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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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Dayan-Rosenman D, Spencer S. Implementation of Medications for Alcohol and Opioid Use Disorders in a Value-Based Organization-Unlocking Value by Addressing Unmet Needs for Medicaid and Dually-Eligible Beneficiaries. Popul Health Manag 2024. [PMID: 38800941 DOI: 10.1089/pop.2024.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
The authors describe a rapid implementation of medication treatment for substance use disorders in a value-based organization, delivered in the community-based, interdisciplinary primary care of Medicaid and dual-eligible members. The determinants of increased need are reviewed, as well as the growing opportunity to improve access to treatments, and a template for implementation is shared.
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Affiliation(s)
- David Dayan-Rosenman
- Cityblock Health, Brooklyn, New York, USA
- Periscope Clinical Analytics LLC, Brookline, Massachusetts, USA
| | - Steven Spencer
- Cityblock Health, Brooklyn, New York, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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McPherson SM, Smith CL, Hall L, Miguel AQ, Bowden T, Keever A, Schmidt A, Olson K, Rodin N, McDonell MG, Roll JM, LeBrun J. Mobile Medication Adherence Platform for Buprenorphine (MAP4BUP): A Phase I feasibility, usability and efficacy pilot randomized clinical trial. Drug Alcohol Depend 2024; 256:111099. [PMID: 38306822 PMCID: PMC10923156 DOI: 10.1016/j.drugalcdep.2024.111099] [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: 05/29/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM Poor medication adherence is one of the main barriers to the long-term efficacy of buprenorphine/naloxone (BUP/NAL). The aims of this pilot investigation were to examine if a Bluetooth-enabled pill cap and mobile application is a feasible, usable tool for increasing BUP/NAL adherence among people with an opioid use disorder. METHODS This pilot randomized clinical trial (RCT; total n = 41) lasted 12 weeks and was conducted in two office-based BUP/NAL provider locations in Spokane, WA and Coeur d'Alene, ID from January 2020 to September of 2021 with an 11-month gap due to COVID-19. Patients receiving BUP/NAL who consented to participate were randomized to receive the pill cap device (PLY group; n = 19) or a service as usual (SAU group; n = 22) group that included an identical but inactive cap for their bottle. The PLY group received reminders via text and voice, and the support of a "helper" (e.g., friend) to monitor pill cap openings. RESULTS Most participants in PLY group found the device both feasible (92.86 %) and usable (78.57 %). Most participants liked using the device (92.86 %) and were satisfied with the device (85.71 %). While not statistically different from one another, medication adherence per the Medication Possession Ratio was 75 % in the SAU group and 84 % in the PLY group. Pill cap openings were significantly higher in the PLY group with an average of 91.8 openings versus the SAU group's average of 56.7 (p < 0.05). CONCLUSION The devices was feasible, usable, and patients had high levels of satisfaction. The device was associated with increased pill openings.
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Affiliation(s)
- Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States.
| | - Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Luke Hall
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - André Q Miguel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Theresa Bowden
- Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States; College of Nursing, Washington State University, Spokane, WA, United States
| | - Abigail Keever
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Alex Schmidt
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | | | - Nicole Rodin
- Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States; College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addiction Research (PEAR), Washington State University, Spokane, WA, United States
| | - Jeff LeBrun
- Optimize Health, 5601 22nd Ave NW #200, Seattle, WA, United States
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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