Supporting HHS’s Opioid Initiative
Deaths from drug overdoses have risen steadily over the past two decades and have become the leading cause of injury death in the United States. Prescription drugs, especially opioids, have been increasingly implicated in drug overdose deaths over the last decade. In response to recent increases in opioid-related morbidity and mortality, the U.S. Department of Health and Human Services (HHS) has made addressing the opioid abuse problem a high priority. HHS is focused on implementing evidence-based approaches to reduce opioid overdoses and overdose-related mortality and the prevalence of opioid use disorder.
HHS’s initiative focuses on three priority areas to combat opioid abuse:
- Opioid prescribing practices to reduce opioid use disorders and overdose.
- Expanded use of naloxone, used to treat opioid overdoses.
- Expanded use of Medication-Assisted Treatment (MAT) to reduce opioid use disorders and overdose.
AHRQ is increasing the evidence base on this topic with research and data and is provides a forum where communities can share their tools for combating the issue of opioid misuse.
AHRQ is investing about $12 million over 3 years in a series of grants to discover how to best support primary care practices and rural communities in delivering MAT for opioid abuse in rural primary care practices. AHRQ-funded projects will explore and test solutions aimed at overcoming barriers to the use of MAT in rural primary care settings, such as limited continuing training opportunities for prescribing physicians, negative perceptions about people with substance abuse disorders, negative expectations about the effectiveness of treatment, and lack of social support services in rural communities.
Practices involved in the initiative will provide access to MAT to more than 20,000 individuals struggling with opioid addiction using innovative technology, including patient-controlled smart phone apps and remote training and expert consultation using Project ECHO—a telehealth program started with AHRQ support that links specialists at an academic hub to primary care providers working on the frontlines in rural communities.
AHRQ has awarded grants to:
- The American Institutes of Research in partnership with the State of Oklahoma, Project ECHO from New Mexico, and expert consultants from the American Society for Addiction Medicine.
- The University of Colorado, Denver.
- The Pennsylvania State Department of Human Services in partnership with the Pennsylvania Office of Mental Health and Substance Abuse Services and the University of Pittsburgh.
- The University of North Carolina at Chapel Hill.
- Opioid Misuse Hospital Stays Increase 64 Percent from 2005-2014
Opioid-related hospital stays involving prescription opioids or illicit opioids such as heroin increased nationwide by 64 percent between 2005 and 2014, according to Statistical Brief #219, Opioid-Related Hospital Stays and Emergency Department Visits by State, 2009–2014, an AHRQ report that provides insights into the Nation’s costly opioid epidemic. The report summarizes State-specific data, provides trends over time, and identifies the States with the highest and lowest rates of opioid-related hospital stays in 2014, the most current year available. For example, in 2014, the District of Columbia, Maryland, Massachusetts, New York, Rhode Island and West Virginia each reported rates exceeding 350 per 100,000 people—far above the national average of 225 per 100,000.
Related AHRQ Views Blog: AHRQ Data Prove What Every Hospital Knows: Opioid Stays Are Going Up
Related infographic: Opioids’ Burden on Hospital Care: A State-by-State Comparison
- Hospitalizations Increase Due to Opioid Overuse
The rate of hospitalizations for overuse of pain medications has increased more than 150 percent since 1993, according to Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993–2012, a statistical brief from AHRQ’s Healthcare Cost and Utilization Project (HCUP). The brief's authors examined HCUP data and found that the rate of hospital stays involving opioid overuse among adults increased from 116.7 to 295.6 stays per 100,000 population from 1993 to 2012.
The authors found that hospitalization rates were climbing among every adult age group and in every region of the country, making the problem more uniformly widespread than has previously been observed. The most significant increases in rates were among women, people living in the Midwest, and people 45 and older. The data also show that in 1993, Medicaid was billed for more than twice as many hospitalizations involving opioid overuse as any other payer, but by 2012 these differences diminished, and the largest increase was seen for discharges billed to Medicare.
Related AHRQ Views Blog: AHRQ Data Reveal Wider Impact of Opioid Overuse.
- Outpatient Expenses for Prescribed Opioids More Than Doubled from 2002 to 2012
Trends in Prescribed Outpatient Opioid Use and Expenses in the U.S. Civilian Noninstitutionalized Population, 2002-2012, a statistical brief from AHRQ’s Medical Expenditure Panel Survey, examines trends in the number of persons purchasing at least one outpatient prescription opioid, and total expenses and total number of prescriptions, as well as average annual cost per person and total and average out-of-pocket costs for the U.S. civilian noninstitutionalized population from 2002 through 2012. The brief finds that:
- Among the U.S. civilian noninstitutionalized population, total expenses (in 2012 dollars) for outpatient prescription opioids more than doubled, increasing from $4.1 billion to $9.0 billion, when comparing 2002 with 2012.
- When comparing 2002 with 2012, total prescription opioid purchases increased from 85.9 million to 143.9 million among the U.S. civilian noninstitutionalized population.
- The total number of people in the U.S civilian noninstitutionalized population purchasing one or more outpatient prescribed opioid increased from 27.2 million to 36.7 million when comparing 2002 with 2012.
- When comparing 2002 with 2012, the mean annual real expense (in 2012 dollars) for outpatient prescribed opioids for those with an expense increased from $149 to $246.
Research Needed To Determine Best Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
"Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings," a Technical Brief in AHRQ’s Effective Health Care Program, examined 12 promising and innovative medication-assisted treatment (MAT) models of care in primary care settings, described barriers to MAT implementation, summarized the evidence available on MAT models of care in primary care settings, identified gaps in the evidence base, and provided guidance for future research. The models of care presented may help inform the individualized implementation of MAT models of care in different primary care settings.
Innovations include the use of designated non-physician staff for the key integration/coordination role; centralized intake and stabilization of patients with ongoing management in community settings; screening and induction performed in alternate settings (emergency department, prenatal setting) with subsequent referral to community settings; community-based stakeholder engagement to develop practice standards and improve quality of care; and use of Internet-based learning networks. Key barriers to implementation of MAT models of care include stigma, lack of institutional support, lack of prescribing physicians, lack of expertise, and inadequate reimbursement.
AHRQ’s Innovations Exchange features several innovations aimed at reducing opioid misuse and associated health and safety consequences. The initiatives include an opioid overdose education and naloxone distribution program targeting high-risk communities, a mayoral task force in New York City that developed a series of strategies to combat the problem, an emergency department that implemented a protocol on the use of controlled substances, and a program to promote appropriate prescribing and monitoring of opioid therapy for patients with chronic pain not caused by cancer.
- State Health Department and Community Agencies Save Lives by Teaching Potential Bystanders To Recognize and Respond to Opioid-Related Overdoses.
- Cross-Agency Mayoral Task Force Promotes Policies and Initiatives To Reduce Prescription Opioid Misuse and Related Problems, Achieves Some Early Successes.
- Emergency Department and Urgent Care Clinicians Use Protocol To Reduce Opioid Prescriptions for Patients Suspected of Abusing Controlled Substances.
- Multifaceted Program Featuring Guideline, Training, and Incentives Reduces Prescribing of High-Dose Opioid Therapy in Patients With Chronic Pain.
AHRQ’s Innovations Exchange also offers a toolkit with resources for first responders, prescribers, patients, family members, and those who are recovering from opioid overdose; guidelines to help clinicians make treatment decisions for patients who may be abusing opioids; a manual on the development of overdose prevention programs; and a guide that supports implementation of overdose prevention and response strategies.
Page originally created November 2016