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Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [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: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Green VR, Kennedy-Hendricks A, Saloner B, Bandara S. Substance use and treatment characteristics among pregnant and non-pregnant females, 2015-2019. Drug Alcohol Depend 2024; 254:111041. [PMID: 38043227 DOI: 10.1016/j.drugalcdep.2023.111041] [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: 07/03/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant. METHODS Our sample included females aged 15-44 years (n=97,830) from the 2015-2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different. RESULTS Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer. DISCUSSION The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015-2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.
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Affiliation(s)
- Victoria R Green
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Alene Kennedy-Hendricks
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Berglas NF, Subbaraman MS, Thomas S, Roberts SCM. Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. Alcohol Alcohol 2023; 58:645-652. [PMID: 37623929 PMCID: PMC10642603 DOI: 10.1093/alcalc/agad056] [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] [Received: 02/03/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
AIMS We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. METHODS We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. RESULTS When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. CONCLUSIONS Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
| | | | - Sue Thomas
- Pacific Institute for Research and Evaluation, PO Box 7042, Santa Cruz, CA 96061, United States
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States
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Cooper HLF, Rice W, Cummings J, Livingston MD, Peddireddy S, Rogers E, Dunlop A, Kramer M, Hernandez ND. Overdoses, Reproductive Justice, and Harm Reduction. Am J Public Health 2023; 113:933-935. [PMID: 37556788 PMCID: PMC10413743 DOI: 10.2105/ajph.2023.307379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Hannah L F Cooper
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Whitney Rice
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Janet Cummings
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Melvin D Livingston
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Snigdha Peddireddy
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Erin Rogers
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Anne Dunlop
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Michael Kramer
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Natalie D Hernandez
- Hannah L. F. Cooper, Whitney Rice, Melvin D. Livingston, and Snigdha Peddireddy are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Janet Cummings is with the Department of Health Policy and Management, Rollins School of Public Health. Erin Rogers and Michael Kramer are with the Department of Epidemiology, Rollins School of Public Health. Anne Dunlop is with the Department of Obstetrics and Gynecology, School of Medicine, Emory University. Natalie D. Hernandez is with the Center for Maternal Health Equity Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
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McCOURT ALEXANDERD, WHITE SARAHA, BANDARA SACHINI, SCHALL THEO, GOODMAN DAISYJ, PATEL ESITA, McGINTY EMMAE. Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy. Milbank Q 2022; 100:1076-1120. [PMID: 36510665 PMCID: PMC9836249 DOI: 10.1111/1468-0009.12591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022] Open
Abstract
Policy Points Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. Using legal mapping and qualitative interviews, we examine the development of state child welfare laws related to substance use in pregnancy from 1974 to 2019, with a particular focus on laws adopted between 2009 and 2019. Our findings reveal policies that may disincentivize treatment-seeking and widespread implementation challenges, suggesting a need for new treatment-oriented policies and refined state and federal guidance. CONTEXT Amid increasing drug use among pregnant individuals, legislators have pursued policies intended to reduce substance use during pregnancy. Many states have utilized child welfare mechanisms despite evidence that these policies might disincentivize treatment-seeking. Recent federal changes were intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation. METHODS We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture state-level perspectives on policy implementation. FINDINGS Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners. CONCLUSIONS Many states have enacted laws that may disincentivize treatment-seeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance.
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Affiliation(s)
- ALEXANDER D. McCOURT
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - SARAH A. WHITE
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - SACHINI BANDARA
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - THEO SCHALL
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - DAISY J. GOODMAN
- Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical PracticeHanoverNew HampshireUnited States
| | - ESITA PATEL
- Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUnited States
| | - EMMA E. McGINTY
- Division of Health Policy and EconomicsDepartment of Population Health SciencesWeill Cornell MedicineNew York, New YorkUnited States
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Roberts SCM, Raifman S, Biggs MA. Relationship between mandatory warning signs for cannabis use during pregnancy policies and birth outcomes in the Western United States. Prev Med 2022; 164:107297. [PMID: 36228875 PMCID: PMC9762150 DOI: 10.1016/j.ypmed.2022.107297] [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: 07/14/2022] [Revised: 09/01/2022] [Accepted: 10/04/2022] [Indexed: 10/31/2022]
Abstract
As U.S. states legalize recreational cannabis, some enact policies requiring Mandatory Warning Signs for cannabis during pregnancy (MWS-cannabis). While previous research has found MWS for alcohol during pregnancy (MWS-alcohol) associated with increases in adverse birth outcomes, research has not examined effects of MWS-cannabis. This study uses Vital Statistics birth certificate data from June 2015 - June 2017 in seven western states and policy data from NIAAA's Alcohol Policy Information System and takes advantage of the quasi-experiment created by Washington State's enactment of MWS-cannabis in June 2016, while nearby states did not. Outcomes are birthweight, low birthweight, gestation, and preterm birth. Analyses use a Difference-in-Difference approach and compare changes in outcomes in Washington to nearby states in the process of legalizing recreational cannabis (Alaska, California, Nevada) and, as a secondary analysis, nearby states continuing to criminalize recreational cannabis (Idaho, Montana, Wyoming). Birthweight was -7.03 g lower (95% CI -10.06, -4.00) and low birthweight 0.3% higher (95% CI 0.0, 0.6) when pregnant people were exposed to MWS-cannabis than when pregnant people were not exposed to MWS-cannabis, both statistically significant (p = 0.005 and p = 0.041). Patterns for gestation, -0.014 weeks earlier (95% CI -0.038, 0.010) and preterm birth 0.2% higher (95% CI -0.2, 0.7), were similar, although not statistically significant (p = 0.168 and 0.202). The direction of findings was similar in secondary analyses, although statistical significance varied. Similar to MWS-alcohol, enacting MWS-cannabis is associated with an increase in adverse birth outcomes. The idea that MWS-cannabis provide a public health benefit is not evidence-based.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America.
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States of America
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