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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 304 Research Studies DisplayedJakubowski A, Norton BL, Hayes BT
Low-threshold buprenorphine treatment in a syringe services program: program description and outcomes.
Investigators described the treatment philosophy, practices, and outcomes of a low-threshold syringe services program (SSP)-based buprenorphine program developed through an SSP-academic medical center partnership. They found that, in an SSP-based low-threshold buprenorphine treatment program, approximately one-third of patients continued buprenorphine treatment for 180 days or more, and buprenorphine adherence was high. They concluded that SSPs can be a pathway to buprenorphine treatment for patients at high risk for opioid-related harms.
AHRQ-funded; HS026396.
Citation: Jakubowski A, Norton BL, Hayes BT .
Low-threshold buprenorphine treatment in a syringe services program: program description and outcomes.
J Addict Med 2022 Jul-Aug;16(4):447-53. doi: 10.1097/adm.0000000000000934..
Keywords: Medication, Opioids, Substance Abuse, Behavioral Health
Wyse JJ, Mackey K, Lovejoy TI
Expanding access to medications for opioid use disorder through locally-initiated implementation.
The purpose of this study was to identify and describe locally- and internally-developed approaches to improve patient access to medication treatment for opioid use disorder (MOUD). The researchers utilized the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews and ethnographic observations to examine the planning, design, and implementation of a locally-initiated process to expand access to MOUD. The study found that a self-appointed local team successfully developed and implemented a Primary Care-based Buprenorphine Clinic and E-Consult Service to expand access to MOUD to patients across the health care system, including national and local policy changes, identifying appropriate and widely supported models of care delivery and consultation, and increasing staff investment in the efforts by including them in collaborative planning and problem-solving. The study concluded that a local team can plan, develop and build new processes of care that are customized to meet local needs and contribute to long-term sustainability in the community.
AHRQ-funded; HS026370.
Citation: Wyse JJ, Mackey K, Lovejoy TI .
Expanding access to medications for opioid use disorder through locally-initiated implementation.
Addict Sci Clin Pract 2022 Jun 20;17(1):32. doi: 10.1186/s13722-022-00312-7..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Access to Care, Practice Patterns, Implementation
Meiselbach MK, Drake C, Saloner B
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
This study examined variation in access to in-network buprenorphine-prescribing primary care providers that can treat opioid use disorder among Medicaid managed care enrollees. Approximately 32.2% of Medicaid enrollees had fewer than one in-network network buprenorphine-prescribing primary care providers per 100,000 county residents. There was on average a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates, but most enrollees lived in areas with a shortage of these providers. The authors found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Drake C, Saloner B .
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
Health Aff 2022 Jun;41(6):901-10. doi: 10.1377/hlthaff.2021.01719..
Keywords: Medicaid, Primary Care, Access to Care, Medication, Care Management, Opioids, Substance Abuse, Behavioral Health
Cedillo G, George MC, Deshpande R
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Healthcare and behavioral health providers are lacking a methodology to implement the 2016 U.S. Centers for Disease Control and Prevention Opioid Prescribing Guideline (CDC Guideline), measure prescriber adherence to it, and systematically test its effect on patient and public health outcomes. The Guideline is currently being reviewed and revised due to concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). The purpose of the study was to develop and test a CDC Guideline implementation strategy termed “TOWER,” focused on an outpatient HIV primary care setting with patients with CP-LTOT. The TOWER strategy included: 1) a patient-facing app for opioid management (OM-App); 2) a template for progress notes (OM-Note) intended to guide the patient’s office visit; and 3) a primary care provider (PCP) training. TOWER was developed in a multi-step, stakeholder-engaged process within a behavioral change framework. The researchers evaluated the TOWER strategy in a randomized-controlled trial of HIV-PCPs (N=11) and their patients with HIV and CP-LTOT (N=40). The main outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the Safer Opioid Prescribing Tool (SOPTET). Qualitative data was also collected, including one-on-one PCP interviews. The study found that the PCPs randomized to utilize the TOWER strategy were 48% more CDC Guideline adherent. Qualitative data reflected high levels of intervention provider confidence in administering the TOWER processes, and that the OM-Note supported provider efforts, but experience with the patient-facing OM-App was mixed. The study concluded that adherence to the 2016 CDC Guidelines is not associated with worsening of outcomes for people with HIV with CP-LTOT, and adherence to the CDC Guidelines can be promoted and measured. The researchers recommend additional research into the scalability of these results and the impact of CDC Guideline adherence on public health.
AHRQ-funded; HS025641.
Citation: Cedillo G, George MC, Deshpande R .
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Addict Sci Clin Pract 2022 May 16;17(1):28. doi: 10.1186/s13722-022-00311-8..
Keywords: Opioids, Medication, Human Immunodeficiency Virus (HIV), Guidelines, Evidence-Based Practice
Chen C, Lo-Ciganic WH, Winterstein AG
Concurrent use of prescription opioids and gabapentinoids in older adults.
This cross-sectional study investigated concurrent opioid-gabapentinoid use among older Medicare opioid users with chronic noncancer pain. The study found 464,732 eligible older beneficiaries aged 65 and older who filled ≥1 opioid prescription within 3 months after a randomly selected chronic noncancer pain diagnosis in a calendar year between 2011 and 2018. The prevalence of concurrent use increased from 17% in 2011 to 23.5% in 2013. The profile of concurrent users tended to be non-Black, low-income subsidy recipients, and Southern residents.
AHRQ-funded; HS027230.
Citation: Chen C, Lo-Ciganic WH, Winterstein AG .
Concurrent use of prescription opioids and gabapentinoids in older adults.
Am J Prev Med 2022 Apr;62(4):519-28. doi: 10.1016/j.amepre.2021.08.024..
Keywords: Elderly, Medication, Opioids, Pain, Chronic Conditions
Sun EC, Rishel CA, Jena AB
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
There is growing interest in identifying and developing interventions aimed at reducing the risk of increased, long-term opioid use among surgical patients. While understanding how these interventions impact health care spending has important policy implications and may facilitate the widespread adoption of these interventions, the extent to which they may impact health care spending among surgical patients who utilize opioids chronically is unknown. This study examined the association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Jena AB .
Association between changes in postoperative opioid utilization and long-term health care spending among surgical patients with chronic opioid utilization.
Anesth Analg 2022 Mar;134(3):515-23. doi: 10.1213/ane.0000000000005865..
Keywords: Opioids, Medication, Healthcare Costs, Long-Term Care, Substance Abuse
Chen C, Winterstein AG, Lo-Ciganic WH
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
This study compared the risk of fall-related injury in two cohorts who used gabapentinoids concurrently with opioid use and those who used opioids only. The authors created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Both cohorts were identified from a sample of older Medicare beneficiaries with chronic non-cancer pain (CNCP). Four concurrent users were matched up with 1 opioid-only user. They identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. Cohort 1’s incidence rate of fall-related injury was 24.5 per 100 person-users during follow-up and was 18.0 per 100-person-years during follow-up for Cohort 2. Concurrent users had had similar risk of fall-related injury as opioid-only users in Cohort 1 but had higher risk for fall-related injury than opioid-only users in Cohort 2.
AHRQ-funded; HS027230.
Citation: Chen C, Winterstein AG, Lo-Ciganic WH .
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
PLoS Med 2022 Mar;19(3):e1003921. doi: 10.1371/journal.pmed.1003921..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Falls, Patient Safety, Injuries and Wounds, Pain, Chronic Conditions
Auty SG, Griffith KN
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. Using data from the CDC’s WONDER database, findings showed that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
AHRQ-funded; HS026395.
Citation: Auty SG, Griffith KN .
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
Drug Alcohol Depend 2022 Mar 1;232:109340. doi: 10.1016/j.drugalcdep.2022.109340..
Keywords: COVID-19, Medicaid, Opioids, Substance Abuse, Behavioral Health, Mortality, Public Health
Encinosa W, Bernard D, Selden TM
AHRQ Author: Encinosa W, Bernard D, Selden TM
Opioid and non-opioid analgesic prescribing before and after the CDC's 2016 opioid guideline.
This study examined opioid and non-opioid prescribing before and after the issuing of CDC’s 2016 opioid guideline. The authors developed a theory of physician prescribing behavior under the CDC’s two-pronged incentive structure. They used MEPS survey data to empirically corroborate the theory that the regulations and guidelines have the intended effects of reducing opioid prescriptions for acute and chronic pain, as well as the predicted unintended effects-income effects cause regulations on acute pain treatment to increase chronic pain opioid prescriptions and the chronic pain treatment guidelines spillover to reduce opioids for acute pain. They also found that the guidelines work as intended in terms of the reduced usage, with chronic pain patients shifting to non-opioids and tapering off opioid doses.
AHRQ-authored.
Citation: Encinosa W, Bernard D, Selden TM .
Opioid and non-opioid analgesic prescribing before and after the CDC's 2016 opioid guideline.
Int J Health Econ Manag 2022 Mar;22(1):1-52. doi: 10.1007/s10754-021-09307-4..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Practice Patterns, Medication, Pain, Chronic Conditions
Cochran G, Cole ES, Sharbaugh M
Provider and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder.
This study examined primary care provider (PCP) and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder (MOUD). The authors assessed a retrospective cohort from 2015 to 2018 within the Pennsylvania Medicaid Program. Participants included PCPs who were Medicaid providers, with no history of MOUD provision, and who treated 10 or more Medicaid enrollees annually. The authors identified 113 rural and 782 urban PCPs who engaged in initial adoption and 36 rural and 288 urban PCPs who engaged in sustained prescribing. Rural/urban PCPs who prescribed increasing larger numbers of antidepressant and antipsychotic medications had greater odds of initial adoption and sustained prescribing compared to those that did not prescribe these medications. Each additional patient out of 100 with opioid use disorder diagnosed before MOUD adoption increased the adjusted odds for initial adoption 2% to 4% and sustained prescribing by 4% to 7%. New Medicaid providers in rural areas were 2.52 and in urban areas were 2.66 more likely to engage in initial MOUD adoption compared to established PCPs.
AHRQ-funded; HS025072.
Citation: Cochran G, Cole ES, Sharbaugh M .
Provider and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder.
J Addict Med 2022 Mar-Apr;16(2):e87-e96. doi: 10.1097/adm.0000000000000859..
Keywords: Opioids, Medication, Substance Abuse, Patient Adherence/Compliance, Behavioral Health
Gertner AK, Rotter JS, Holly ME
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
This observational study’s goal was to determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD). Claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017 was used. During the period from 2014 to 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period the number of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. The percent of Medicaid enrollees receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. In the 12 months before being newly diagnosed, approximately 82% with Medicaid or private insurance had a PCP visit. There was no difference in receiving an MOUD with those who had not seen a PCP. However, there was a higher probability of receiving MOUD with a PCP, than seeing an emergency provider, but lower than seeing a behavioral health specialist or other provider type.
AHRQ-funded; HS025065.
Citation: Gertner AK, Rotter JS, Holly ME .
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
J Addict Med 2022 Mar-Apr;16(2):183-91. doi: 10.1097/adm.0000000000000860..
Keywords: Primary Care, Opioids, Substance Abuse, Behavioral Health, Health Insurance
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
AHRQ-funded; HS027230.
Citation: Wei YJ, Chen C, Lewis MO .
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
Wyse JJ, McGinnis KA, Edelman EJ
Twelve-month retention in opioid agonist treatment for opioid use disorder among patients with and without HIV.
Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder (OUD). The investigators concluded that history of homelessness was associated with a lower likelihood of retention. Predictors of retention were largely distinct between patients with HIV and patients without HIV. Findings highlighted the need for clinical, systems, and research initiatives to better understand and improve OAT retention.
AHRQ-funded; HS026370.
Citation: Wyse JJ, McGinnis KA, Edelman EJ .
Twelve-month retention in opioid agonist treatment for opioid use disorder among patients with and without HIV.
AIDS Behav 2022 Mar;26(3):975-85. doi: 10.1007/s10461-021-03452-0..
Keywords: Opioids, Substance Abuse, Behavioral Health, Human Immunodeficiency Virus (HIV)
Holtrop JS, Mullen R, Curcija K
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
The purpose of this qualitative study was to investigate clinician and staff perceptions related to medication assisted treatment (MAT) for opioid use disorder, particularly buprenorphine treatment, in rural primary care practices. Staff members from rural 42 practices were interviewed. Although there was almost no provision of MAT, policies and procedures to reduce opioid prescribing were usually in place and many practices expressed interest in learning more to help their patients and local communities.
AHRQ-funded; HS025056.
Citation: Holtrop JS, Mullen R, Curcija K .
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
J Health Care Poor Underserved 2022; 33(1):253-67. doi: 10.1353/hpu.2022.0019..
Keywords: Opioids, Substance Abuse, Behavioral Health, Primary Care, Rural Health, Medication
Rikin S, Perez HR, Zhang C
Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis.
Changes in health care delivery during the COVID-19 pandemic may have impacted opioid prescribing. This study evaluated the impact of restrictions on in-person care on opioid prescribing in the outpatient setting. The hypothesis was that after restrictions to in-person care were implemented, there would be a reduction in the number of chronic and non-chronic opioid prescriptions.
AHRQ-funded; HS026396.
Citation: Rikin S, Perez HR, Zhang C .
Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis.
J Prim Care Community Health 2022 Jan-Dec;13:21501319221076926. doi: 10.1177/21501319221076926..
Keywords: COVID-19, Opioids, Medication, Practice Patterns, Healthcare Delivery
Meisel ZF, Shofer F, Dolan A
AHRQ Author: Rhodes KV
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
The purpose of this trial was to compare the effectiveness of three approaches for communicating opioid risk during an emergency department visit for a common painful condition. Participants were adult patients with kidney stone or musculoskeletal back pain, randomly assigned to one of three risk communication strategies: a personalized probabilistic risk visual aid, a visual aid and video narrative, or general risk information. Findings showed that an emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall.
AHRQ-authored.
Citation: Meisel ZF, Shofer F, Dolan A .
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
Am J Public Health 2022 Feb;112(S1):S45-s55. doi: 10.2105/ajph.2021.306511..
Keywords: Pain, Emergency Department, Education: Patient and Caregiver, Opioids, Comparative Effectiveness, Clinician-Patient Communication, Communication
Yunusa I, Gagne JJ, Yoshida K
Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors.
Oxycodone is a potent prescription opioid. Some Selective Serotonin Reuptake Inhibitors (SSRIs) inhibit oxycodone metabolism in the body, but the clinical consequences of this interaction on overdose risk have not been adequately determined. The study researchers compared the rates of opioid overdoses in patients who had initiated oxycodone while taking enzyme-inhibiting SSRIs with the overdose rates of patents who had initiated oxycodone while taking non-enzyme inhibiting SSRIs. Data from 3 U.S. health insurance databases was used to analyze a cohort of adults who initiated oxycodone while receiving SSRI therapy between the years 2000 and 2020. Of the total of 2,037,490 who initiated oxycodone, 69.6% were receiving SSRIs at the time of the initiation of the oxycodone. One-thousand-thirty-five overdose events were observed during this time, and the resulting incidence rate in those initiating oxycodone while using enzyme-inhibiting SSRI’s was higher than in those using other SSRIs. The researchers concluded that in the study cohort of U.S. adults, there is a small increased risk of opioid overdose when initiating oxycodone in patients taking enzyme-inhibiting SSRIs.
AHRQ-funded; HS027623.
Citation: Yunusa I, Gagne JJ, Yoshida K .
Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors.
JAMA Netw Open 2022 Feb;5(2):e220194. doi: 10.1001/jamanetworkopen.2022.0194..
Keywords: Opioids, Medication, Risk, Depression, Adverse Drug Events (ADE), Adverse Events
Schoenfeld EM, Soares WE, Schaeffer EM
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. In this study, the investigators explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians. The investigators concluded that while some participants were hesitant to adopt a "new" role in treating patients with medications for OUD, many already had.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Soares WE, Schaeffer EM .
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Acad Emerg Med 2022 Jan;29(1):28-40. doi: 10.1111/acem.14369..
Keywords: Emergency Department, Opioids, Medication, Substance Abuse, Behavioral Health
Curcija K, Zittleman L, Fisher M
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.
As part of the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study, this paper describes the implementation of community-based interventions developed by rural community members and researchers to increase awareness and to promote positive attitudes toward medication-assisted treatment (MAT) for opioid use disorder (OUD) and explores changes in community members' OUD and MAT knowledge and beliefs. Findings showed that partnering with local community members resulted in the successful development and implementation of community-based interventions, exposure to which was associated with OUD knowledge and beliefs. Locally-created interventions should be included in comprehensive approaches to stem the OUD epidemic.
AHRQ-funded; HS025065.
Citation: Curcija K, Zittleman L, Fisher M .
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.
J Rural Health 2022 Jan;38(1):120-28. doi: 10.1111/jrh.12545..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Rural Health
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Nease DE .
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords: Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Green TC, Soipe A, Baloy B
Pharmacy on-site overdose protocols and prevention of overdose.
The objective of this study was to assess prevalence of on-site pharmacy overdose incidents and pharmacist and site characteristics associated with having a known protocol for responding to on-site overdose emergencies. 3,100 pharmacists in Massachusetts and Rhode Island responded to an anonymous, online survey; 17.5% reported at least one suspected overdose at their practice and 42.9% reported knowledge of their practice’s overdose protocol. Pharmacists knowledgeable about protocols were also more likely to offer naloxone to patients and did not practice at chain pharmacies. The authors concluded that community pharmacies that stock and distribute naloxone are key parts of community efforts to address the opioid crisis, and that other healthcare settings should implement on-site overdose response protocols and cultivate a standard of providing naloxone to patients.
AHRQ-funded; HS024021.
Citation: Green TC, Soipe A, Baloy B .
Pharmacy on-site overdose protocols and prevention of overdose.
Subst Abus 2022; 43(1):64-68. doi: 10.1080/08897077.2020.1736236..
Keywords: Provider: Pharmacist, Opioids, Medication, Substance Abuse, Behavioral Health, Prevention
Herzig SJ, Anderson TS,, Jung y
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
This study examined patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. Administrative billing codes and medication claims were used to define potential opioid-related ADEs within 30 days of hospital discharge. Findings showed that potential opioid-related ADEs occurred in 7% of older adults discharged from a medical hospitalization with an opioid prescription. Recommendations included using identified risk factors to inform physician decision-making, having conversations with older adults about risk, and increasing development and targeting of harm reduction strategies.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS,, Jung y .
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
J Am Geriatr Soc 2022 Jan;70(1):228-34. doi: 10.1111/jgs.17453..
Keywords: Elderly, Opioids, Risk, Adverse Drug Events (ADE), Adverse Events, Medication, Hospital Discharge
McClellan C, Moriya A, Simon K
AHRQ Author: McClellan C Moriya A
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
This paper provides national estimates of financial costs faced by the population receiving retail medications for opioid use disorders (MOUD). Using MEPS data, findings showed that patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage was associated with reduced annual out-of-pocket MOUD expenditures. Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with opioid use disorders.
AHRQ-authored.
Citation: McClellan C, Moriya A, Simon K .
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
J Subst Abuse Treat 2022 Jan;132:108645. doi: 10.1016/j.jsat.2021.108645..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Substance Abuse, Behavioral Health, Healthcare Costs, Medication
White AEC, Hood-Medland EA, Kravitz RL
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. This study created a novel measure, "visit linearity," to assess visit organization and examined whether visits that required less shifting back and forth between topics were associated with better patient and physician visit experiences.
AHRQ-funded; HS022236.
Citation: White AEC, Hood-Medland EA, Kravitz RL .
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
J Gen Intern Med 2022 Jan;37(1):78-86. doi: 10.1007/s11606-021-06917-z..
Keywords: Opioids, Pain, Chronic Conditions, Primary Care, Medication
Agbalajobi OM, Gmelin T, Moon AM
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
This retrospective cohort study investigated opioid prescribing patterns among patients with chronic liver disease (CLD) at a single medical center. These patients (12,425) were followed for one year from October 2015 to September 2016. Nearly half (47%) were prescribed opioids over a one-year period, with 17% receiving high-risk prescriptions. Characteristics associated with high-risk opioid prescriptions included female gender, Medicaid insurance, cirrhosis and baseline chronic pain, depression, anxiety, substance use disorder, and Charlson comorbidity score. Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions.
AHRQ-funded; HS019461.
Citation: Agbalajobi OM, Gmelin T, Moon AM .
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
PLoS One 2021 Dec 17;16(12):e0261377. doi: 10.1371/journal.pone.0261377..
Keywords: Opioids, Medication, Practice Patterns, Pain, Chronic Conditions