Opioids and Substance Use Disorders: What's New
Notice of Funding Opportunity Announcement
On 2.10.23, AHRQ released a NOFO for the Management of Substance Use Disorders in Primary Care and other Ambulatory Settings (R18). The proposed Notice of Funding Opportunity (NOFO) announcement uses the R18 mechanism to support projects that develop and test strategies to improve the capacity of primary care and ambulatory settings to provide evidence-based, patient-centered care for people who misuse opioids and other substances. AHRQ is interested in projects that build on recent research on effective treatments and effective models of care and that lead to sustainable changes in how substance use disorder (SUD) care is delivered in primary care and/or develop lasting partnerships between primary care and other care settings. Applications are due April 14, 2023.
MAT and Ongoing Treatment Linked to Lower Costs
Total Cost of Care Associated With Opioid Use Disorder Treatment, a retrospective study among adult patients diagnosed with opioid use disorder (OUD), co-authored by Mohammad Usama Toseef and colleagues, found that patients with OUD who initiated medication treatment but were not linked to ongoing care had the highest healthcare costs, while those who received medication treatment for OUD and were linked to ongoing treatment had the lowest costs. December 2022
AHRQ SUD Presentations at the 15th Annual Conference on the Science of Dissemination and Implementation in Health, December 12-14, 2022
- Implementation of Opioid Prescribing and Management Strategies for Older Adults in Primary Care: Preliminary Findings from the AHRQ Opioids in Older Adults Learning Collaborative.
- Electronic Health Records (EHRs) Used by Small to Medium Primary Care Practices: Do They Include Elements Required to Support Evidence-Based Primary Care for Unhealthy Alcohol Use?
Centers for Disease Control and Prevention Releases the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline) is now available in the Morbidity and Mortality Weekly Report (MMWR), published on November 3, 2022. The publication updates and replaces the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. CDC also released a suite of tools and resources to help patients and clinicians understand and use the recommendations in the new Guideline in their pain care decision making.November 2022
Analysis of the Impact of ACA Insurance Expansion on Opioid-Related ED Visits
“The Impact of the Affordable Care Act (ACA) Insurance Expansions on Opioid-Related Emergency Department Visits,” co-authored by Sandy Decker, Michael Dworsky (RAND), and Teresa Gibson, Rachel Henke, and Kimberly McDermott (IBM Health) in the American Journal of Health Economics. This study examines the impact of ACA coverage expansions (including Medicaid expansion and Marketplaces) on opioid-related emergency department (ED) visits while accounting for potentially confounding changes in relevant state-level policies. The study found that areas with higher uninsurance rates prior to the ACA saw larger reductions in opioid-related ED visits after the ACA took effect. Effects were also time-varying, with no significant dose-response relationship emerging until the third year of ACA implementation. These estimates suggest that increasing insurance coverage among the uninsured may help mitigate harms of the opioid crisis. October 2022
American Society of Addiction Medicine 4th Edition Available for Public Comment
The American Society of Addiction Medicine (ASAM) Criteria are national standards for addiction treatment including:
- Assessment and treatment planning.
- The levels of care that should be available within the treatment system (i.e., the Continuum of Care).
- The service characteristics for each level of care (e.g., staffing, support systems, services, etc.).
- Determining what level of care should be recommended for a given patient.
ASAM has posted the draft 4th edition standards for public comment and will be accepting public comment through an online submission form until COB Friday, November 11, 2022. Please note that comments may be made public. October 2022.
Older Opioid Patients Experience More Adverse Events After Injury
Chronic non-cancer pain Medicare patients with new opioid prescriptions who experience an injury--such as a fall or traumatic brain injury--have a 1.4 times greater risk of future opioid-related adverse events than those patients who did not experience an injury. According to an AHRQ-funded review in PLOS Medicine, the risk was highest in the 30 days before an adverse event. The findings indicated that identifying injuries that emerge after opioid initiation may assist in the early detection of older patients at high risk for adverse events such as overdoses. July 2022
Management of Pain and Opioids in Older Adults: Study Protocol Published
The study protocol for the I-COPE (Improving Chicago Older Adult Opioid and Pain Management Through Patient-Centered Clinical Decision Support and Project ECHO®) study has published in Trials. This study will provide evidence about the effectiveness of collecting patient-reported data on symptoms and treatment preferences and providing clinical decision support and shared decision-making tools to improve management for older adults with chronic pain, opioid use, and opioid use disorder. It is one of three trials funded under AHRQ's Opioids and Older Adults Initiative. July 2022
Analyses on How Rates of Prescription Opioid Use Vary by Socioeconomic Characteristics
The Medical Expenditure Panel Survey (MEPS) has published two analyses of prescription opioid use among elderly and non-elderly adults. Any Use and "Frequent Use" of Opioids Among Elderly Adults in 2018-2019, by Socioeconomic Characteristics (MEPS 541) found that in 2018-2019, 15.8 percent of elderly adults, on average, filled at least one outpatient opioid prescription, and 4.9 percent obtained five or more prescription fills during the year. Opioid use was inversely related to income and perceived health status. Any Use and "Frequent Use" of Opioids Among Non-Elderly Adults in 2018-2019, by Socioeconomic Characteristics (MEPS 542) found a similar but slightly lower pattern of opioid use. The briefs also include analyses by sex, race, insurance coverage, and census region. March 2022
Impact Case Study Posted on the Successful Spread and Adoption of AHRQ-Funded MOUD Implementation Model
The AHRQ Office of Communications has posted a case study on the continued spread and adoption of the AHRQ-funded Rural Access to Medication Assisted Treatment in Pennsylvania project (Project RAMP) after the end of the grant. The Lehigh Valley Health Network (LVHN) used an AHRQ initiative to expand treatment for opioid use disorders in Pennsylvania. As a result, primary care physicians are now using medication-assisted treatment to care for their patients with opioid use disorders. This new practice has been a success; approximately 72 percent of LVHN's patients in this program have remained in treatment after 120 days; 65% remain after 180 days. Nationally, 20% to 30% of patients usually remain in treatment by 120 to 180 days. Read more about RAMP and the other MAT grants here. November 2021
AHRQ's blog posts, infographics, and announcements on its latest efforts to help end the opioid epidemic.