This qualitative study used the ExpertLens online platform to conduct a 3-round modified Delphi process to examine expert consensus on the effectiveness and the ability to implement state-level OUD treatment policies.
This qualitative study conducted a three-round modified-Delphi process using the online ExpertLens platform. Researchers identified and summarized the views of experts on state-level naloxone access laws.
This study gathered expert consensus on the effectiveness and implementability of various state-level naloxone strategies.
This study examined how PDMPs, pain clinic laws, and prescribing limit laws have influenced several types of high-risk opioid prescribing, focusing on initial high-risk opioid prescriptions for individuals not routinely taking opioids.
Researchers used Medicaid claims during the period 2006–2013 to investigate the relationship between buprenorphine prior authorization requirements and changes in treatment in the years following policy implementation.
This study reports on the results of a qualitative analysis that identified and categorized state medications for opioid use disorder related statutes and regulations in a stratified random sample of 16 states and Washington D.C.
This cross-sectional study used pharmacy claims to examine the association of state policies with the odds of receiving buprenorphine treatment from a nurse practitioner or physician assistant versus a physician.
Researchers conducted an extensive simulation study to compare the statistical performance of commonly used methods for evaluating state-level opioid policies, including popular difference-in-differences methods.
The existing literature on naloxone access laws in the United States supports beneficial effects for increased naloxone distribution, but provides inconclusive evidence for reduced fatal opioid overdose.
The rigor of study design varies notably across policy categories, highlighting the need for broader adoption of rigorous methods in opioid policy research.
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.
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.
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.
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.
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.
Researchers analyzed data to determine what proportion of the national population had local geographic availability to a licensed SUD treatment facility that accepted Medicare, Medicaid, private insurance, or cash.
This study used a decade of data from U.S. counties to examine how rates of neonatal opioid withdrawal syndrome (NOWS) and county-level characteristics were associated with entry in the child welfare system.
This study examined receipt of services for mental health conditions and non-opioid substance use disorders among privately insured adolescents and young adults (ie, youth) with subsequent clinically diagnosed opioid use disorder or opioid poisoning.
In this Perspective, we describe three strategies hospitals can use to multiply the reach of their opioid settlement funding by addressing root causes of opioid use through primary prevention.
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.
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.
The national growth in opioid supply explains 75% of the national rise in opioid treatment admissions and the diversion component is a critical driver of the opioid epidemic.
This article explores variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.
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.
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.
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.
The growing use of medication treatment for opioid use disorder in the West Virginia Medicaid expansion population provides an opportunity to reduce overdose deaths.
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.
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.
States that provide legal access to marijuana through dispensaries experience lower treatment admissions for addiction to pain medication.
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.
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.
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.
The findings suggest that the out-of-pocket cost of naloxone has been an increasingly substantial barrier to naloxone access for uninsured patients, a population that constitutes nearly one-fifth of adults with opioid use disorder.
In this paper, we examine the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis.
In this paper, we find that over a longer time horizon, OxyContin reformulation stimulated illicit drug markets to grow and evolve.
Researchers examined how increased use of illicit opioids such as heroin and fentanyl affected labor market participation and claims for disability insurance.
We compared relative prevalences across 6 racial/ethnic groups for prescription opioid misuse analyses and 4 racial/ethnic groups for heroin analyses.
This paper stems from recent research into understanding the past, present and possible futures of synthetic opioids in North America and beyond.
The national growth in opioid supply explains 75% of the national rise in opioid treatment admissions and the diversion component is a critical driver of the opioid epidemic.
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.
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.
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.
This study used a decade of data from U.S. counties to examine how rates of neonatal opioid withdrawal syndrome (NOWS) and county-level characteristics were associated with entry in the child welfare system.
In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
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 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.
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.
This qualitative study used the ExpertLens online platform to conduct a 3-round modified Delphi process to examine expert consensus on the effectiveness and the ability to implement state-level OUD treatment policies.
This qualitative study conducted a three-round modified-Delphi process using the online ExpertLens platform. Researchers identified and summarized the views of experts on state-level naloxone access laws.
This study gathered expert consensus on the effectiveness and implementability of various state-level naloxone strategies.
Researchers conducted an extensive simulation study to compare the statistical performance of commonly used methods for evaluating state-level opioid policies, including popular difference-in-differences methods.
The rigor of study design varies notably across policy categories, highlighting the need for broader adoption of rigorous methods in opioid policy research.
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.
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 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.
The findings suggest that the out-of-pocket cost of naloxone has been an increasingly substantial barrier to naloxone access for uninsured patients, a population that constitutes nearly one-fifth of adults with opioid use disorder.
This study gathered expert consensus on the effectiveness and implementability of various state-level naloxone strategies.
This qualitative study conducted a three-round modified-Delphi process using the online ExpertLens platform. Researchers identified and summarized the views of experts on state-level naloxone access laws.
This retrospective analysis examines filled naloxone prescriptions among patients receiving buprenorphine treatment and assesses how rates of filled naloxone prescriptions varies by patient, prescriber, and community characteristics.
The existing literature on naloxone access laws in the United States supports beneficial effects for increased naloxone distribution, but provides inconclusive evidence for reduced fatal opioid overdose.
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.
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 article explores variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.
Individuals with a history of depression who received opioid analgesics had a significantly lower risk for overdose and self-harm after they had been taking antidepressants for at least 6 weeks.
In this Perspective, we describe three strategies hospitals can use to multiply the reach of their opioid settlement funding by addressing root causes of opioid use through primary prevention.
We reviewed medical literature for recent studies that use claims data to construct opioid utilization measures, then developed a guide for researchers regarding opioid utilization measures and measure definitions, and how these may influence study results.
This retrospective analysis examines naloxone co-prescribing in the general population and assess how co-prescribing varies by individual and community characteristics.
A small share of prescription opioid users account for a large percent of total prescription opioid use.
The national growth in opioid supply explains 75% of the national rise in opioid treatment admissions and the diversion component is a critical driver of the opioid epidemic.
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.
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.
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 work provides a foundation for evaluation of morphine equivalent daily dose policies and may inform states considering adopting such policies.
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.
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.
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.
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.
Implementation of a prescription drug monitoring program in 10 states was associated with a reduction in overall volume of opioid drugs prescribed.
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.
This study examined the rates of subsequent buprenorphine treatment for buprenorphine-naïve individuals filling buprenorphine prescriptions from emergency physicians and initiated buprenorphine treatment and how such rates varied before and during the COVID-19 pandemic.
Researchers examined IQVIA Longitudinal Prescription Claims data and assessed predictors of buprenorphine discontinuation in the early months of the COVID-19 pandemic (April–July 2020) compared with a pre-pandemic period (April–July 2019).
This study reports on the results of a qualitative analysis that identified and categorized state medications for opioid use disorder related statutes and regulations in a stratified random sample of 16 states and Washington D.C.
This cross-sectional study found that the per capita supply of methadone declined significantly in the second quarter of 2020 and had not returned to 2019 levels as of June 2021. The per capita supply of buprenorphine increased during the same period.
This cross-sectional study used pharmacy claims to examine the association of state policies with the odds of receiving buprenorphine treatment from a nurse practitioner or physician assistant versus a physician.
This study of state laws governing buprenorphine prescribing found that these vary; nurse practitioner and physician assistant supervision should include state non-scope of practice laws.
This retrospective analysis examines filled naloxone prescriptions among patients receiving buprenorphine treatment and assesses how rates of filled naloxone prescriptions varies by patient, prescriber, and community characteristics.
Researchers summarize the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy during COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication.
This study examined changes in the use of buprenorphine to treat opioid use disorder in 2020 during the onset of the COVID-19 pandemic using pharmaceutical claims.
This cross-sectional study of substance use disorder treatment facilities examined the national share of facilities that offer medication treatment for opioid use disorder (MOUD) and population-based measures of geographic accessibility of facilities offering MOUD.
This study examined weekly changes in the number of substance use disorder treatment facility visits in 2020 compared to 2019, and explored variation in change in weekly visits by COVID-19 incidence and historical fatal drug overdose rate.
We examine buprenorphine-prescribing clinicians' patient caseloads over time and explore prescriber characteristics associated with different caseload trajectories.
Drawing on national retail pharmacy data, researchers identified and categorized clinicians who prescribed buprenorphine for OUD at least once between January 2017 and December 2018.
We find ecological evidence consistent with racial/ethnic disparities in buprenorphine distribution. Our finding that initiatives to increase the number of waivered prescribers are insufficient to achieve equitable buprenorphine access.
States have made significant policy changes to SUD treatment policies during COVID-19, particularly regarding telehealth and facilitation of remote care. Understanding these changes could help policymakers prioritize guidance during the pandemic and for future health crises.
Buprenorphine is a gold standard treatment for opioid use disorder. Some states have passed laws regulating office-based buprenorphine treatment, with requirements beyond those required in federal law. This study identified themes in state laws.
Retail buprenorphine sales for opioid addiction plateau during COVID-19 pandemic amidst sharp declines in total prescription sales.
This study aimed to quantify the availability of telehealth services at substance use treatment facilities in the U.S. at the beginning of the COVID-19 pandemic, and determine whether telehealth is available at facilities in counties with the greatest amount of social distancing. Relatively few substance use treatment facilities offered telehealth services at the onset of the COVID-19 pandemic. Policymakers and public health officials should do more to support facilities in offering telehealth services.
This cross-sectional study examines the number of patients prescribed buprenorphine by waivered-clinicians. Evidence shows waivered-clinicians who are able to prescribe buprenorphine treat fewer patients than their limit allows. With so much unmet demand for OUD treatment, this suggests the need for ongoing efforts to address treatment barriers.
In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
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.
The growing use of medication treatment for opioid use disorder in the West Virginia Medicaid expansion population provides an opportunity to reduce overdose deaths.
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.
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.
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.
Three possible measures for quality of care may help reduce deaths from opioid addiction by one-third.
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.
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.
