Opioids: What's New
EPC Systematic Review on Treatment for Migraine Published in JAMA
"Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-Analysis" was published on June 15 in JAMA. The authors from the Mayo Evidence-based Practice Center found that multiple acute interventions, including nonsteroidal anti-inflammatory drugs, triptans, calcitonin gene-related peptide receptor antagonists, 5HT1F receptor agonist, dihydroergotamine, acetaminophen, and remote electrical neuromodulation, were associated with improvements in short-term pain outcomes with moderate to high strength of evidence. The evidence with regard to opioids and other interventions was low or insufficient. The article was accompanied by an editorial.
The FY 2022 President's Budget Request for AHRQ: Building Back Better
The President's FY2022 budget request to Congress calls for AHRQ to remain an independent Agency and appropriates $380 million to support the Agency's work next year, a $42 million increase. This includes an additional $7 million for research to improve the Nation's response to the opioid and polysubstance abuse epidemics. AHRQ Acting Director David Meyers, M.D., gives an overview of the President's FY22 budget request and its implications for AHRQ in his AHRQ Views Blog.
Draft Report on Integrated and Comprehensive Pain Programs Posted for Public Comment
The Evidence-based Practice Center Program at AHRQ has posted the drafted report for the systematic review on Integrated Pain Management Programs. The purpose of this review is to evaluate the effectiveness and harms of integrated pain management programs and describe contextual, process, and structural factors that may impact outcomes particularly in the Medicare population. The draft is available for review and feedback until June 21, 2021 at the Effective Healthcare website.
Draft Review on Cannabis and Other Plant-Based Treatments Posted for Public Comment
AHRQ has posted the draft for a Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain report for comment on the AHRQ website until June 15, 2021.
Analysis of Opioid Prescribing Before and After 2016 Guideline
"Opioid and non-opioid analgesic prescribing before and after the CDC's 2016 opioid guideline," an analysis of AHRQ's Medical Expenditure Panel Survey data, was published in the International Journal of Health Economic Management on May 8, 2021. The paper found that the CDC's 2016 opioid guidelines worked as intended in terms of the reduced usage, with chronic pain patients shifting to non-opioids and also tapering opioid doses. Those who discontinued opioids under State regulations and CDC guidelines showed no harm in terms of increased work limitations due to pain a year after discontinuing opioids. However, the analysis revealed an unexplained dichotomy—State regulations appeared to reduce opioid use by causing fewer new starts, whereas guidelines reduced opioid use by discontinuing current users, with no impact on new starts.
Rapid Reviews on Opioids and Pain Management
As part of the Congressionally mandated Todd Graham Study, AHRQ has posted three rapid reviews on improving pain management in the context of America's opioid and substance use disorders crisis:
- Care Coordination and Care Plans for Transitions Across Care Settings (PDF, 502 KB)
- Treatments and Technologies Supporting Appropriate Opioid Tapers (PDF, 538 KB)
- Treatments, Technologies, and Models for Management of Acute and Chronic Pain in Persons With a History of Substance Use Disorder (PDF, 562 KB)
AHRQ Announces Interest in Health Services Research To Address the Opioids Crisis
AHRQ is interested in health services research to improve pain management, opioid abuse prevention, opioid abuse treatment and recovery, and overdose prevention and treatment with a high degree of interest in applications that respond to the following three specific areas of focus:
- Evaluating State, local, and health system policy efforts to address the opioids crisis.
- Developing and evaluating interventions to prevent progression to opioid use disorders in people who are misusing or have experimented with opioids.
- Understanding and addressing the rapid increase in opioid-related hospitalizations among older adults.
AHRQ has a particular interest in health services research applications that address the experience, needs, preferences, and outcomes of priority populations including children and adolescents, women, older adults, people with chronic medical conditions, racial and ethnic minorities, low-income, and rural populations. Please direct all inquiries to: Sebastian Tong, M.D., M.P.H., Sebastian.Tong@ahrq.hhs.gov
Funding Opportunity for Substance Use Disorder Research Around Digital Healthcare
AHRQ posted a funding announcement, "Using Innovative Digital Healthcare Solutions to Improve Quality at the Point of Care (R21/R33--Clinical Trial Optional)--PA-21-164." Although the announcement is not restricted to substance abuse disorder (SUD), there is a need for more research on how digital healthcare can improve patient outcomes related to SUD. For more information, contact DigitalHealthcareResearch@ahrq.hhs.gov.
AHRQ's Work To Help Primary Care Practitioners Address Substance Use in Older Adults Described in Generations
"Help for Primary Care Practitioners in Addressing Older Adult Alcohol and Opioid Use," a review of AHRQ's work to improve outcomes related to alcohol and opioid use in older adults, was published in Generations, the journal of the American Society on Aging. The article is part of a special issue focused on substance use and older adults.
Stat Brief on Opioid-Related and Stimulant-Related Adult Inpatient Stays
AHRQ posted a stat brief on Opioid-Related and Stimulant-Related Adult Inpatient Stays, 2012-2018. This brief presents statistics on inpatient stays involving opioids and stimulants among adults aged 18 years and older using the 2012-2014 and 2016-2018 National Inpatient Sample and State Inpatient Databases.
HCUP Analysis of Neonatal Abstinence Syndrome Published in JAMA
"Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the U.S., 2010-2017," an analysis of AHRQ's HCUP data, found that both neonatal abstinence syndrome and maternal opioid-related diagnoses increased from 2010-2017, with notable state-level variation.
Interim Report Posted
AHRQ has posted Cannabis and Other Plant-Based Treatments for Chronic Pain, the first progress report for a living systematic review assessing the effectiveness and harms of plant-based treatments for chronic pain conditions. The review will be "living" in the sense that it will identify and synthesize recently published literature on an ongoing basis. The review will cover plant-based compounds (PBCs) that are similar to opioids n effect and that have the potential for addiction, misuse, and serious adverse effects; other PBCs such as herbal treatments are not included. The intended audience includes policy- and decision makers, funders and researchers of treatments for chronic pain, and clinicians who treat chronic pain.
USPSTF Releases Final Recommendation Statement on Interventions for Tobacco Smoking Cessation in Adults
The U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement on interventions for tobacco smoking cessation in adults, including pregnant persons. The full statement is available on the USPSTF website.
Both Individual and Community Characteristics Determine Patterns in Opioid Use
"The Complex Relationships Among Race/Ethnicity, Social Determinants, and Opioid Utilization," an analysis of Medical Expenditure Panel Survey (MEPS), American Community Health Survey, and Health Area Resources File data, by Asako Moriya (AHRQ) and Lanlan Xu (CMS) was published in Health Services Research.
Two Systematic Reviews on Pain Management Posted
AHRQ has posted two systematic reviews, Treatments for Acute Pain: A Systematic Review and Treatment of Acute Episodic Migraine. The intended audience includes the Centers for Disease Control and Prevention, policy- and decisionmakers, and clinicians who treat acute pain. Concurrent systematic reviews address treatments for other acute pain conditions.
How To Increase Utilization of MAT in Rural Primary Care
"Does a Rural Community-Based Intervention Improve Knowledge and Attitudes of Opioid Use Disorder and Medication-Assisted Treatment? A Report From the IT MATTTRs Study (November 2020)" has been published by AHRQ grantees Kristen Curcija, et al., in The Journal of Rural Health. Findings show that primary care practice use of medication-assisted treatment for opioid use disorder works when access to the services is improved and when rural communities expand their knowledge and attitudes about the disorder and related treatment.
Technical Brief on Opioids and Older Adults Posted
AHRQ has published a technical brief on Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults. The technical brief lays out a conceptual framework for care of older adults who require or use opioids, outlining possible risk factors and potential points for interventions to improve outcomes, and maps available studies to different parts of the framework.
Training Practice Teams To Deliver MAT in Rural Primary Care
"Building Capacity for Medication Assisted Treatment in Rural Primary Care Practices: The IT MATTTRs Practice Team Training," by AHRQ grantees Linda Zittleman et al., was published in September in the Journal of Primary Care & Community Health. This article describes the IT MATTTRs Practice Team Training and reports on its implementation, trainee satisfaction, and perceived ability to deliver MAT.
AHRQ's blog posts, infographics, and announcements on its latest efforts to help end the opioid epidemic.