Early evidence suggests that opioid duration limits had a variable association with postoperative opioid prescribing and should only be part of a larger, multifaceted effort to reduce excessive postoperative opioid prescribing.
This review reveals a growing literature on the effects of certain state opioid misuse prevention policies, but persistent gaps in evidence on other prevalent state policies remain.
State-level prescription drug monitoring programs that incorporate robust design features can significantly reduce the proportion of commercially insured adults who receive opioid prescriptions as well as the strength of those prescriptions.
We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk.
Developing and using a state-level opioid policy can facilitate the design and implementation of more effective state-level policies-an essential tool in addressing the opioid crisis.
State policies that impose punitive action against pregnant women who use illicit substances are associated with higher rates of infants being born with opioid withdrawal.
Administration of naloxone by emergency medical services personnel is increasing faster than opioid-related deaths.
Although many states have passed some type of law affecting naloxone availability, only laws allowing direct dispensing by pharmacists appear to be useful. Communities in which access to naloxone is improved should prepare for increases in nonfatal overdoses and link these individuals to effective treatment.
Implementation of a prescription drug monitoring program in 10 states was associated with a reduction in overall volume of opioid drugs prescribed.
The growing use of medication treatment for opioid use disorder in the West Virginia Medicaid expansion population provides an opportunity to reduce overdose deaths.
States that provide legal access to marijuana through dispensaries experience lower treatment admissions for addiction to pain medication.
This analysis of the dependent coverage expansion under the ACA suggests that historical trends rather than the insurance expansion itself account for increases in substance use among people ages 19-25 since 2010.
Testimony presented before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on April 5, 2017.
Uses the introduction of the Medicare Prescription Drug Benefit Program (Part D) to explore how increasing medical access to opioids contributes to the opioid epidemic.
Increasing the number of physicians who can prescribe buprenorphine for opioid abuse and supporting their ability to treat more patients may be the fastest approach to enhancing capacity for treatment, particularly in less populated counties.
This study examines the evolution of states' coverage and policies with respect to opioid agonist therapy and present an overview of the Medicaid policy environment from 2004 to 2013.
The authors calculated the number of buprenorphine-waivered physicians and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents as a function of county characteristics, state policies and efforts to promote buprenorphine use.
This study found an increase in the rate of overdose after Medicare Part D coverage began to include benzodiazepines among adults aged 65 to 69 years and 80 years or older and an increase in the rate of fall-related injury in adults 80 years or older.
The COVID-19 pandemic strikes at a moment when our national response to the opioid crisis was beginning to coalesce. COVID-19 threatens to dramatically overshadow and reverse this progress.
Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4%,18.7%, and 20.2%, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.
This article explores variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.
We conducted a scoping study to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address public health research questions.
This analysis found a significant association among higher long-term unemployment, higher mental health clinician shortage areas, and higher county-level rates of neonatal abstinence syndrome.
Although many states have passed some type of law affecting naloxone availability, only laws allowing direct dispensing by pharmacists appear to be useful. Communities in which access to naloxone is improved should prepare for increases in nonfatal overdoses and link these individuals to effective treatment.
Administration of naloxone by emergency medical services personnel is increasing faster than opioid-related deaths.
This analysis of the dependent coverage expansion under the ACA suggests that historical trends rather than the insurance expansion itself account for increases in substance use among people ages 19-25 since 2010.
New opioid prescriptions decreased among higher-risk patients who used benzodiazepines from 2010 to 2015, suggesting that the rapid increase in opioid-related deaths is primarily associated with factors other than physicians writing new opioid prescriptions.
Older age was the strongest predictor of undergoing potentially inappropriate prescribing (PIP) among individuals who were prescribed opioids. PIP was also associated with risk of adverse outcomes in both older and younger adults.
While any opioid prescription carries some risk, a subset of prescriptions is particularly risky: identifying potentially inappropriate prescribing (PIP) through state-level online prescription monitoring programs could help reduce PIP.
Among Medicaid recipients, high-risk prescribing of opioids occurred in 39.4% of episodes. Four characteristics -- older age, rural county of residence, white race, and major depression diagnosis -- were associated with higher rates of all types of high-risk prescribing.
Uses the introduction of the Medicare Prescription Drug Benefit Program (Part D) to explore how increasing medical access to opioids contributes to the opioid epidemic.
This web-based tool aims to inform policymakers about the rates of neonatal abstinence syndrome by county across eight states from 2009 to 2015. This analysis is displayed via maps and interactive charts.
Newborns exposed to opioids before birth can experience withdrawal symptoms known as neonatal abstinence syndrome (NAS). From 2009 to 2015, the average NAS rate per 1,000 hospital births across eight states rose from about six to more than 25.
This analysis found a significant association among higher long-term unemployment, higher mental health clinician shortage areas, and higher county-level rates of neonatal abstinence syndrome.
Older age was the strongest predictor of undergoing potentially inappropriate prescribing (PIP) among individuals who were prescribed opioids. PIP was also associated with risk of adverse outcomes in both older and younger adults.
Most buprenorphine prescribers treat many fewer patients than allowed by the current patient limit. Increasing the limit above 100 would likely improve access only for patients of a few high prescribers.
We conducted a scoping study to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address public health research questions.
Results suggest that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.
In dealing with the opioid crisis, supply-side policies that consider the full market (both prescription opioids as well as heroin and fentanyl), if coupled with effective treatment, are likely to be the most effective.
This paper reports estimates of the price elasticity of demand for heroin based on a newly constructed dataset.
How legalizing marijuana would affect consumption and tax revenues will depend on many design choices including tax level, incentives for a continued black market, whether advertising is restricted, and how the regulatory system is designed and adjusted.
The 2010 reformulation of Oxycontin to prevent abuse of the drug (by making it crush-proof and therefore impossible to dissolve in liquid) had the unintended effect of driving some users to switch to heroin, which contributed to a dramatic rise in Hepatitis C.
This study found an increase in the rate of overdose after Medicare Part D coverage began to include benzodiazepines among adults aged 65 to 69 years and 80 years or older and an increase in the rate of fall-related injury in adults 80 years or older.
Early evidence suggests that opioid duration limits had a variable association with postoperative opioid prescribing and should only be part of a larger, multifaceted effort to reduce excessive postoperative opioid prescribing.
State-level prescription drug monitoring programs that incorporate robust design features can significantly reduce the proportion of commercially insured adults who receive opioid prescriptions as well as the strength of those prescriptions.
Results demonstrating heterogeneity in prescription opioid misuse characteristics across age groups highlight the need for a diverse range of clinical and policy responses.
We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk.
This article explores variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.
We conducted a scoping study to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address public health research questions.
Among Medicaid recipients, high-risk prescribing of opioids occurred in 39.4% of episodes. Four characteristics -- older age, rural county of residence, white race, and major depression diagnosis -- were associated with higher rates of all types of high-risk prescribing.
Implementation of a prescription drug monitoring program in 10 states was associated with a reduction in overall volume of opioid drugs prescribed.
Morphine equivalent daily dose thresholds are a promising policy tool, but there is a lack of consensus about how to use the thresholds and what the threshold level should be.
New opioid prescriptions decreased among higher-risk patients who used benzodiazepines from 2010 to 2015, suggesting that the rapid increase in opioid-related deaths is primarily associated with factors other than physicians writing new opioid prescriptions.
This report highlights key research questions and identifies opportunities to use existing data sources and implement data-linking strategies that can support the HHS five point strategy to combat the opioid crisis.
Older age was the strongest predictor of undergoing potentially inappropriate prescribing (PIP) among individuals who were prescribed opioids. PIP was also associated with risk of adverse outcomes in both older and younger adults.
States that provide legal access to marijuana through dispensaries experience lower treatment admissions for addiction to pain medication.
While any opioid prescription carries some risk, a subset of prescriptions is particularly risky: identifying potentially inappropriate prescribing (PIP) through state-level online prescription monitoring programs could help reduce PIP.
Among Medicaid recipients, high-risk prescribing of opioids occurred in 39.4% of episodes. Four characteristics -- older age, rural county of residence, white race, and major depression diagnosis -- were associated with higher rates of all types of high-risk prescribing.
A substantial number of Medicaid enrollees were able to fill prescriptions for opioid analgesics, benzodiazepines, or both in the year following diagnosis for an opioid use disorder.
Uses the introduction of the Medicare Prescription Drug Benefit Program (Part D) to explore how increasing medical access to opioids contributes to the opioid epidemic.
The COVID-19 pandemic strikes at a moment when our national response to the opioid crisis was beginning to coalesce. COVID-19 threatens to dramatically overshadow and reverse this progress.
In the profitable buprenorphine market, pharmaceutical manufacturer Reckitt Benckiser exploited various Food and Drug Administration regulatory procedures to impede entry of generic competitors and maintain elevated prices.
In this article, the authors use the case of Suboxone to demonstrate egregious anti-competitive practices that delay generic entry, estimate the costs of these delays to the public, and suggest legislative and regulatory reforms to prevent these practices going forward.
This study sheds light on the distribution of buprenorphine-waivered prescribers over the past decade. Growth has been rapid in communities affected by the opioid crisis, but slower in rural communities, and those with lower levels of education.
We conducted a scoping study to identify data sources and linking strategies commonly used in opioid studies, describe data source strengths and limitations, and highlight opportunities to use data to address public health research questions.
State policies that impose punitive action against pregnant women who use illicit substances are associated with higher rates of infants being born with opioid withdrawal.
In the six jurisdictions with the highest rate of opioid-related mortality in 2016, the most prominent barrier to accessing buprenorphine treatment was the difficulty of finding clinicians.
The number of Medicaid recipients receiving medication to treat opioid abuse increased sharply in the years after approval of a new drug, but the increase was smaller in poorer counties and areas with larger populations of black and Hispanic residents.
Most buprenorphine prescribers treat many fewer patients than allowed by the current patient limit. Increasing the limit above 100 would likely improve access only for patients of a few high prescribers.
The growing use of medication treatment for opioid use disorder in the West Virginia Medicaid expansion population provides an opportunity to reduce overdose deaths.
Fewer than 10% of West Virginia Medicaid enrollees received medication for opioid use disorder after a non-fatal overdose, making it an opportunity to increase treatment for opioid use disorder and co-occurring mental health conditions.
The number of Medicaid recipients receiving medication to treat opioid abuse increased sharply in the years after approval of a new drug, but the increase was smaller in poorer counties and areas with larger populations of black and Hispanic residents.
Most buprenorphine prescribers treat many fewer patients than allowed by the current patient limit. Increasing the limit above 100 would likely improve access only for patients of a few high prescribers.
Three possible measures for quality of care may help reduce deaths from opioid addiction by one-third.
Many physicians who prescribe buprenorphine are prescribing below the patient limits historically allowed under U.S. law.
Increasing the number of physicians who can prescribe buprenorphine for opioid abuse and supporting their ability to treat more patients may be the fastest approach to enhancing capacity for treatment, particularly in less populated counties.
This study examines the evolution of states' coverage and policies with respect to opioid agonist therapy and present an overview of the Medicaid policy environment from 2004 to 2013.
Opioid use disorders are a significant public health problem.
Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing.
The authors developed an updated and expanded set of buprenorphine treatment guidelines; this additional guidance may increase credentialed physicians' comfort with prescribing buprenorphine to patients with opioid use disorders.
The authors calculated the number of buprenorphine-waivered physicians and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents as a function of county characteristics, state policies and efforts to promote buprenorphine use.
Guidance on how to prevent or treat the misuse of prescription drugs in the U.S. Department of Defense and Veterans Administration is similar to directives outside the military system, and tends to focus on opioids.
This report presents the framework of an analytic tool that can help the military predict future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs.
