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Andraka-Christou B, Golan O, Totaram R, Ohama M, Saloner B, Gordon AJ, Stein BD. Prior authorization restrictions on medications for opioid use disorder: trends in state laws from 2005 to 2019. Ann Med 2023; 55:514-520. [PMID: 36724766 PMCID: PMC9897778 DOI: 10.1080/07853890.2023.2171107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RESEARCH OBJECTIVE Medications for opioid use disorder (MOUDs) - including methadone, buprenorphine, and naltrexone - are the most effective treatments for opioid use disorder (OUD). Historically, insurers have required prior authorization for MOUD, but prior authorization is often reported as a key barrier to MOUD prescribing. Some states have passed laws prohibiting MOUD prior authorization requirements. We sought to identify the frequency of MOUD prior authorization prohibitions in state laws and to categorize types of prohibitions. METHODS We searched for regulations and statutes present in all U.S. states and Washington DC between 2005 and 2019 using MOUD-related terms in Westlaw legal software. In qualitative software, we coded laws discussing MOUD prior authorization using template analysis - a mixed deductive/inductive approach. Finally, we used coded laws to identify frequencies of states with prior authorization prohibitions, including changes over time. RESULTS No states had laws prohibiting MOUD prior authorization between 2005 and 2015, with the first prohibition appearing in 2016. By 2019, fifteen states had MOUD prior authorization prohibitions. States varied significantly in their approach to prohibiting MOUD prior authorization. In 2019, it was more common for states to have MOUD prior authorization prohibitions applying to all insurers (n = 10 states) than to only Medicaid (n = 7 states) or only non-Medicaid insurers (n = 1 state). In 2019, general prior authorization prohibitions (n = 10 states) were more common than prohibitions only applicable to medications on the formulary, prohibitions only applicable to medications on the preferred drug list, prohibitions only applicable during the first 5 days of treatment, and prohibitions only applicable during the first 30 days of treatment. CONCLUSIONS The number of states with an MOUD prior authorization law prohibition increased in recent years. Such laws could help expand access to life-saving OUD treatments by making it easier for clinicians to prescribe MOUD.KEY MESSAGESNo states had MOUD prior authorization prohibitions between 2005 and 2015 in state statutes or regulations, and only one state had such a prohibition in 2016.By 2019, fifteen states had an MOUD prior authorization prohibition law.States varied significantly in their approach to prohibiting MOUD prior authorization, including with respect to the insurer type, duration of the prohibition, and applicable medication.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA
- CONTACT Barbara Andraka-Christou School of Global Health Management and Informatics, University of Central Florida, 525 W Livingston Street, Suite 401, Orlando, 32801FL, USA
| | - Olivia Golan
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Rachel Totaram
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Maggie Ohama
- The Cardiac and Vascular Institute, Gainesville, FL, USA
| | - Brendan Saloner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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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 Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Andraka-Christou B, McAvoy E, Ohama M, Smart R, Vaiana ME, Taylor E, Stein BD. Systematic Identification and Categorization of Opioid Prescribing and Dispensing Policies in 16 States and Washington, DC. Pain Med 2023; 24:130-138. [PMID: 35984301 PMCID: PMC9890304 DOI: 10.1093/pm/pnac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/28/2022] [Accepted: 08/09/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES State policies can impact opioid prescribing or dispensing. Some state opioid policies have been widely examined in empirical studies, including prescription drug monitoring programs and pain clinic licensure requirements. Other relevant policies might exist that have received limited attention. Our objective was to identify and categorize a wide range of state policies that could affect opioid prescribing/dispensing. METHODS We used stratified random sampling to select 16 states and Washington, DC, for our sample. We collected state regulations and statutes effective during 2020 from each jurisdiction, using search terms related to opioids, pain management, and prescribing/dispensing. We then conducted qualitative template analysis of the data to identify and categorize policy categories. RESULTS We identified three dimensions of opioid prescribing/dispensing laws: the prescribing/dispensing rule, its applicability, and its disciplinary consequences. Policy categories of prescribing/dispensing rules included clinic licensure, staff credentials, evaluating the appropriateness of opioids, limiting the initiation of opioids, preventing the diversion or misuse of opioids, and enhancing patient safety. Policy categories related to applicability of the law included the pain type, substance type, practitioner, setting, payer, and prescribing situation. The disciplinary consequences dimension included specific consequences and inspection processes. DISCUSSION Policy categories within each dimension of opioid prescribing/dispensing laws could become a foundation for creating variables to support empirical analyses of policy effects, improving operationalization of policies in empirical studies, and helping to disentangle the effects of multiple state laws enacted at similar times to address the opioid crisis. Several of the policy categories we identified have been underexplored in previous empirical studies.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, Florida
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, Florida
| | - Elizabeth McAvoy
- School of Environmental and Public Affairs, Indiana University, Bloomington, Indiana
| | - Maggie Ohama
- The Cardiac and Vascular Institute, Gainesville, Florida
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Miyagi T, Itonaga H, Aosai F, Taguchi J, Norose K, Mochizuki K, Fujii H, Furumoto A, Ohama M, Karimata K, Yamanoha A, Taniguchi H, Sato S, Taira N, Moriuchi Y, Fukushima T, Masuzaki H, Miyazaki Y. Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature. Transpl Infect Dis 2015; 17:593-8. [PMID: 25970830 DOI: 10.1111/tid.12401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/31/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
Toxoplasmic encephalitis represents a rare, but often fatal infection after allogeneic hematopoietic stem cell transplantation. Polymerase chain reaction (PCR)-based preemptive therapy is considered promising for this disease, but is not routinely applied, especially in low seroprevalence countries including Japan. We encountered 2 cases of toxoplasmic encephalitis after transplantation that were successfully treated. The diagnosis of toxoplasmic encephalitis in these cases was confirmed by PCR testing when neurological symptoms were observed. Both patients received pyrimethamine and sulfadiazine treatments within 2 weeks of the development of neurological symptoms, and remained free of recurrence for 32 and 12 months. These results emphasized the importance of the PCR test and immediate treatment after diagnosis for the management of toxoplasmic encephalitis.
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Affiliation(s)
- T Miyagi
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - H Itonaga
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - F Aosai
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - J Taguchi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan
| | - K Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Mochizuki
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - H Fujii
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - A Furumoto
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - M Ohama
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - K Karimata
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - A Yamanoha
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - H Taniguchi
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - S Sato
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - N Taira
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - Y Moriuchi
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - T Fukushima
- Laboratory of Hematoimmunology, Department of Clinical Laboratory Sciences, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - H Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Y Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan
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Matsuo T, Maekawa T, Inaba A, Yamamuro O, Ohama M, Ichikawa M, Tsuchida T. Isotope-dependent crystalline phases at ambient temperature: Spectroscopic and calorimetric evidence for a deuteration-induced phase transition at 320K in α-DCrO2. J Mol Struct 2006. [DOI: 10.1016/j.molstruc.2005.11.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suemura N, Ohama M, Kaizaki S. Direct observation of light induced spin transitions in new 3,5-bis(2-pyridyl)pyrazolato bridged thiocyanato diiron(II) complexes by monitoring variable temperature laser Raman spectra. Chem Commun (Camb) 2001:1538-9. [PMID: 12240370 DOI: 10.1039/b104121p] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The light induced excited spin state trapping LIESST and the reverse LIESST-like phenomena are observed below and above the spin transition temperature, respectively, for new dinuclear diiron(II) complexes and familiar Fe(II) complexes with thiocyanate ligands by monitoring the Raman spectra where only excitation light of various wavelengths for the spectroscopy was used without extra excitation light sources.
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Affiliation(s)
- N Suemura
- Department of Chemistry, Graduate School of Science, Osaka University, Toyonaka, Osaka, 560-0043, Japan
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Matsumoto S, Fujiwara T, Ohama M, Ikushima AJ. Crystallization of GeO(2)-SiO(2) glass by poling with ArF-laser excitation. Opt Lett 1999; 24:1404-1406. [PMID: 18079816 DOI: 10.1364/ol.24.001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report on crystallization of 15.7GeO(2) 84.3SiO(2) (in mol.%) glass by poling with ArF-laser excitation. The UV intensity was 100(mJ/cm (2))/pulse , and the number of shots was 10(4) . The crystallites that were observed in the glass were approximately 15-20microm in diameter. The crystallization feature was dependent on the poling electric field, showing a threshold field of ~0.5x10(5)V/cm , beyond which crystallization occurred.
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Shingu H, Kimura I, Nasu Y, Shiotani A, Ohama M, Murata M, Fukuda F, Kayaoka M. [Injuries of the spine and the spinal cord in sports]. Nihon Seikeigeka Gakkai Zasshi 1996; 70:353-365. [PMID: 8797198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- H Shingu
- Department of Orthopaedic Surgery, San-in Rosai Hospital
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Shingu H, Ohama M, Ikata T, Katoh S, Akatsu T. A nationwide epidemiological survey of spinal cord injuries in Japan from January 1990 to December 1992. Paraplegia 1995; 33:183-8. [PMID: 7609973 DOI: 10.1038/sc.1995.42] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This survey of traumatic spinal cord injuries in Japan from January 1990 to December 1992 was carried out by a statistical method of the nationwide epidemiological study. The number of the registered patients during these 3 years was 9752 and the mean response rate of every of the 47 prefectures was 51.4%. The registered patients with neurological deficits (Frankel A-D) were 7471 and the annual spinal cord injury incidence was 40.2 per million. The ratio of cervical cord injuries to more caudal SCI was 3:1. The age distribution and the causes of spinal cord injuries are presented in detail. From the results of this study, the prevention campaign should be focused mainly on the following topics: sports and motorcycle accidents involving young people; traffic accidents involving adults; falling accidents involving aged people.
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Affiliation(s)
- H Shingu
- Prevention Committee of Japan Medical Society of Paraplegia, Department of Orthopaedic Surgery, San-in Rosai Hospital, Yonago
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Tsunoda A, Yamada R, Ohama M. [Esophageal atresia: management and postoperative gastroesophageal reflux]. Rinsho Kyobu Geka 1981; 1:181-188. [PMID: 7052588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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