HR 2.31, 95% CI 1.17, 4.57), neonatal opioid withdrawal syndrome hospitalizations (HR 1.55, 95% CI 1.09, 2.19), and number of prior opioid policies (HR 2.13, 95% CI 1.13, 4.00) were associated with mandatory use policies. Prior prescription opioid overdose deaths (HR 1.21, 95% CI 1.08, 1.35) were also associated with mandatory use policies in a model that did not include opioid dispensing or neonatal opioid withdrawal syndrome. No study variables were associated with implementation of PDMP integration. CONCLUSION Understanding state-level factors associated with implementing PDMP approaches can provide insights into factors that motivate the adoption of future public health interventions.
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Affiliation(s)
- Christian E Johnson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Elizabeth A Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Stephan Arndt
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Ryan M Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
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Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024; 59:e14299. [PMID: 38456488 PMCID: PMC11366955 DOI: 10.1111/1475-6773.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To examine rural-urban disparities in substance use disorder treatment access and continuation. DATA SOURCES AND STUDY SETTING We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. STUDY DESIGN This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. DATA COLLECTION We included individuals 18-64 years old with continuous employer-sponsored insurance. PRINCIPAL FINDINGS Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. CONCLUSIONS These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.
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Affiliation(s)
- Eli Raver
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Sheldon M. Retchin
- Division of General Internal Medicine, Department of Internal Medicine, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Yiting Li
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Present address:
Nationwide Children's HospitalColumbusOhioUSA
| | - Andrew D. Carlo
- Meadows Mental Health Policy InstituteNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Wendy Y. Xu
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
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Cosler LE, Midence L, Hayes JJ, Gondeck JT, Moy K, Chen MH, Hogan JD. The Influence of State Restrictions on Opioid Prescribing: 2006-2018. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00371. [PMID: 39321427 DOI: 10.1097/phh.0000000000002004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
OBJECTIVE To measure the longitudinal effect of opioid restrictions on prescribing patterns at the state and regional levels. DESIGN Health policy evaluation using a Poisson regression of opioid metrics from federal repositories to model what the estimated opioid counts are for the next fiscal year. SETTING State-specific prescribed opioid counts between 2006 and 2018 from CDC reports; population data were obtained from the U.S. Census Bureau for 2006-2018; and opioid prescribing restrictions were extracted from published reports and state regulatory databases. INTERVENTION Poisson regression models were fitted to assess the relationship of statewide restrictions on opioid prescribing counts adjusting for states' population. MAIN OUTCOME MEASURE Estimated opioid counts provided by the Poisson regression model. RESULTS Per capita rates of prescribed opioids peaked in 2012 at 86.2 per 100 population. Prescribing restrictions are associated with statistically significant decreases in opioid prescribing. Controlling for population and year, we found for every 100 opioid prescriptions in a state without restrictions, only 98 opioid prescriptions are expected for every additional year in a state with restrictions in place. CONCLUSIONS Contrary to other research conducted over a shorter study period, we found that restrictions do reduce opioid prescribing; however, a statistically significant change in rates may not be detectable in the early years after restrictions are enacted.
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Affiliation(s)
- Leon E Cosler
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Johnson City, New York (Dr Cosler, Ms Midence, and Drs Hayes, Gondeck, and Moy); Department of Mathematics and Statistics, Harpur College, Binghamton University, Vestal, New York (Dr Mei-Hsiu); and Albany Medical Health System, Albany, New York (Hogan)
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Verhagen R, Gerber C, Thai PK, Connor J, Loveday B, Bade R, O'Brien J, Jaunay EL, Simpson BS, Chan G, Hall W, Thomas KV, Mueller JF, Tscharke BJ. Wastewater-based evaluation of the efficacy of oxycodone regulations in Australia. Addiction 2024. [PMID: 39259037 DOI: 10.1111/add.16653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/15/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND AND AIMS Between 2018 and 2020, Australia implemented major policy changes to improve the quality and safety of opioid prescribing, with a specific focus on oxycodone. This study used wastewater-based epidemiology to assess the efficacy of Australia's regulatory reforms by measuring change in consumption of oxycodone via exploratory analysis. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS Wastewater analysis data on oxycodone consumption was from the National Wastewater Drug Monitoring Program. The program captures data from more than 50 wastewater treatment plant catchments across Australia, equivalent to more than 50% of the national population. Geographic trend analyses were conducted for both major cities and regional areas within all states and territories of Australia over a 6-year period between 2017 and 2023. FINDINGS Oxycodone consumption showed a statistically significant increase nationally from 78 mg/day/1000 people (95% confidence interval [CI] = 71, 84) in 2017 to 120 mg/day/1000 people in August 2019 (95% CI = 110, 120), an increase of 52% (95% CI = 42, 62, P < 0.0001). From August 2019 to December 2020, there was a statistically significant decrease from 120 to 65 mg/day/1000 people (95% CI = 60, 71), a decrease of 45% (95% CI = 40, 51), followed by a modest 2.4% increase to the end of the study period in April 2023 (95% CI [2.0,2.7]). CONCLUSIONS A 45% reduction in oxycodone consumption in Australia from 2019 to 2020 coincided with national policy changes that aimed to reduce consumption of prescription opioids. The overall declining trend in consumption was suggestive of the effectiveness of national interventions in reducing pharmaceutical opioid use. Wastewater-based epidemiology provides an effective approach for assessing the effectiveness of controlled substances policy changes.
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Affiliation(s)
- Rory Verhagen
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Cobus Gerber
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- Discipline of Psychiatry, The University of Queensland, Herston, Australia
| | - Bill Loveday
- Healthcare Protection and Regulation Branch, Queensland Public Health and Scientific Services, Queensland Health, Australia
| | - Richard Bade
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Jake O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Emma L Jaunay
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Bradley S Simpson
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Wayne Hall
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
| | - Benjamin J Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Australia
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Kuo TY, Lu CH, Falls Z, Jette G, Gibson W, Elkin PL, Leonard KE, Bednarczyk EM, Jacobs DM. High-risk use of prescription opioids among patients treated for alcohol problems in New York State. A repeated cross-sectional study, 2005-2018. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100278. [PMID: 39286536 PMCID: PMC11403464 DOI: 10.1016/j.dadr.2024.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/25/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
Background Patients with alcohol use disorder (AUD) and high-risk opioid use are at risk of serious complications. The purpose of this study was to estimate the prevalence of and factors associated with high-risk opioid use in patients with an alcohol use problem from 2005 to 2018. Methods This repeated cross-sectional study analyzed data from first admissions for alcohol treatment (2005-2018) to the NYS Office of Addiction Services and Supports merged with Medicaid Claims Data. High-risk opioid use was defined as opioid dose ≥50 morphine mg equivalents (MME) per day; opioid prescriptions overlapping ≥7 days; opioids for chronic pain >90 days or opioids for acute pain >7 days. Results Patients receiving ≥50 MME increased from 690 to 3226 from 2005 to 2010; then decreased to 2330 in 2018. From 2005-2011, patients with opioid prescriptions overlapping ≥7 days increased from 226 to 1594 then decreased to 892 in 2018. From 2005-2010, opioid use >7 days for acute pain increased from 133 to 970 and plateaued after 2010. From 2005-2018, patients who received opioids >90 days for chronic pain trended from 186 to 1655. White patients, females, age 36-55, patients with chronic and acute pain diagnoses had the highest rates of high-risk use. Conclusions The prevalence of high-risk opioid use in patients with alcohol use problems increased from 2005 to 2011, and generally decreased after 2010. However, prevalence of opioids >90 days for chronic pain trended up from 2005 to 2018. High-risk opioid use among patients with AUD emphasizes the need to develop interventional strategies to improve patient care.
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Affiliation(s)
- Tzu-Yin Kuo
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Chi-Hua Lu
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Zackary Falls
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Gail Jette
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Walter Gibson
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Peter L Elkin
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kenneth E Leonard
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Edward M Bednarczyk
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - David M Jacobs
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
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Smart R, Powell D, Pacula RL, Peet E, Abouk R, Davis CS. Investigating the complexity of naloxone distribution: Which policies matter for pharmacies and potential recipients. JOURNAL OF HEALTH ECONOMICS 2024; 97:102917. [PMID: 39043099 PMCID: PMC11392605 DOI: 10.1016/j.jhealeco.2024.102917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 04/13/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
Despite efforts to expand naloxone access, opioid-related overdoses remain a significant contributor to mortality. We study state efforts to expand naloxone distribution through pharmacies by reducing the non-monetary costs to prescribers, dispensers, and/or potential recipients of naloxone. We find that laws that only address liability costs have small and insignificant effects on the volume of naloxone dispensed through pharmacies. In contrast, we estimate large effects of laws removing the need for patients to obtain prescriptions from traditional prescribers (e.g., primary care physicians): laws authorizing non-patient-specific prescription distribution and laws granting pharmacists prescriptive authority. We test whether areas designated as primary care shortage areas-where it would be costlier to obtain a prescription-were disproportionately impacted. Shortage areas experienced sharper growth in pharmacy naloxone dispensing in states adopting prescriptive authority policies. These gains were primarily due to those facing low out-of-pocket costs, suggesting that price barriers also must be addressed to increase naloxone purchases.
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Affiliation(s)
| | | | | | | | - Rahi Abouk
- William Paterson University, United States
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7
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Johnson CE, Wehby GL, Chrischilles EA, Arndt S, Carnahan RM. Examining the effect of prescription drug monitoring program integration and mandatory use policies on the distribution of methadone and buprenorphine for opioid use disorder, United States, 2009-2021. Drug Alcohol Depend 2024; 264:112432. [PMID: 39241503 DOI: 10.1016/j.drugalcdep.2024.112432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/30/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) have been shown to reduce opioid prescribing for pain, but it is not well understood whether PDMPs influence utilization of medications for opioid use disorder. PDMP integration and mandatory use policies are two approaches implemented by states to increase use of PDMPs by prescribers. This study examined the effect of these approaches on distribution of methadone and buprenorphine from 2009 to 2021 for 50 states and DC. METHODS The effect of PDMP integration and mandatory use policies on four outcomes (distribution of buprenorphine to opioid treatment programs, distribution of buprenorphine to pharmacies, distribution of methadone to opioid treatment programs, and the total combined distribution of methadone and buprenorphine) was estimated using a Callaway and Sant'Anna difference-in-differences model, controlling for co-occurring opioid-related state policies. RESULTS Distribution of buprenorphine to pharmacies decreased 8 % (95 % CI -14 %, -1 %) following implementation of mandatory use policies. Distribution of methadone to opioid treatment programs increased 17 % (95 % CI 4 %, 34 %) and the total combined distribution of methadone and buprenorphine increased 6 % (95 % CI -0 %, 14 %) following the joint implementation of both approaches. CONCLUSION Distribution of methadone and buprenorphine has increased since 2009, but less than a quarter of people with opioid use disorder currently receive these medications. We observed a small net benefit of PDMP integration and mandatory use policies on distribution of methadone and buprenorphine. Policymakers should continue to assess the impact of PDMPs on access to medications for opioid use disorder and consider additional approaches to increase access to treatment.
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Affiliation(s)
- Christian E Johnson
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA.
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Elizabeth A Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Stephan Arndt
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Biostatistics, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Ryan M Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
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8
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Henegan P, Koczara J, Bluhm R, Cabrera LY. Public Perceptions of Treating Opioid Use Disorder With Deep Brain Stimulation: Comment Analysis Study. Online J Public Health Inform 2024; 16:e49924. [PMID: 39151160 PMCID: PMC11364942 DOI: 10.2196/49924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 03/19/2024] [Accepted: 07/10/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND The number of opioid-related deaths in the United States has more than tripled over the past 7 years, with a steep increase beginning at the same time as the COVID-19 pandemic. There is an urgent need for novel treatment options that can help alleviate the individual and social effects of refractory opioid use disorder (OUD). Deep brain stimulation (DBS), an intervention that involves implanting electrodes in the brain to deliver electrical impulses, is one potential treatment. Currently in clinical trials for many psychiatric conditions, including OUD, DBS's use for psychiatric indications is not without controversy. Several studies have examined ethical issues raised by using DBS to counter treatment-resistant depression, obsessive-compulsive disorder, and eating disorders. In contrast, there has been limited literature regarding the use of DBS for OUD. OBJECTIVE This study aims to gain empirical neuroethical insights into public perceptions regarding the use of DBS for OUD, specifically via the analysis of web-based comments on news media stories about the topic. METHODS Qualitative thematic content analysis was performed on 2 Washington Post newspaper stories that described a case of DBS being used to treat OUD. A total of 292 comments were included in the analysis, 146 comments from each story, to identify predominant themes raised by commenters. RESULTS Predominant themes raised by commenters across the 2 samples included the hopes and expectations with treatment outcomes, whether addiction is a mental health disorder, and issues related to resource allocation. Controversial comments regarding DBS as a treatment method for OUD seemingly decreased when comparing the first printed newspaper story to the second. In comparison, the number of comments relating to therapeutic need increased over time. CONCLUSIONS The general public's perspectives on DBS as a treatment method for OUD elucidated themes via this qualitative thematic content analysis that include overarching sociopolitical issues, positions on the use of technology, and technological and scientific issues. A better understanding of the public perceptions around the use of DBS for OUD can help address misinformation and misperceptions about the use of DBS for OUD, and identify similarities and differences regarding ethical concerns when DBS is used specifically for OUD compared to other psychiatric disorders.
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Affiliation(s)
- Patricia Henegan
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
| | - Jack Koczara
- College of Natural Sciences, Michigan State University, East Lansing, MI, United States
| | - Robyn Bluhm
- Department of Philosophy, Michigan State University, East Lansing, MI, United States
- Lyman Briggs College, Michigan State University, East Lansing, MI, United States
| | - Laura Y Cabrera
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA, United States
- Rock Ethics Institute, Pennsylvania State University, University Park, PA, United States
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Bradford AC, Nguyen T, Schulson L, Dick A, Gupta S, Simon K, Stein BD. High-Dose Opioid Prescribing in Individuals with Acute Pain: Assessing the Effects of US State Opioid Policies. J Gen Intern Med 2024:10.1007/s11606-024-08947-9. [PMID: 39028403 DOI: 10.1007/s11606-024-08947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND How state opioid policy environments with multiple concurrent policies affect opioid prescribing to individuals with acute pain is unknown. OBJECTIVE To examine how prescription drug monitoring programs (PDMPs), pain management clinic regulations, initial prescription duration limits, and mandatory continued medical education affected total and high-dose prescribing. DESIGN A county-level multiple-policy difference-in-difference event study framework. SUBJECTS A total of 2,425,643 individuals in a large national commercial insurance deidentified claims database (aged 12-64 years) with acute pain diagnoses and opioid prescriptions from 2007 to 2019. MAIN MEASURES The total number of acute pain opioid treatment episodes and number of episodes containing high-dose (> 90 morphine equivalent daily dosage (MEDD)) prescriptions. KEY RESULTS Approximately 7.5% of acute pain episodes were categorized as high-dose episodes. Prescription duration limits were associated with increases in the number of total episodes; no other policy was found to have a significant impact. Beginning five quarters after implementation, counties in states with pain management clinic regulations experienced a sustained 50% relative decline in the number of episodes containing > 90 MEDD prescriptions (95 CIs: (Q5: - 0.506, - 0.144; Q12: - 1.000, - 0.290)). Mandated continuing medical education regarding the treatment of pain was associated with a 50-75% relative increase in number of high-dose episodes following the first year-and-a-half of enactment (95 CIs: (Q7: 0.351, 0.869; Q12: 0.413, 1.107)). Initial prescription duration limits were associated with an initial relative reduction of 25% in high-dose prescribing, with the effect increasing over time (95 CI: (Q12: - 0.967, - 0.335). There was no evidence that PDMPs affected high-dose opioids dispensed to individuals with acute pain. Other high-risk prescribing indicators were explored as well; no consistent policy impacts were found. CONCLUSIONS State opioid policies may have differential effects on high-dose opioid dispensing in individuals with acute pain. Policymakers should consider effectiveness of individual policies in the presence of other opioid policies to address the ongoing opioid crisis.
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Affiliation(s)
- Ashley C Bradford
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Thuy Nguyen
- School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Lucy Schulson
- RAND Corporation, Boston, MA, USA
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Sumedha Gupta
- Department of Economics, Indiana University, Indianapolis, IN, USA
| | - Kosali Simon
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
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10
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Lübker C, Murtin F. Educational inequalities in deaths of despair in 14 OECD countries: a cross-sectional observational study. J Epidemiol Community Health 2024:jech-2024-222089. [PMID: 39019490 DOI: 10.1136/jech-2024-222089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Deaths of despair are a key contributor to stagnating life expectancy in the USA, especially among those without a university-level education, but these findings have not been compared internationally. METHODS Mortality and person-year population exposure data were collected in 14 Organisation for Economic Co-operation and Development member countries and stratified by age, sex, educational attainment and cause of death. The sample included 1.4 billion person-year observations from persons aged ≥25 years between 2013 and 2019. Country-specific and sex-specific contributions of deaths of despair to: (a) the life expectancy gap at age 25 and (b) rate differences in age-standardised mortality rates between high and low educational attainment groups were calculated. RESULTS Eliminating deaths of despair could reduce the life expectancy gap in the USA by 1.1 years for men and 0.6 years for women was second only to Korea, where it would reduce the gap by 3.4 years for men and 2.2 years for women. In Italy, Spain and Türkiye, eliminating deaths of despair would improve life expectancy gains by less than 0.1 years for women and 0.3 years for men, closing the educational gap by <1%. Findings were robust to controls for differences in population structures. CONCLUSIONS Deaths of despair are a major determinant of educational inequalities in longevity in Korea and the USA, while having limited impact in Southern European countries, indicating substantial international variation and scope for improvement in high burden high-income countries.
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Affiliation(s)
- Christopher Lübker
- Department of Health Sciences, University of York, York, UK
- Centre for Health Economics, University of York, York, UK
| | - Fabrice Murtin
- Centre for Wellbeing, Inclusion, Sustainability, and Equal Opportunity, Organisation for Economic Co-operation and Development, Paris, France
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11
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Choo EK, Charlesworth CJ, Livingston CJ, Hartung DM, El Ibrahimi S, Kraynov L, McConnell KJ. Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon. J Gen Intern Med 2024:10.1007/s11606-024-08776-w. [PMID: 38951321 DOI: 10.1007/s11606-024-08776-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/18/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND A novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies. OBJECTIVE To examine the effect of the policy on prescribing, health outcomes, and health service utilization. DESIGN Using Medicaid enrollment, medical and prescription claims, prescription drug monitoring program, and vital statistics files, we analyzed the policy's association with selected outcomes using interrupted time series models. SUBJECTS Adult Medicaid patients with back pain enrolled between 2014 and 2018. INTERVENTION The Oregon Medicaid back pain policy. MAIN MEASURES Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization. KEY RESULTS The policy was associated with decreases in the percentage of Medicaid enrollees with back pain receiving any opioids (- 2.68 percentage points [95% CI - 3.14, - 2.23] level, - 1.01 pp [95% CI - 1.1, - 0.92] slope), days of short-acting opioid use (- 0.4 days [95% CI - 0.53, - 0.26] slope), receipt of more than 7 days of short-acting opioids (- 2.36 pp [95% CI - 2.76, - 1.95] level, - 0.91 pp [95% CI - 1, - 0.83] slope), chronic opioid use (- 1.27 pp [95% CI - 1.59, - 0.94] level, - 0.46 [95% CI - 0.53, - 0.39 slope), and spinal surgeries and procedures. Among secondary outcomes, we found no increase in opioid overdose and a small, statistically significant trend decrease in opioid use disorders. There were small increases in non-opioid substance use and mental health diagnoses and visits but no increase in self-harm. CONCLUSIONS A state Medicaid policy emphasizing evidence-based back pain management was associated with decreases in opioid prescribing, spinal surgeries, and opioid use disorder trends, but also short-term increases in mental health encounters and an increase in non-opioid substance use disorder trends. Such policies may help reinforce evidence-based care, but must be designed with consideration of potential harms.
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Affiliation(s)
- Esther K Choo
- Center for Policy & Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Christina J Charlesworth
- Center for Health Systems Effectiveness (CHSE), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Sanae El Ibrahimi
- Division of Research and Evaluation, Comagine Health, Portland, OR, USA
- School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, NV, USA
| | | | - K John McConnell
- Center for Health Systems Effectiveness (CHSE), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
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Sahebi-Fakhrabad A, Sadeghi AH, Kemahlioglu-Ziya E, Handfield R. Exploring Opioid Prescription Patterns and Overdose Rates in South Carolina (2017-2021): Insights into Rising Deaths in High-Risk Areas. Healthcare (Basel) 2024; 12:1268. [PMID: 38998803 PMCID: PMC11241688 DOI: 10.3390/healthcare12131268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
With opioid overdose rates on the rise, we aimed to develop a county-level risk stratification that specifically focused on access to medications for opioid use disorder (MOUDs) and high overdose rates. We examined over 15 million records from the South Carolina Prescription Tracking System (SCRIPTS) across 46 counties. Additionally, we incorporated data from opioid treatment programs, healthcare professionals prescribing naltrexone, clinicians with buprenorphine waivers, and county-level overdose fatality statistics. To assess the risk of opioid misuse, we classified counties into high-risk and low-risk categories based on their prescription rates, overdose fatalities, and treatment service availability. Statistical methods employed included the two-sample t-test and linear regression. The t-test assessed the differences in per capita prescription rates between high-risk and low-risk counties. Linear regression was used to analyze the trends over time. Our study showed that between 2017 and 2021, opioid prescriptions decreased from 64,223 to 41,214 per 100,000 residents, while fentanyl-related overdose deaths increased by 312%. High-risk counties had significantly higher rates of fentanyl prescriptions and relied more on out-of-state doctors. They also exhibited higher instances of doctor shopping and had fewer medical doctors per capita, with limited access to MOUDs. To effectively combat the opioid crisis, we advocate for improved local healthcare infrastructure, broader treatment access, stricter management of out-of-state prescriptions, and vigilant tracking of prescription patterns. Tailored local strategies are essential for mitigating the opioid epidemic in these communities.
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Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA; (A.S.-F.); (A.H.S.)
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA; (A.S.-F.); (A.H.S.)
| | - Eda Kemahlioglu-Ziya
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA;
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA;
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13
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Martucci KT. Neuroimaging of opioid effects in humans across conditions of acute administration, chronic pain therapy, and opioid use disorder. Trends Neurosci 2024; 47:418-431. [PMID: 38762362 PMCID: PMC11168870 DOI: 10.1016/j.tins.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
Evidence of central nervous system (CNS) exogenous opioid effects in humans has been primarily gained through neuroimaging of three participant populations: individuals after acute opioid administration, those with opioid use disorder (OUD), and those with chronic pain receiving opioid therapy. In both the brain and spinal cord, opioids alter processes of pain, cognition, and reward. Opioid-related CNS effects may persist and accumulate with longer opioid use duration. Meanwhile, opioid-induced benefits versus risks to brain health remain unclear. This review article highlights recent accumulating evidence for how exogenous opioids impact the CNS in humans. While investigation of CNS opioid effects has remained largely disparate across contexts of opioid acute administration, OUD, and chronic pain opioid therapy, integration across these contexts may enable advancement toward effective interventions.
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Affiliation(s)
- Katherine T Martucci
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA; Center for Translational Pain Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
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14
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Schuler MS, Dick AW, Gordon AJ, Saloner B, Kerber R, Stein BD. Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009-2018. Drug Alcohol Depend 2024; 259:111290. [PMID: 38678682 DOI: 10.1016/j.drugalcdep.2024.111290] [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] [Received: 08/23/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018. METHODS In this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009-2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined. RESULTS Overall, 94,491 clinicians prescribed buprenorphine dispensed during 2009-2018. The proportion of active prescribers meeting high-volume criteria increased from 7.4 % in 2009 to 16.7 % in 2018. High-volume prescribers accounted for 80 % of dispensed buprenorphine prescriptions during 2009-2018; very high-volume prescribers accounted for 26 %. Adult primary care physicians consistently comprised the majority of high-volume prescribers. Addiction specialists were much more likely to be high-volume prescribers compared to other specialties, including psychiatrists and pain specialists. By 2018, the proportion of prescriptions from high-volume prescribers paid by Medicaid had doubled to 40 %, accompanied by a decline in both self-pay and commercial insurance. High-volume prescribers were overwhelmingly concentrated in urban counties with the highest fatal overdose rates. In 2018, the highest density of high-volume prescribers was in New England and the mid-Atlantic region. CONCLUSIONS Growth in high-volume prescribers outpaced the overall growth in buprenorphine prescribers across 2009-2018. High-volume prescribers play an increasingly central role in providing medication for OUD in the U.S., yet results indicate key regional variation in the availability of high-volume buprenorphine prescribers.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA.
| | - Andrew W Dick
- RAND Corporation, 20 Park Plaza #920, Boston, MA 022, USA
| | - Adam J Gordon
- 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; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Rose Kerber
- RAND Corporation, 20 Park Plaza #920, Boston, MA 022, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA
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Lindenfeld Z, Silver D, Pagán JA, Zhang DS, Chang JE. Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017-2020. PLoS One 2024; 19:e0304256. [PMID: 38781234 PMCID: PMC11115243 DOI: 10.1371/journal.pone.0304256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Despite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020. METHODS This longitudinal analysis of 2,846 counties from 2017-2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure. RESULTS In our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7`; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents. CONCLUSIONS Our findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, United States of America
| | - Diana Silver
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, United States of America
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, United States of America
| | - Donglan Stacy Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, New York, United States of America
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, United States of America
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Mudumbai SC, He H, Chen JQ, Kapoor A, Regala S, Mariano ER, Stafford RS, Abnet CC, Pfeiffer RM, Freedman ND, Etemadi A. Opioid use in cancer patients compared with noncancer pain patients in a veteran population. JNCI Cancer Spectr 2024; 8:pkae012. [PMID: 38457606 PMCID: PMC11009465 DOI: 10.1093/jncics/pkae012] [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: 10/04/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Opioid safety initiatives may secondarily impact opioid prescribing and pain outcomes for cancer care. METHODS We reviewed electronic health record data at a tertiary Veterans Affairs system (VA Palo Alto) for all patients from 2015 to 2021. We collected outpatient Schedule II opioid prescriptions data and calculated morphine milligram equivalents (MMEs) using Centers for Disease Control and Prevention conversion formulas. To determine the clinical impact of changes in opioid prescription, we used the highest level of pain reported by each patient on the 0-to-10 Numeric Rating Scale in each year, categorized into mild (0-3), moderate (4-6), and severe (7 and above). RESULTS Among 89 569 patients, 9073 had a cancer diagnosis. Cancer patients were almost twice as likely to have an opioid prescription compared with noncancer patients (69.0% vs 36.7%, respectively). The proportion of patients who received an opioid prescription decreased from 27.1% to 18.1% (trend P < .01) in cancer patients and from 17.0% to 10.2% in noncancer patients (trend P < .01). Cancer and noncancer patients had similar declines of MMEs per year between 2015 and 2019, but the decline was more rapid for cancer patients (1462.5 to 946.4, 35.3%) compared with noncancer patients (1315.6 to 927.7, 29.5%) from 2019 to 2021. During the study period, the proportion of noncancer patients who experienced severe pain was almost unchanged, whereas it increased among cancer patients, reaching a significantly higher rate than among noncancer patients in 2021 (31.9% vs 27.4%, P < .01). CONCLUSIONS Our findings suggest potential unintended consequences for cancer care because of efforts to manage opioid-related risks.
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Affiliation(s)
- Seshadri C Mudumbai
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Han He
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ji-Qing Chen
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aditi Kapoor
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Samantha Regala
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward R Mariano
- Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Randall S Stafford
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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17
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Cascella M, Capuozzo M, Ferrara F, Ottaiano A, Perri F, Sabbatino F, Conti V, Santoriello V, Ponsiglione AM, Romano M, Amato F, Piazza O. Two-year Opioid Prescription Trends in Local Sanitary Agency Naples 3 South, Campania Region, Italy. Descriptive Analyses and AI-based Translational Perspectives. Transl Med UniSa 2024; 26:1-14. [PMID: 38560616 PMCID: PMC10980290 DOI: 10.37825/2239-9747.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
Aims This study delves into the two-year opioid prescription trends in the Local Sanitary Agency Naples 3 South, Campania Region, Italy. The research aims to elucidate prescribing patterns, demographics, and dosage categories within a population representing 1.7% of the national total. Perspectives on artificial intelligence research are discussed. Methods From the original dataset, spanning from January 2022 to October 2023, we processed multiple variables including demographic data, medications, dosages, drug consumption, and administration routes. The dispensing quantity was calculated as defined daily doses (DDD). Results The analysis reveals a conservative approach to opioid therapy. In subjects under the age of 20, prescriptions accounted for 2.1% in 2022 and declined to 1.4% in 2023. The drug combination paracetamol/codeine was the most frequently prescribed, followed by tapentadol. Approximately two-thirds of the consumption pertains to oral formulations. Transdermal formulations were 15% (fentanyl 9.8%, buprenorphine 5.1%) in 2022; and 16.6% (fentanyl 10%, buprenorphine 6.6%) in 2023. These data were confirmed by the DDD analysis. The trend analysis demonstrated a significant reduction ( p < 0.001) in the number of prescribed opioids from 2022 to 2023 in adults (40-69 years). The study of rapid-onset opioids (ROOs), drugs specifically used for breakthrough cancer pain, showed higher dosage (>267 mcg) consumption among women, whereas a lower dosage (<133 mcg) was calculated for men. Fentanyl pectin nasal spray accounted for approximately one-fifth of all ROOs. Conclusion Despite limitations, the study provides valuable insights into prescribing practices involving an important study population. The findings underscore the need for tailored approaches to prescribing practices, recognizing the complexities of pain management in different contexts. This research can contribute to the ongoing discourse on opioid use, advocating for innovative strategies that optimize therapeutic outcomes while mitigating potential risks.
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Affiliation(s)
- Marco Cascella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081, Salerno,
Italy
| | - Maurizio Capuozzo
- Pharmaceutical Department, ASL Napoli 3 Sud, Ercolano, 80056, Naples,
Italy
| | - Francesco Ferrara
- Pharmaceutical Department, ASL Napoli 3 Sud, Ercolano, 80056, Naples,
Italy
| | - Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131, Naples,
Italy
| | - Francesco Perri
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, via M. Semmola, 80131, Naples,
Italy
| | - Francesco Sabbatino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081, Salerno,
Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081, Salerno,
Italy
| | - Vittorio Santoriello
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125, Naples,
Italy
| | - Alfonso Maria Ponsiglione
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125, Naples,
Italy
| | - Maria Romano
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125, Naples,
Italy
| | - Francesco Amato
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125, Naples,
Italy
| | - Ornella Piazza
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081, Salerno,
Italy
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Peri K, Honeycutt L, Wennberg E, Windle SB, Filion KB, Gore G, Kudrina I, Paraskevopoulos E, Moiz A, Martel MO, Eisenberg MJ. Efficacy of interventions targeted at physician prescribers of opioids for chronic non-cancer pain: an overview of systematic reviews. BMC Med 2024; 22:76. [PMID: 38378544 PMCID: PMC10877926 DOI: 10.1186/s12916-024-03287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND To combat the opioid crisis, interventions targeting the opioid prescribing behaviour of physicians involved in the management of patients with chronic non-cancer pain (CNCP) have been introduced in clinical settings. An integrative synthesis of systematic review evidence is required to better understand the effects of these interventions. Our objective was to synthesize the systematic review evidence on the effect of interventions targeting the behaviours of physician opioid prescribers for CNCP among adults on patient and population health and prescriber behaviour. METHODS We searched MEDLINE, Embase, and PsycInfo via Ovid; the Cochrane Database of Systematic Reviews; and Epistemonikos. We included systematic reviews that evaluate any type of intervention aimed at impacting opioid prescriber behaviour for adult CNCP in an outpatient setting. RESULTS We identified three full texts for our review that contained 68 unique primary studies. The main interventions we evaluated were structured prescriber education (one review) and prescription drug monitoring programmes (PDMPs) (two reviews). Due to the paucity of data available, we could not determine with certainty that education interventions improved outcomes in deprescribing. There is some evidence that PDMPs decrease the number of adverse opioid-related events, increase communication among healthcare workers and patients, modify healthcare practitioners' approach towards their opioid prescribed patients, and offer more chances for education and counselling. CONCLUSIONS Our overview explores the possibility of PDMPs as an opioid deprescribing intervention and highlights the need for more high-quality primary research on this topic.
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Affiliation(s)
- Katya Peri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Lucy Honeycutt
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Erica Wennberg
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Temerty Faculty of Medicine and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah B Windle
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Science and Engineering, McGill University, Montreal, QC, Canada
| | - Irina Kudrina
- Departments of Family Medicine and of Anesthesia, McGill University, Montreal, QC, Canada
| | - Elena Paraskevopoulos
- Departments of Family Medicine, Royal Ottawa Mental Health Center and Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Areesha Moiz
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Marc O Martel
- Faculty of Dentistry and Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Division of Cardiology, Jewish General Hospital, Jewish General Hospital, McGill University, 3755 Cote Ste-Catherine Road, Suite H-421, Montreal, QC, H3T 1E2, Canada.
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Baum LVM, Kc M, Soulos PR, Jeffery MM, Ruddy KJ, Lerro CC, Lee H, Graham DJ, Rivera DR, Leapman MS, Jairam V, Dinan MA, Gross CP, Park HS. Trends in new and persistent opioid use in older adults with and without cancer. J Natl Cancer Inst 2024; 116:316-323. [PMID: 37802882 DOI: 10.1093/jnci/djad206] [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: 06/08/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The impact of ongoing efforts to decrease opioid use on patients with cancer remains undefined. Our objective was to determine trends in new and additional opioid use in patients with and without cancer. METHODS This retrospective cohort study used data from Surveillance, Epidemiology, and End Results program-Medicare for opioid-naive patients with solid tumor malignancies diagnosed from 2012 through 2017 and a random sample of patients without cancer. We identified 238 470 eligible patients with cancer and further focused on 4 clinical strata: patients without cancer, patients with metastatic cancer, patients with nonmetastatic cancer treated with surgery alone ("surgery alone"), and patients with nonmetastatic cancer treated with surgery plus chemotherapy or radiation therapy ("surgery+"). We identified new, early additional, and long-term additional opioid use and calculated the change in predicted probability of these outcomes from 2012 to 2017. RESULTS New opioid use was higher in patients with cancer (46.4%) than in those without (6.9%) (P < .001). From 2012 to 2017, the predicted probability of new opioid use was more stable in the cancer strata (relative declines: 0.1% surgery alone; 2.4% surgery+; 8.8% metastatic cancer), than in the noncancer stratum (20.0%) (P < .001 for each cancer to noncancer comparison). Early additional use declined among surgery patients (‒14.9% and ‒17.5% for surgery alone and surgery+, respectively) but was stable among patients with metastatic disease (‒2.8%, P = .50). CONCLUSIONS Opioid prescribing declined over time at a slower rate in patients with cancer than in patients without cancer. Our study suggests important but tempered effects of the changing opioid climate on patients with cancer.
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Affiliation(s)
- Laura Van Metre Baum
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Madhav Kc
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Molly M Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | | | - Catherine C Lerro
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Hana Lee
- Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - David J Graham
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Donna R Rivera
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael S Leapman
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Vikram Jairam
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Michaela A Dinan
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
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20
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Carrasco-Labra A, Polk DE, Urquhart O, Aghaloo T, Claytor JW, Dhar V, Dionne RA, Espinoza L, Gordon SM, Hersh EV, Law AS, Li BSK, Schwartz PJ, Suda KJ, Turturro MA, Wright ML, Dawson T, Miroshnychenko A, Pahlke S, Pilcher L, Shirey M, Tampi M, Moore PA. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. J Am Dent Assoc 2024; 155:102-117.e9. [PMID: 38325969 PMCID: PMC10919895 DOI: 10.1016/j.adaj.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND A panel convened by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania conducted systematic reviews and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management (ie, definitive dental treatment not immediately available) of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults. TYPES OF STUDIES REVIEWED The panel conducted 4 systematic reviews to determine the effect of opioid and nonopioid analgesics, local anesthetics, corticosteroids, and topical anesthetics on acute dental pain. The panel used the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations, Assessment, Development and Evaluation Evidence-to-Decision Framework to formulate recommendations. RESULTS The panel formulated recommendations and good practice statements using the best available evidence. There is a beneficial net balance favoring the use of nonopioid medications compared with opioid medications. In particular, nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile than opioids. CONCLUSIONS AND PRACTICAL IMPLICATIONS Nonopioid medications are first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache. The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs. Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults.
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21
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Schoenfeld AJ, Munigala S, Gong J, Schoenfeld RJ, Banaag A, Coles C, Koehlmoos TP. Reductions in sustained prescription opioid use within the US between 2017 and 2021. Sci Rep 2024; 14:1432. [PMID: 38228721 DOI: 10.1038/s41598-024-52032-4] [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: 10/13/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
Over the last decade, various efforts have been made to curtail the opioid crisis. The impact of these efforts, since the onset of the COVID-19 pandemic, has not been well characterized. We sought to develop national estimates of the prevalence of sustained prescription opioid use for a time period spanning the COVID-19 pandemic (2017-2021). We used TRICARE claims data (fiscal year 2017-2021) to identify patients who were prescription opioid non-users prior to receipt of a new opioid medication. We evaluated eligible patients for subsequent sustained prescription opioid use. The prevalence of sustained prescription opioid use during 2020-2021 was compared to 2017-2019. We performed multivariable logistic regression analyses to adjust for confounding. We performed secondary analyses that accounted for interactions between the time period and age, as well as a proxy for socioeconomic status. We determined there was a 68% reduction in the odds of sustained prescription opioid use (OR 0.32; 95% CI 0.27, 0.38; p < 0.001) in 2020-2021 as compared to 2017-2019. Significant reductions were identified across all US census divisions and all patient age groups. In both time periods, the plurality of encounters associated with initial receipt of an opioid that culminated in sustained prescription opioid use were associated with non-specific primary diagnoses. We found significant reductions in sustained prescription opioid use in 2020-2021 as compared to 2017-2019. The persistence of prescribing behaviors that result in issue of opioids for poorly characterized conditions remains an area of concern.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Satish Munigala
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jonathan Gong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Amanda Banaag
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Christian Coles
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
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22
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Khouja T, Shah NH, Suda KJ, Polk DE. Trajectories of opioid prescribing by general dentists, specialists, and oral and maxillofacial surgeons in the United States, 2015-2019. J Am Dent Assoc 2024; 155:7-16.e7. [PMID: 37988047 PMCID: PMC10870999 DOI: 10.1016/j.adaj.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite decreases in opioid prescribing from 2016 through 2019, some dentists (general, specialists, oral and maxillofacial surgeons) in the United States continue to prescribe opioids at high rates. The authors' objective was to define dentists' trajectories of opioid prescribing. METHODS The authors identified actively prescribing dentists from the IQVIA Longitudinal Prescription data set, from 2015 through 2019. Group-based trajectory modeling identified opioid prescribing trajectories on the basis of dentists' annual prescribing rates for the overall sample (model 1) and for high prescribers (model 2). The authors used χ2 or Mann-Whitney U tests to characterize the model 2 trajectory groups. RESULTS In model 1 (n = 199,145 prescribers), group-based trajectory modeling identified 8 trajectories that were grouped into 5 categories. A total of 14.8% were nonprescribers who composed less than 1% of all prescriptions, low prescribers (3 groups; 46.0%) prescribed at low rates (2015: 5.5%-16.9%; 2019: 1.5%-11.9%), decliners (7.3%) decreased prescribing rapidly (2015: 29.4%; 2019: 5.1%), moderately high prescribers (2 groups; 28.5%) prescribed moderately (2015: 28.7% and 39.2%; 2019: 18.1% and 28.8%), and consistently high prescribers (3.4%) prescribed at high rates (2015: 54.6%; 2019: 44.7%). In model 2, from consistently high prescribers (n = 6,845), 4 trajectories were identified. Of these 4 groups, 1 group (7.5%) declined prescribing rapidly. The groups did not differ meaningfully; however, the rapid decliners included fewer oral and maxillofacial surgeons (13.0% vs 18.4%), saw more Medicaid patients (2.5% vs 1.0%), and had higher opioid prescribing rates in 2015 (95.5% vs 91.6%) (P < .001 for all). CONCLUSIONS The authors identified variations in dentists' opioid prescribing rates. Although 60% of dentists decreased prescribing rates by 30% through 83%, 3.4% of dentists consistently prescribed at high rates. PRACTICAL IMPLICATIONS Some dentists continue to prescribe opioids at high levels, indicating that additional information is needed to better inform policy and clinical decision making.
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Joshi S, Rivera BD, Cerdá M, Guy GP, Strahan A, Wheelock H, Davis CS. One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington. JAMA Psychiatry 2023; 80:1277-1283. [PMID: 37755815 PMCID: PMC10535015 DOI: 10.1001/jamapsychiatry.2023.3416] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023]
Abstract
Importance Two states modified laws to remove or substantially reduce criminal penalties for any drug possession. The hypothesis was that removing criminal penalties for drug possession may reduce fatal drug overdoses due to reduced incarceration and increased calls for help at the scene of an overdose. Objective To evaluate whether decriminalization of drug possession in Oregon and Washington was associated with changes in either direction in fatal drug overdose rates. Design, Setting, and Participants This cohort study used a synthetic control method approach to examine whether there were changes in drug possession laws and fatal drug overdose rates in Oregon and Washington in the postpolicy period (February 1, 2021, to March 31, 2022, in Oregon and March 1, 2021, to March 31, 2022, in Washington). A counterfactual comparison group (synthetic controls) was created for Oregon and Washington, using 48 states and the District of Columbia, that did not implement similar policies during the study period (January 1, 2018, to March 31, 2022). For 2018-2021, final multiple cause-of-death data from the National Vital Statistics System (NVSS) were used. For 2022, provisional NVSS data were used. Drug overdose deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. Exposures In Oregon, Measure 110 went into effect on February 1, 2021. In Washington, the Washington Supreme Court decision in State v Blake occurred on February 25, 2021. Main Outcome Monthly fatal drug overdose rates. Results Following the implementation of Measure 110, absolute monthly rate differences between Oregon and its synthetic control were not statistically significant (probability = 0.26). The average rate difference post Measure 110 was 0.268 fatal drug overdoses per 100 000 state population. Following the implementation of the policy change in Washington, the absolute monthly rate differences between Washington and synthetic Washington were not statistically significant (probability = 0.06). The average rate difference post Blake was 0.112 fatal drug overdoses per 100 000 state population. Conclusions and Relevance This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates. Additional research could examine potential other outcomes as well as longer-term associations with fatal drug overdose overall and across racial and ethnic groups.
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Affiliation(s)
- Spruha Joshi
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Bianca D. Rivera
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Strahan
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Corey S. Davis
- Department of Population Health, New York University Grossman School of Medicine, New York
- Network for Public Health Law, Edina, Minnesota
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24
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Andraka-Christou B, McAvoy E, Gordon AJ, Ohama M, Brach M, Taylor EA, Vaiana M, Saloner B, Stein BD. Urine drug testing in the context of opioid analgesic prescribing for chronic pain: a content analysis of U.S. state laws in 2022. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1306-1317. [PMID: 37551941 PMCID: PMC10690857 DOI: 10.1093/pm/pnad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In response to the opioid crisis, U.S. states have passed laws requiring urine drug testing (UDT) when opioid analgesics are prescribed for chronic pain. We sought to identify state law UDT requirements. METHODS We searched NexisUni legal database using terms related to UDT, chronic pain, and opioids. We included laws effective during spring 2022 that required UDT when opioids were prescribed for chronic pain. We performed deductive content analysis, coding laws for mandated UDT frequency, type of clinician and type of payer to whom the law applied, and circumstances under which UDT was mandated. RESULTS We found 32 laws across 13 states that met our inclusion criteria. UDT requirements varied substantially by state, including with regard to the type of clinician to whom the law applied, the mandated frequency of UDT (eg, at initiation/assessment, at least annually, more than once per year), and the circumstances in which UDT was mandated (eg, patient had substance use disorder; dosage/day threshold). DISCUSSION Relatively few states have UDT mandates associated with prescribing opioids as chronic pain treatment. When developing policy indicators for empirical studies, researchers evaluating how UDT policy affects health outcomes must consider the complexity and lack of uniformity of UDT requirements. In addition, even if states mandate UDT, it is unclear whether clinicians understand the best way to use the test results.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL 32801, United States
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL 32827, United States
| | - Elizabeth McAvoy
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN 47405, United States
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, United States
- 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 84108, United States
| | - Maggie Ohama
- The Cardiac and Vascular Institute, Gainesville, FL 32605, United States
| | | | - Erin A Taylor
- RAND Corporation, Santa Monica, CA 90401, United States
| | - Mary Vaiana
- RAND Corporation, Santa Monica, CA 90401, United States
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
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25
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Eriksen AMA, Melhus M, Schei B, Skurtveit S, Broderstad AR. Opioid prescriptions among Sami and non-Sami with chronic pain: The SAMINOR 2 Questionnaire Survey and the Norwegian Prescription Database. Int J Circumpolar Health 2023; 82:2241202. [PMID: 37506380 PMCID: PMC10392314 DOI: 10.1080/22423982.2023.2241202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
This study is the first to investigate the prevalence of filled opioid prescriptions among indigenous Sami people with self-reported chronic musculoskeletal pain (CMSP) and compare it with that of non-Sami living in the same area. Baseline data from the SAMINOR 2 Questionnaire Survey (2012) was linked prospectively to the Norwegian Prescription Database. Information on filled opioid prescriptions during 2012-2019 was collected for 4767 persons who reported CMSP in SAMINOR 2. Gender-stratified chi-square tests, two-sample t-tests, Kruskal - Wallis tests, and multinomial logistic regression was applied. Two out of three CMSP respondents received no or only one prescription of opioids during 2012-2019. In each year, 80% of women received no opioids, 7-10% received one prescription of ≤ 180 defined daily doses (DDD), 8-9% received in total ≤ 180 DDD in two or more prescriptions, and 2-3% received > 180 DDD of opioids. Among men, 81-83% received no opioids, 8-11% received one prescription with ≤ 180 DDD, 5-9% received ≤ 180 DDD in two or more prescriptions, and 1-2% received > 180 DDD of opioids in a single year. There were no overall ethnic differences, which indicates a similar prescription policy for opioids for Sami and non-Sami with CMSP.
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Affiliation(s)
- Astrid M A Eriksen
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian University of Science and Technology (NTNU), Department of Obstetrics and Gynecology, Trondheim, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ann-Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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26
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Pieters T. The Imperative of Regulation: The Co-creation of a Medical and Non-medical US Opioid Crisis. PSYCHOACTIVES 2023; 2:317-336. [PMID: 39280929 PMCID: PMC7616444 DOI: 10.3390/psychoactives2040020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
The ravaging COVID-19 pandemic has almost pushed into oblivion the fact that the United States is still struggling with an immense addiction crisis. Drug overdose deaths rose from 16,849 in 1999 to nearly 110000-of which an estimated 75,000 involved opioids-in 2022. On a yearly basis, the opioid casualty rate is higher than the combined number of victims of firearm violence and car accidents. The Covid-19 epidemic might have helped to worsen the addiction crisis by stimulating drug use among adolescents and diverting national attention to yet another public health crisis. In the past decade the sharpest increase in deaths occurred among those related to fentanyl and fentanyl analogs (illicitly manufactured, synthetic opioids of greater potency). In the first opioid crisis wave (1998-2010), opioid-related deaths were mainly associated with prescription opioids such as Oxycontin (oxycodone hydrochloride). The mass prescription of these narcotic drugs did anything but control the pervasive phenomenon of 'addiction on prescription' that played such an important role in the emergence and robustness of the US opioid crisis. Using a long-term drug lifecycle analytic approach in this article I will show how opioid producing pharmaceutical companies created a medical market for opioid painkillers. They thus fueled a consumer demand for potent opioid drugs that was eagerly capitalized on by criminal entrepreneurs and their international logistic networks. I will also point out the failure of US authorities to effectively respond to this crisis due to the gap between narcotic product regulation, regulation of marketing practices and the rise of a corporate dominated health care system. Ironically, this turned the most powerful geopolitical force in the war against drugs into its greatest victim. Due to formulary availability and regulatory barriers to accessibility European countries have been relatively protected against following suit the US opioid crisis.
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Affiliation(s)
- Toine Pieters
- Freudenthal Institute and Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
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27
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Du AL, Rishel CA, Sun EC. Association Between Naloxone Coprescription Mandates and Postoperative Outcomes. Ann Surg 2023; 278:e995-e1002. [PMID: 36805578 PMCID: PMC10439975 DOI: 10.1097/sla.0000000000005821] [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] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone coprescription mandates and postoperative outcomes. BACKGROUND Data on naloxone coprescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored. METHODS Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004, and June 30, 2019, and categorized as high risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone coprescription mandates was estimated using a difference-in-differences approach. RESULTS The study included 429,878 surgical patients with an average age of 54.8 years (SD=15.9 years) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of hospital admission was 3.26% after implementation of a naloxone coprescription mandate compared with 3.33% before (difference change: -0.08%, 95% CI: -0.44% to 0.29%, P =0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone coprescription mandate compared with 7.73% before (difference: -0.67%, 95% CI: -1.39% to 0.05%, P =0.07). These results were robust to a variety of sensitivity and subgroup analyses. CONCLUSIONS Naloxone coprescription mandates were not associated with a statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days.
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Affiliation(s)
- Austin L Du
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chris A Rishel
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA
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28
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Qiu S, Liu Y, Adetunji DO, Hartzell S, Larson M, Friedman S. Dose Changes for Long-term Opioid Patients Following a State Opioid Prescribing Policy. Med Care 2023; 61:657-664. [PMID: 37582299 PMCID: PMC10566257 DOI: 10.1097/mlr.0000000000001907] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND In 2018, Nevada implemented opioid prescribing legislation (AB474) to support the uptake of CDC pain care guidelines. We studied the law's association with doses over threshold levels of morphine milligram equivalents (MMEs) and with time to dose increases and decreases, among long-term opioid patients. METHODS A difference-in-difference study examined dosing changes across opioid prescription episodes (ie, prescriptions within 30 day and within the same dosing threshold). Patients with at least 120 days supply over 6 months in Nevada and Colorado Medicaid pharmacy claims were included. Using a logistic regression model, we compare the predicted probabilities that opioid episodes exceeded 50 MME before and after implementation of the law, in both states. Adjusted hazard ratios (aHR) from a gap time survival model estimated time to escalate above 50 MME among low-dose episodes (<50 MME), and time to de-escalate below 50 MME among high-dose episodes (≥50 MME). RESULTS Among 453,577 episodes (74,292 patients), the Nevada law was associated with a 2.9% reduction in prescriptions over 50 MME (95% CI: -3.5, -2.3) compared with Colorado. While the law was also associated with slower escalation (Nevada: aHR = 0.75; 95% CI: 0.72, 0.77, Colorado: aHR = 1.04; 95% CI: 1.01, 1.06), it was also associated with slower de-escalation (Nevada: aHR = 0.87; 95% CI: 0.84, 0.89, Colorado: aHR = 0.97; 95% CI: 0.96, 0.99). CONCLUSIONS Slower dose escalations, rather than faster dose de-escalation, likely explain post-law reductions in doses over 50 MME. Slower dose de-escalations may be due to longer days supply post-policy.
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Affiliation(s)
- Sijia Qiu
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
- Kaiser Permanente Southern California, 100 S Los Robles Ave., Pasadena, CA 91101, USA
| | - Yan Liu
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
| | - Doyinsola O Adetunji
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
| | - Sarah Hartzell
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
| | - Madalyn Larson
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
| | - Sarah Friedman
- School of Public Health, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA
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29
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Mitra B, Roman C, Wu B, Luckhoff C, Goubrial D, Amos T, Bannon-Murphy H, Huynh R, Dooley M, Smit DV, Cameron PA. Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial. Br J Pain 2023; 17:491-500. [PMID: 38107754 PMCID: PMC10722107 DOI: 10.1177/20494637231189031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background The prescription of opioids in emergency care has been associated with harm, including overdose and dependence. The aim of this trial was to assess restriction of access to oxycodone (ROXY), in combination with education and guideline modifications, versus education and guideline modifications alone (standard care) to reduce oxycodone administration in the Emergency Department (ED). Methods An unblinded, active control, randomised controlled trial was conducted in an adult tertiary ED. Participants were patients aged 18-75 years who had analgesics administered in the ED. The primary intervention was ROXY, through removal of all oxycodone immediate release tablets from the ED imprest, with availability of a small supply after senior clinician approval. The intervention did not restrict prescription of discharge medications. The primary outcome measure was oxycodone administration rates. Secondary outcomes were administration rates of other analgesic medications, time to initial analgesics and oxycodone prescription on discharge. Results There were 2258 patients eligible for analysis. Oxycodone was administered to 80 (6.1%) patients in the ROXY group and 221 (23.3%) patients in the standard care group (relative risk (RR) 0.26; 95% CI: 0.21 to 0.33; p < .001). Tapentadol was prescribed more frequently in the ROXY group (RR 2.17; 95% CI: 1.71-2.74), while there were no differences in prescription of other analgesic medications. On discharge, significantly fewer patients were prescribed oxycodone (RR 0.51; 95% CI: 0.39-0.66) and no differences were observed in prescription rates of other analgesic medications. There was no difference in time to first analgesic (HR 0.94; 95% CI: 0.86-1.02). Conclusions Restricted access to oxycodone was superior to education and guideline modifications alone for reducing oxycodone use in the ED and reducing discharge prescriptions of oxycodone from the ED. The addition of simple restrictive interventions is recommended to enable rapid changes to clinician behaviour to reduce the potential harm associated with the prescribing of oxycodone in the ED.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cristina Roman
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Bertha Wu
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Carl Luckhoff
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Diana Goubrial
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Timothy Amos
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ronald Huynh
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Dooley
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - De Villiers Smit
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A. Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Seo CH, Howe KL, McAllister KB, McDaniel BL, Sharp HD, Lucktong TA, Bower KL, Collier BR, Gillen JR. Standardizing Opioids Prescribed at Discharge in Trauma Surgery. J Surg Res 2023; 290:52-60. [PMID: 37196608 DOI: 10.1016/j.jss.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Excessive opioid use after sustaining trauma has contributed to the opioid epidemic. Standardizing the quantity of opioids prescribed at discharge can improve prescribing behavior. We hypothesized that adopting new electronic medical record order sets would be associated with decreased morphine milligram equivalents (MME) prescribed at discharge for trauma patients. METHODS This was a quasi-experimental study examining opioid prescribing practices at a Level 1 Trauma Center. All patients ages 18-89 admitted to the Trauma Service from January 2017 through March 2021 and hospitalized for at least 2 d were included. In November 2020, new trauma admission and discharge order sets were implemented with recommended discharge opioid quantity based on inpatient opioid usage the day prior to discharge multiplied by five. Postintervention prescribing practices were compared to historical controls. The primary outcome was MME at discharge. RESULTS Baseline characteristics between preintervention and postintervention cohorts were comparable. There was a significant reduction in median MME prescribed at discharge postintervention (112.5 versus 75.0, P < 0.0001). Median inpatient MME usage also significantly reduced postintervention (184.1 versus 160.5; P < 0.0001). There were trends toward increased ideal prescribing per order set recommendation and a reduction in overprescribing. Patients receiving the recommended opioid quantity at discharge had the lowest opioid refill prescription rate (under: 29.6%, ideal: 7.3%, over: 19.7%, P < 0.0001). CONCLUSIONS For trauma patients requiring inpatient opioid therapy, a pragmatic and individualized intervention was associated with a reduced quantity of discharge opioids without negative outcomes. Reduction in inpatient opioid use was also associated with standardizing prescribing practices of surgeons with electronic medical record order sets.
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Affiliation(s)
- Claire H Seo
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
| | - Katherine L Howe
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Kelly B McAllister
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Bradford L McDaniel
- Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hunter D Sharp
- Carilion Clinic Health Analytics Research, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Tananchai A Lucktong
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Katie L Bower
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Brian R Collier
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Jacob R Gillen
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
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Lyu X, Guy GP, Baldwin GT, Losby JL, Bohnert ASB, Goldstick JE. State-to-State Variation in Opioid Dispensing Changes Following the Release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. JAMA Netw Open 2023; 6:e2332507. [PMID: 37695587 PMCID: PMC10495870 DOI: 10.1001/jamanetworkopen.2023.32507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Evidence suggests that opioid prescribing was reduced nationally following the 2016 release of the Guideline for Prescribing Opioids for Chronic Pain by the US Centers for Diseases Control and Prevention (CDC). State-to-state variability in postguideline changes has not been quantified and could point to further avenues for reducing opioid-related harms. Objective To estimate state-level changes in opioid dispensing following the 2016 CDC Guideline release and explore state-to-state heterogeneity in those changes. Design, Setting, and Participants This cross-sectional study included information on opioid prescriptions for US individuals between 2012 and 2018 from an administrative database. Serial cross-sections of monthly opioid dispensing trajectories in each US state and the District of Columbia were analyzed using segmented regression to characterize preguideline dispensing trajectories and to estimate how those trajectories changed following the 2016 guideline release. Data were analyzed January to March 2023. Exposure The March 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Main Outcomes and Measures Four measures of opioid dispensing: opioid dispensing rate per 100 000 persons, long-acting opioid dispensing rate per 100 000 persons, high-dose (90 or more morphine milligram equivalents [MME] per day) dispensing rate per 100 000 persons, and average per capita MME. All measures were calculated monthly, from January 2012 through December 2018. Results Data from approximately 58 900 retail pharmacies were included in analysis, representing approximately 92% of US retail prescriptions. The overall monthly dispensing rate in the US in early 2012 was approximately 7000 per 100 000 population. Following the 2016 guideline release, the already-decreasing slope accelerated nationally for the overall dispensing rate (preguideline slope, -23.19; postguideline slope, -48.97; change in slope, 25.97 [95% CI, 18.67-32.95]), long-acting dispensing rate (preguideline slope, -1.03; postguideline slope, -5.94; change in slope, 4.90 [95% CI, 4.26-5.55]), high-dose dispensing (preguideline slope, -3.52; postguideline slope, -7.63; change in slope, 4.11 [95% CI, 3.49-4.73]), and per-capita MME (preguideline slope, -0.22; postguideline slope, -0.58; change in slope, 0.36 [95% CI, 0.30-0.42]). For all outcomes, nearly all states showed analogous acceleration of an already-decreasing slope, but there was substantial state-to-state heterogeneity. Slope changes (preguideline - postguideline slope) ranged from 9.15 (Massachusetts) to 74.75 (Mississippi) for overall dispensing, 1.88 (Rhode Island) to 13.41 (Maine) for long-acting dispensing, 0.71 (District of Columbia) to 13.68 (Maine) for high-dose dispensing, and 0.06 (Hawaii) to 0.91 (Arkansas) for per capita MME. Conclusions and Relevance The 2016 CDC Guideline release was associated with broad reductions in prescription opioid dispensing, and those changes showed substantial geographic variability. Determining the factors associated with these state-level differences may inform further improvements to ensure safe prescribing practices.
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Affiliation(s)
- Xiru Lyu
- Injury Prevention Center, University of Michigan, Ann Arbor
| | - Gery P Guy
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grant T Baldwin
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan L Losby
- Division of Overdose Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy S B Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
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Millhollon R, Elenwo C, Lundberg A, Roberts W, Beaman J, Bray N, Hartwell M. Associations of clinical personnel characteristics and controlled substance prescribing practices. J Osteopath Med 2023; 123:451-458. [PMID: 37134110 DOI: 10.1515/jom-2022-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023]
Abstract
CONTEXT Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. OBJECTIVES This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). METHODS We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. RESULTS Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02). CONCLUSIONS Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.
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Affiliation(s)
- Robert Millhollon
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Covenant Elenwo
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Alex Lundberg
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Will Roberts
- Department of Anesthesia, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Jason Beaman
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Natasha Bray
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Kaminski P, Perry BL, Green HD. Comparing professional communities: Opioid prescriber networks and Public Health Preparedness Districts. Harm Reduct J 2023; 20:120. [PMID: 37658379 PMCID: PMC10474636 DOI: 10.1186/s12954-023-00840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/22/2023] [Indexed: 09/03/2023] Open
Abstract
Problem opioid use and opioid-related drug overdoses remain a major public health concern despite attempts to reduce and monitor opioid prescriptions and increase access to office-based opioid treatment. Current provider-focused interventions are implemented at the federal, state, regional, and local levels but have not slowed the epidemic. Certain targeted interventions aimed at opioid prescribers rely on populations defined along geographic, political, or administrative boundaries; however, those boundaries may not align well with actual provider-patient communities or with the geographic distribution of high-risk opioid use. Instead of relying exclusively on commonly used geographic and administrative boundaries, we suggest augmenting existing strategies with a social network-based approach to identify communities (or clusters) of providers that prescribe to the same set of patients as another mechanism for targeting certain interventions. To test this approach, we analyze 1 year of prescription data from a commercially insured population in the state of Indiana. The composition of inferred clusters is compared to Indiana's Public Health Preparedness Districts (PHPDs). We find that in some cases the correspondence between provider networks and PHPDs is very high, while in other cases the overlap is low. This has implications for whether an intervention is reaching its intended provider targets efficiently and effectively. Assessing the best intervention targeting strategy for a particular outcome could facilitate more effective interventions to tackle the ongoing opioid use epidemic.
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Affiliation(s)
- Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN, USA.
- Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, USA.
| | - Brea L Perry
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Harold D Green
- Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
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Wally MK, Thompson ME, Odum S, Kazemi DM, Hsu JR, Seymour RB. Changes in opioid prescription duration for musculoskeletal injury associated with the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:926-932. [PMID: 36943361 DOI: 10.1093/pm/pnad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To assess whether implementation of the Strengthen Opioid Misuse Prevention (STOP) Act was associated with an increase in the percentage of opioid prescriptions written for 7 days or fewer among patients with acute or postsurgical musculoskeletal conditions. DESIGN An interrupted time-series study was conducted to determine the change in duration of opioid prescriptions associated with the STOP Act. SETTING Data were extracted from the electronic health record of a large health care system in North Carolina. SUBJECTS Patients presenting from 2016 to 2020 with an acute musculoskeletal injury and the clinicians treating them were included in an interrupted time-series study (n = 12 839). METHODS Trends were assessed over time, including the change in trend associated with implementation of the STOP Act, for the percentage of prescriptions written for ≤7 days. RESULTS Among patients with acute musculoskeletal injury, less than 30% of prescriptions were written for ≤7 days in January of 2016; by December of 2020, almost 90% of prescriptions were written for ≤7 days. Prescriptions written for ≤7 days increased 17.7% after the STOP Act was implemented (P < .001), after adjustment for the existing trend. CONCLUSIONS These results demonstrate significant potential for legislation to influence opioid prescribing behavior.
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Affiliation(s)
- Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Michael E Thompson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Donna M Kazemi
- College of Health and Human Services, School of Nursing, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
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Lu CH, Jette G, Falls Z, Jacobs DM, Gibson W, Bednarczyk EM, Kuo TY, Lape-Newman B, Leonard KE, Elkin PL. A cohort of patients in New York State with an alcohol use disorder and subsequent treatment information - A merging of two administrative data sources. J Biomed Inform 2023; 144:104443. [PMID: 37455008 PMCID: PMC11178131 DOI: 10.1016/j.jbi.2023.104443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Despite the high prevalence of alcohol use disorder (AUD) in the United States, limited research is focused on the associations among AUD, pain, and opioids/benzodiazepine use. In addition, little is known regarding individuals with a history of AUD and their potential risk for pain diagnoses, pain prescriptions, and subsequent misuse. Moreover, the potential risk of pain diagnoses, prescriptions, and subsequent misuse among individuals with a history of AUD is not well known. The objective was to develop a tailored dataset by linking data from 2 New York State (NYS) administrative databases to investigate a series of hypotheses related to AUD and painful medical disorders. METHODS Data from the NYS Office of Addiction Services and Supports (OASAS) Client Data System (CDS) and Medicaid claims data from the NYS Department of Health Medicaid Data Warehouse (MDW) were merged using a stepwise deterministic method. Multiple patient-level identifier combinations were applied to create linkage rules. We included patients aged 18 and older from the OASAS CDS who initially entered treatment with a primary substance use of alcohol and no use of opioids between January 1, 2003, and September 23, 2019. This cohort was then linked to corresponding Medicaid claims. RESULTS A total of 177,685 individuals with a primary AUD problem and no opioid use history were included in the dataset. Of these, 37,346 (21.0%) patients had an OUD diagnosis, and 3,365 (1.9%) patients experienced an opioid overdose. There were 121,865 (68.6%) patients found to have a pain condition. CONCLUSION The integrated database allows researchers to examine the associations among AUD, pain, and opioids/benzodiazepine use, and propose hypotheses to improve outcomes for at-risk patients. The findings of this study can contribute to the development of a prognostic prediction model and the analysis of longitudinal outcomes to improve the care of patients with AUD.
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Affiliation(s)
- Chi-Hua Lu
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Gail Jette
- Division of Outcomes, Management, and Systems Information, Office of Addiction Services and Supports, Albany, NY, USA
| | - Zackary Falls
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Walter Gibson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Edward M Bednarczyk
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Tzu-Yin Kuo
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Kenneth E Leonard
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Peter L Elkin
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Faculty of Engineering, University of Southern Denmark, Denmark; U.S. Department of Veterans Affairs, WNY VA, Buffalo, NY, USA
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Swartz JA, Lieberman M, Jimenez AD, Mackesy-Amiti ME, Whitehead HD, Hayes KL, Taylor L, Prete E. Current attitudes toward drug checking services and a comparison of expected with actual drugs present in street drug samples collected from opioid users. Harm Reduct J 2023; 20:87. [PMID: 37420196 PMCID: PMC10327398 DOI: 10.1186/s12954-023-00821-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/03/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The opioid epidemic continues to be associated with high numbers of fatalities in the USA and other countries, driven mainly by the inclusion of potent synthetic opioids in street drugs. Drug checking by means of various technologies is being increasingly implemented as a harm reduction strategy to inform users about constituent drugs in their street samples. We assessed how valued drug checking services (DCS) would be for opioid street drug users given the ubiquity of fentanyl and related analogs in the drug supply, the information they would most value from drug checking, and compared expected versus actual constituent drugs in collected samples. METHODS A convenience sample of opioid street drug users (N = 118) was recruited from two syringe service exchange programs in Chicago between 2021 and 2022. We administered brief surveys asking about overdose history, whether fentanyl was their preferred opioid, and interest in DCS. We also collected drug samples and asked participants what drug(s) they expected were in the sample. Provided samples were analyzed using LC-MS technology and the results compared to their expected drugs. RESULTS Participants reported an average of 4.4 lifetime overdoses (SD = 4.8, range = 0-20) and 1.1 (SD = 1.8, range = 0-10) past-year overdoses. A majority (92.1%) believed they had recently used drugs containing fentanyl whether intentionally or unintentionally. Opinions about the desirability of fentanyl were mixed with 56.1% indicating they did not and 38.0% indicating they did prefer fentanyl over other opioids, mainly heroin. Attitudes toward DCS indicated a general but not uniform receptiveness with a majority indicating interest in DCS though sizeable minorities believed DCS was "too much trouble" (25.2%) or there was "no point" in testing (35.4%). Participants were especially inaccurate identifying common cutting agents and potentiating drugs such as diphenhydramine in their samples (sensitivity = .17). CONCLUSIONS Results affirmed street drug users remain interested in using DCS to monitor their drugs and such services should be more widely available. Advanced checking technologies that provide information on the relative quantities and the different drugs present in a given sample available at point-of-care, would be most valuable but remain challenging to implement.
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Affiliation(s)
- James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison Street, (MC 309), Chicago, IL, 60607, USA.
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, USA
| | - A David Jimenez
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Mary Ellen Mackesy-Amiti
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, USA
| | - Heather D Whitehead
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, USA
| | - Kathleen L Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, USA
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Gravlee E, Ramachandran S, Cafer A, Holmes E, McGregor J, Jordan T, Rosenthal M. Naloxone Accessibility Under the State Standing Order Across Mississippi. JAMA Netw Open 2023; 6:e2321939. [PMID: 37410464 PMCID: PMC10326645 DOI: 10.1001/jamanetworkopen.2023.21939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
Importance Naloxone is a life-saving medication for individuals experiencing an opioid overdose. Naloxone standing orders aim to make naloxone more available by allowing patients improved access to this medication at community pharmacies; however, lawful availability does not mean that this life-saving intervention is accessible to patients. Objective To characterize naloxone availability and out-of-pocket cost under the state standing order in Mississippi. Design, Setting, and Participants This telephone-based, mystery-shopper census survey study included Mississippi community pharmacies open to the general public in Mississippi at the time of data collection. Community pharmacies were identified using the Hayes Directories April 2022 complete Mississippi pharmacy database. Data were collected from February to August 2022. Exposures Mississippi House bill 996, the Naloxone Standing Order Act, signed into law in 2017, allowing pharmacists to dispense naloxone under a physician state standing order at a patient's request. Main Outcomes and Measures The main outcomes were naloxone availability under Mississippi's state standing order and the out-of-pocket cost of available formulations. Results There were 591 open-door community pharmacies surveyed for this study, with a 100% response rate. The most common pharmacy type was independent (328 [55.50%]), followed by chain (147 [24.87%]) and grocery store (116 [19.63%]). When asked, "Do you have naloxone that I can pick up today?" 216 Mississippi pharmacies (36.55%) had naloxone available for purchase under the state standing order. Of the 591 pharmacies, 242 (40.95%) were unwilling to dispense naloxone under the state standing order. Among the 216 pharmacies with naloxone available, the median out-of-pocket cost for naloxone nasal spray (n = 202) across Mississippi was $100.00 (range, $38.11-$229.39; mean [SD], $105.58 [$35.42]) and the median out-of-pocket cost of naloxone injection (n = 14) was $37.70 (range, $17.00-$208.96; mean [SD], $66.62 [$69.27]). Conclusions and Relevance In this survey study of open-door Mississippi community pharmacies, availability of naloxone was limited despite standing order implementation. This finding has important implications for the effectiveness of the legislation in preventing opioid overdose deaths in this region. Further studies are needed to understand pharmacists' unwillingness to dispense naloxone and the implications of lack of availability and unwillingness for further naloxone access interventions.
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Affiliation(s)
- Emily Gravlee
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, University
| | - Sujith Ramachandran
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, The University of Mississippi School of Pharmacy, University
| | - Anne Cafer
- Department of Sociology and Anthropology, The University of Mississippi, University
| | - Erin Holmes
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, University
| | - Jacob McGregor
- Department of Pharmacy Practice, The University of Mississippi School of Pharmacy, University
| | - Taylor Jordan
- Department of Pharmacy Practice, The University of Mississippi School of Pharmacy, University
- now with Mississippi Baptist Medical Center, Jackson
| | - Meagen Rosenthal
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, University
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Castillo-Carniglia A, Rivera-Aguirre A, Santaella-Tenorio J, Fink DS, Crystal S, Ponicki W, Gruenewald P, Martins SS, Keyes KM, Cerdá M. Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020. Epidemiology 2023; 34:467-475. [PMID: 36943813 PMCID: PMC10712490 DOI: 10.1097/ede.0000000000001609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020. METHODS Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin. RESULTS Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR] = 1.14; 95% credible interval [CrI] = 1.11, 1.18), benzodiazepines (RR = 1.19; 95% CrI = 1.12, 1.26), and opioids+benzodiazepines (RR = 1.22; 95% CrI = 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR = 0.88; 95% CrI = 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR = 0.81; 95% CrI = 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid- (RR = 0.83; 95% CrI = 0.76, 0.91), benzodiazepine- (RR = 0.79; 95% CrI = 0.68, 0.92), and opioid+benzodiazepine-related poisonings (RR = 0.83; 95% CrI = 0.70, 0.98). CONCLUSIONS Implementation of medical cannabis laws was associated with higher rates of opioid- and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Millennium Nucleus on Sociomedicine (Sociomed), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | - Ariadne Rivera-Aguirre
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
- Department of Population Health, New York University Grossman School of Medicine, NY
| | | | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ
| | - William Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA
| | | | | | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, NY
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Witkiewitz K, Vowles KE. Everybody Hurts: Intersecting and Colliding Epidemics and the Need for Integrated Behavioral Treatment of Chronic Pain and Substance Use. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2023; 32:228-235. [PMID: 37645017 PMCID: PMC10465109 DOI: 10.1177/09637214231162366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Chronic pain and substance use disorders are both common, debilitating, and often persist over the longer term. On their own, each represents a significant health problem, with estimates indicating a substantial proportion of the adult population has chronic pain or a substance use disorder (SUD), and their co-occurrence is increasing. Chronic pain and SUD are also both often invisible, stigmatized disorders and persons with both regularly have difficulty accessing evidence-based treatments, particularly those that offer coordinated and integrated treatment for both conditions. But there is hope. Research is unraveling the mechanisms of chronic pain and substance use, as well as their co-occurrence, integrated behavioral treatment options based on acceptance- and mindfulness-based approaches are increasingly being developed and tested, government agencies are devoting more funds and resources to increase research on chronic pain and SUD, and there have been growing efforts in training, dissemination, and implementation of evidence-based treatments. At the very heart of the matter, though, is to recognize that everybody hurts sometimes, and treatments must empower people to life effectively with these experiences of being human.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance use, And Addictions University of New Mexico
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Nielsen S, Picco L, Russell G, Pearce C, Andrew NE, Lubman DI, Bell JS, Buchbinder R, Xia T. Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104053. [PMID: 37209441 DOI: 10.1016/j.drugpo.2023.104053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. METHOD We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). RESULTS We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). CONCLUSION PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Stein BD, Saloner BK, Golan OK, Andraka-Christou B, Andrews CM, Dick AW, Davis CS, Sheng F, Gordon AJ. Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment. JAMA HEALTH FORUM 2023; 4:e231102. [PMID: 37234015 PMCID: PMC10220518 DOI: 10.1001/jamahealthforum.2023.1102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/24/2023] [Indexed: 05/27/2023] Open
Abstract
Importance Expanding the use of buprenorphine for treating opioid use disorder is a critical component of the US response to the opioid crisis, but few studies have examined how state policies are associated with buprenorphine dispensing. Objective To examine the association of 6 selected state policies with the rate of individuals receiving buprenorphine per 1000 county residents. Design, Setting, and Participants This cross-sectional study used 2006 to 2018 US retail pharmacy claims data for individuals dispensed buprenorphine formulations indicated for treating opioid use disorder. Exposures State implementation of policies requiring additional education for buprenorphine prescribers beyond waiver training, continuing medical education related to substance misuse and addiction, Medicaid coverage of buprenorphine, Medicaid expansion, mandatory prescriber use of prescription drug monitoring programs, and pain management clinic laws were examined. Main Outcomes and Measures The main outcome was buprenorphine treatment months per 1000 county residents as measured using multivariable longitudinal models. Statistical analyses were conducted from September 1, 2021, through April 30, 2022, with revised analyses conducted through February 28, 2023. Results The mean (SD) number of months of buprenorphine treatment per 1000 persons nationally increased steadily from 1.47 (0.04) in 2006 to 22.80 (0.55) in 2018. Requiring that buprenorphine prescribers receive additional education beyond that required to obtain the federal X-waiver was associated with significant increases in the number of months of buprenorphine treatment per 1000 population in the 5 years following implementation of the requirement (from 8.51 [95% CI, 2.36-14.64] months in year 1 to 14.43 [95% CI, 2.61-26.26] months in year 5). Requiring continuing medical education for physician licensure related to substance misuse or addiction was associated with significant increases in buprenorphine treatment per 1000 population in each of the 5 years following policy implementation (from 7.01 [95% CI, 3.17-10.86] months in the first year to 11.43 [95% CI, 0.61-22.25] months in the fifth year). None of the other policies examined was associated with a significant change in buprenorphine months of treatment per 1000 county residents. Conclusions and Relevance In this cross-sectional study of US pharmacy claims, state-mandated educational requirements beyond the initial training required to prescribe buprenorphine were associated with increased buprenorphine use over time. The findings suggest requiring education for buprenorphine prescribers and training in substance use disorder treatment for all controlled substance prescribers as an actionable proposal for increasing buprenorphine use, ultimately serving more patients. No single policy lever can ensure adequate buprenorphine supply; however, policy maker attention to the benefits of enhancing clinician education and knowledge may help to expand buprenorphine access.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah
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Butler C, Stechlinski P. Modeling Opioid Abuse: A Case Study of the Opioid Crisis in New England. Bull Math Biol 2023; 85:45. [PMID: 37088864 PMCID: PMC10122875 DOI: 10.1007/s11538-023-01148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.
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Affiliation(s)
- Cole Butler
- Department of Mathematics and Statistics, University of Maine, 5752 Neville Hall, Orono, ME, 04469, USA
| | - Peter Stechlinski
- Department of Mathematics and Statistics, University of Maine, 5752 Neville Hall, Orono, ME, 04469, USA.
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Fuss C, Romm KF, Crawford ND, Harrington KRV, Wang Y, Ma Y, Taggart T, Ruiz MS, Berg CJ. Psychosocial Correlates of Opioid Use Profiles among Young Adults in a Longitudinal Study across 6 US Metropolitan Areas. Subst Use Misuse 2023; 58:981-988. [PMID: 37082785 PMCID: PMC10645480 DOI: 10.1080/10826084.2023.2201839] [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: 04/22/2023]
Abstract
Background: Examining opioid use profiles over time and related factors among young adults is crucial to informing prevention efforts. Objectives: This study analyzed baseline data (Fall 2018) and one-year follow-up data from a cohort of 2,975 US young adults (Mage=24.55, 42.1% male; 71.7% White; 11.4% Hispanic). Multinomial logistic regression was used to examine: 1) psychosocial correlates (i.e. adverse childhood experiences [ACEs], depressive symptoms, parental substance use) of lifetime opioid use (i.e. prescription use vs. nonuse, nonmedical prescription [NMPO] use, and heroin use, respectively); and 2) psychosocial correlates and baseline lifetime use in relation to past 6-month use at one-year follow-up (i.e. prescription use vs. nonuse and NMPO/heroin use, respectively). Results: At baseline, lifetime use prevalence was: 30.2% prescription, 9.7% NMPO, and 3.1% heroin; past 6-month use prevalence was: 7.6% prescription, 2.5% NMPO, and 0.9% heroin. Compared to prescription users, nonusers reported fewer ACEs and having parents more likely to use tobacco, but less likely alcohol; NMPO users did not differ; and heroin users reported more ACEs and having parents more likely to use cannabis but less likely alcohol. At one-year follow-up, past 6-month use prevalence was: 4.3% prescription, 1.3% NMPO, and 1.4% heroin; relative to prescription users, nonusers were less likely to report baseline lifetime opioid use and reported fewer ACEs, and NMPO/heroin users were less likely to report baseline prescription opioid use but more likely heroin use. Conclusions: Psychosocial factors differentially correlate with young adult opioid use profiles, and thus may inform targeted interventions addressing different use patterns and psychosocial risk factors.
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Affiliation(s)
- Caroline Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, Department of Pediatrics, College of Medicine,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Natalie D Crawford
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara Taggart
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- GW Cancer Center, George Washington University, Washington, DC, USA
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Sahebi-Fakhrabad A, Sadeghi AH, Kemahlioglu-Ziya E, Handfield R, Tohidi H, Vasheghani-Farahani I. The Impact of Opioid Prescribing Limits on Drug Usage in South Carolina: A Novel Geospatial and Time Series Data Analysis. Healthcare (Basel) 2023; 11:healthcare11081132. [PMID: 37107966 PMCID: PMC10137799 DOI: 10.3390/healthcare11081132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study investigates the impact of South Carolina's prescription limit law (S.C. Code Ann. 44-53-360), which aims to reduce opioid overdose deaths, on opioid prescription rates. The study utilizes South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) data and proposes a distance classification system to group records based on proximity and evaluates prescription volumes in each distance class. Prescription volumes were found to be highest in classes with pharmacies located further away from the patient. An Interrupted Time Series (ITS) model is utilized to assess the policy impact, with benzodiazepine prescriptions as a control group. The ITS models indicate an overall decrease in prescription volume, but with varying impacts across the different distance classes. While the policy effectively reduced opioid prescription volumes overall, an unintended consequence was observed as prescription volume increased in areas where prescribers were located at far distances from patients, highlighting the limitations of state-level policies on doctors. These findings contribute to the understanding of the effects of prescription limit laws on opioid prescription rates and the importance of considering location and distance in policy design and implementation.
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Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Eda Kemahlioglu-Ziya
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
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Sohn M, Delcher C, Talbert JC, Cheng Y, Xu Y, Jadhav ED, Freeman PR. The Impact of Naloxone Coprescribing Mandates on Opioid-Involved Overdose Deaths. Am J Prev Med 2023; 64:483-491. [PMID: 36496279 DOI: 10.1016/j.amepre.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Since 2017, a total of 10 states have mandated naloxone coprescribing intended to prevent fatal opioid overdoses. This study aims to assess the association between naloxone coprescribing/offering mandates and opioid-involved overdose deaths on the basis of the opioid type. METHODS Data on overdose deaths from 1999 to 2020 came from the National Center for Health Statistics CDC WONDER Online Database. This study examined deaths stratified by illicit/synthetic opioids and prescription/treatment opioids. Difference-in-difference negative binomial regression models estimated average marginal effects and 95% CIs. Covariates included opioid dispensing rate, Good Samaritan law, pharmacy-based naloxone access law, mandatory use of prescription drug monitoring program, and recreational cannabis dispensaries. Data collection and analysis were conducted in 2022. RESULTS Ten states implemented naloxone coprescribing/offering mandates during the period. Coprescribing/offering mandates significantly reduced the number of prescription/treatment overdose deaths by 8.61 per state per quarter (95% CI= -15.13, -2.09), a 16% reduction from the counterfactual estimates. Coprescribing/offering mandates did not significantly impact illicit/synthetic overdose deaths (average marginal effect=0.32; 95% CI= -18.27, 18.91). CONCLUSIONS Coprescribing/offering mandates prevent overdose deaths for its target population, individuals using prescription/treatment opioids. These mandates do not appear to impact populations using illicit/synthetic opioids; thus, expanded efforts are needed to reach these individuals.
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Affiliation(s)
- Minji Sohn
- College of Pharmacy, Ferris State University, Big Rapids, Michigan.
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Jeffery C Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Yue Cheng
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Yong Xu
- Marketing Department, College of Business, Ferris State University, Big Rapids, Michigan
| | - Emmanuel D Jadhav
- College of Health Professions, Ferris State University, Big Rapids, Michigan
| | - Patricia R Freeman
- Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Daniulaityte R, Nahhas RW, Silverstein S, Martins S, Carlson RG. Trajectories of non-prescribed buprenorphine and other opioid use: A multi-trajectory latent class growth analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208973. [PMID: 36804351 PMCID: PMC10044504 DOI: 10.1016/j.josat.2023.208973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/26/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION With the increasing use of non-prescribed buprenorphine (NPB), we need more data to identify the longitudinal patterns of NPB use. The goal of this natural history study is to characterize heterogeneity in trajectories of NPB, other opioid use, and participation in medication for opioid disorder (MOUD) treatment among a community-recruited sample of individuals with current opioid use disorder (OUD). METHODS The study recruited a community-based sample of 357 individuals with OUD who used NPB in the past 6 months in Ohio, United States, for baseline and follow-up assessments (every 6 months for 2 years) of drug use, treatment participation, and other health and psychosocial characteristics. The study used multiple imputation to handle missing data. We used a multi-trajectory latent class growth analysis (MT-LCGA) to find salient groupings of participants based on the trajectories of NPB, other opioid use, and treatment participation. RESULTS Over time, NPB use frequency declined from a mean of 14.6 % of days at baseline to 3.6 % of days at 24-month follow-up along with declines in heroin/fentanyl (56.4 % to 23.6 % of days) and non-prescribed pharmaceutical opioid (NPPO) use (11.6 % to 1.5 % of days). Participation in MOUD treatment increased from a mean of 17.0 % of days at baseline to 52.4 % of days at 24 months. MT-LCGA identified a 6-class model. All six classes showed declines in NPB use. Class 1 (28 %) was characterized by high and increasing MOUD treatment utilization. Class 2 (21 %) showed sustained high levels of heroin/fentanyl use and had the lowest levels of NPB use (2.2 % of days) at baseline. Class 3 (3 %) was characterized as the primary NPPO use group. Class 4 (5 %) transitioned from high levels of NPB use to increased MOUD treatment utilization. It had the highest levels of NPB use at baseline (average of 80.7 % of days) that decreased to an average of 12.9 % of days at 24 months. Class 5 (16 %) showed transition from high levels of heroin/fentanyl use to increased MOUD treatment utilization. Class 6 (27 %) showed decreased heroin/fentanyl use over time and low MOUD treatment utilization. Classes showed varying levels of improvement in psychosocial functioning, polydrug use, and overdose risks. CONCLUSION Overall, our findings suggest that NPB use was generally self-limiting with individuals reducing their use over time as some engage in greater utilization of MOUD treatment. A need exists for continuing improvements in MOUD treatment access and retention.
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Affiliation(s)
- Raminta Daniulaityte
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America.
| | - Ramzi W Nahhas
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, United States of America
| | - Sydney Silverstein
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America
| | - Silvia Martins
- Department of Epidemiology Columbia University Mailman School of Public Health, United States of America
| | - Robert G Carlson
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America
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Toce MS, Michelson KA, Hudgins JD, Hadland SE, Olson KL, Monuteaux MC, Bourgeois FT. Association of Prescription Drug Monitoring Programs With Opioid Prescribing and Overdose in Adolescents and Young Adults. Ann Emerg Med 2023; 81:429-437. [PMID: 36669914 PMCID: PMC10091852 DOI: 10.1016/j.annemergmed.2022.11.003] [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: 09/12/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE Prescription opioid use is associated with substance-related adverse outcomes among adolescents and young adults through a pathway of prescribing, diversion and misuse, and addiction and overdose. Assessing the effect of current prescription drug monitoring programs (PDMPs) on opioid prescribing and overdoses will further inform strategies to reduce opioid-related harms. METHODS We performed interrupted time series analyses to measure the association between state-level implementation of PDMPs with annual opioid prescribing and opioid-related overdoses in adolescents (13 to 18 years) and young adults (19 to 25 years) between 2008 and 2019. We focused on PDMPs that included mandatory reviews by providers. Data were obtained from a commercial insurance company. RESULTS Among 9,344,504 adolescents and young adults, 1,405,382 (15.0%) had a dispensed opioid prescription, and 6,262 (0.1%) received treatment for an opioid-related overdose. Mandated PDMP review was associated with a 4.2% (95% CI, 1.9% to 6.4%) reduction in annual opioid dispensations among adolescents and a 7.8% (95% CI, 4.7% to 10.9%) annual reduction among young adults. For opioid-related overdoses, mandated PDMP review was associated with a 16.1% (95% CI, 3.8 to 26.7) and 15.9% (95% CI, 7.6 to 23.4) reduction in annual opioid overdoses for adolescents and young adults, respectively. CONCLUSION PDMPs were associated with sustained reductions in opioid prescribing and overdoses in adolescents and young adults. Although these findings support the value of mandated PDMPs as part of ongoing strategies to reduce opioid overdoses, further studies with prospective study designs are needed to characterize the effect of these programs fully.
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Affiliation(s)
- Michael S Toce
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Joel D Hudgins
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Scott E Hadland
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, MA
| | - Karen L Olson
- Department of Pediatrics, Harvard Medical School, Boston, MA; Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA
| | | | - Florence T Bourgeois
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA
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Reese TJ, Nelson SD, Marcovitz D, Shotwell M, Edwards DA, Wright A, Barrett TW. Evaluation of Compensatory Prescribing After Opioid-Restricting Legislation. J Gen Intern Med 2023; 38:1338-1340. [PMID: 36380174 PMCID: PMC10110774 DOI: 10.1007/s11606-022-07941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas J. Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, 37203 USA
| | - Scott D. Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, 37203 USA
| | - David Marcovitz
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - David A. Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, 37203 USA
| | - Tyler W. Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
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Bruzelius E, Cerdá M, Davis CS, Jent V, Wheeler-Martin K, Mauro CM, Crystal S, Keyes KM, Samples H, Hasin DS, Martins SS. Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 114:103980. [PMID: 36863285 PMCID: PMC11268161 DOI: 10.1016/j.drugpo.2023.103980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Naloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated. METHODS We examined relationships between naloxone access laws and pharmacy naloxone distribution with lifetime heroin and injection drug use (IDU), 2007-2019. Models generating adjusted odds ratios (aOR) and 95% confidence intervals (CI) included year and state fixed effects, controlled for demographics and sources of variation in opioid environments (e.g., fentanyl penetration), as well as additional policies expected to impact substance use (e.g., prescription drug monitoring). Exploratory and sensitivity analyses further examined naloxone law provisions (e.g., third-party prescribing) and applied e-value testing to assess vulnerability to unmeasured confounding. RESULTS Adoption of any naloxone law was not associated with changes in adolescent lifetime heroin or IDU. For pharmacy dispensing, we observed a small decrease in heroin use (aOR: 0.95 [CI: 0.92, 0.99]) and a small increase in IDU (aOR: 1.07 [CI: 1.02, 1.11]). Exploratory analyses of law provisions suggested that third-party prescribing (aOR: 0.80, [CI: 0.66, 0.96]) and non-patient-specific dispensing models (aOR: 0.78, [CI: 0.61, 0.99]) were associated with decreased heroin use but not decreased IDU. Small e-values associated with the pharmacy dispensing and provision estimates indicate that unmeasured confounding may explain observed findings. CONCLUSION Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.
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Affiliation(s)
- Emilie Bruzelius
- Columbia University, Department of Epidemiology, 722 W. 168th St. New York, NY, 10032, USA.
| | - Magdalena Cerdá
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4th Floor, New York, NY 10016, USA
| | - Corey S Davis
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4th Floor, New York, NY 10016, USA; Network for Public Health Law, 7101 York Avenue South, #270 Edina, MN 55435, USA
| | - Victoria Jent
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4th Floor, New York, NY 10016, USA
| | - Katherine Wheeler-Martin
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4th Floor, New York, NY 10016, USA
| | - Christine M Mauro
- Columbia University, Department of Biostatistics, 722 W. 168th St. New York, NY, 10032, USA
| | - Stephen Crystal
- Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA
| | - Katherine M Keyes
- Columbia University, Department of Epidemiology, 722 W. 168th St. New York, NY, 10032, USA
| | - Hillary Samples
- Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA
| | - Deborah S Hasin
- Columbia University, Department of Psychiatry, 722 W. 168th Street, Room 228F, New York, New York 10032, USA
| | - Silvia S Martins
- Columbia University, Department of Epidemiology, 722 W. 168th St. New York, NY, 10032, USA
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