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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
1 to 24 of 24 Research Studies DisplayedCarlile N, Fuller TE, Benneyan JC
Lessons learned in implementing a chronic opioid therapy management system.
This article describes a research collaborative of health service researchers, systems engineers, and clinicians that sought to improve processes for safer chronic opioid therapy management in an academic primary care center. The authors present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization. They designed, tested, and implemented two key safe opioid use process metrics-percent for patients with recent opioid treatment agreements and urine drug tests. Focus groups were conducted after the conclusion of the implementation. They found a general lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 69% of clinicians reported largely “inheriting” (rather than initiating) their chronic opioid therapy patients. They also tracked 68 patients over a 4-year period and found although process measures improved, full adherence was not achieved for the entire population. Barriers identified included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus.
AHRQ-funded; HS024453.
Citation: Carlile N, Fuller TE, Benneyan JC .
Lessons learned in implementing a chronic opioid therapy management system.
J Patient Saf 2022 Dec 1;18(8):e1142-e49. doi: 10.1097/pts.0000000000001039..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Substance Abuse, Behavioral Health, Practice Patterns
Grove LR, Rao N, Domino ME
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
This study’s goal was to inform efforts to increase prescriptions of medications for opioid use disorder (MOUD) among Medicaid beneficiaries. A retrospective study of North Carolina licensed physicians, physician assistants, and nurse practitioners was conducted to estimate Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and to estimate the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Outcomes looked for were indicators of any Medicaid professional claims and Medicaid claims data for buprenorphine and naltrexone. Licensure data from 2018 was merged with 2019 US Drug Enforcement Administration to identify clinicians who used the DEA waiver required to prescribe buprenorphine (n = 1714). Services by waivered clinicians to Medicare beneficiaries ranged from 67% of behavioral health clinicians to 82.9% of specialist physicians. Prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians.
AHRQ-funded; HS000032.
Citation: Grove LR, Rao N, Domino ME .
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
Addiction 2022 Nov;117(11):2855-63. doi: 10.1111/add.15854..
Keywords: Opioids, Substance Abuse, Behavioral Health, Vulnerable Populations, Medication, Access to Care, Medicaid
Calcaterra SL, Martin M, Bottner R
Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine.
This paper discusses the findings of a Society of Hospital Medicine working group convened to develop a Consensus Statement on the management of opioid use disorder (OUD) and associated conditions among hospitalized adults. The statement is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, advanced practice nurses, and physician assistants) and is intended to apply to hospitalized adults at risk for, or diagnosed with, OUD. The first step of the working group to develop the statement was to conduct a systematic review of relevant guidelines and compose a draft statement based on extracted recommendations. In the next step the working group obtained feedback on the draft statement from external experts in addiction medicine, SHM members, professional societies, harm reduction organizations and advocacy groups, and peer reviewers. This iterative development process resulted in a final Consensus Statement consisting of 18 recommendations covering the following topics: (1) identification and treatment of OUD and opioid withdrawal, (2) perioperative and acute pain management in patients with OUD, and (3) methods to optimize care transitions at hospital discharge for patients with OUD.
AHRQ-funded; HS026215.
Citation: Calcaterra SL, Martin M, Bottner R .
Management of opioid use disorder and associated conditions among hospitalized adults: a consensus statement from the Society of Hospital Medicine.
J Hosp Med 2022 Sep;17(9):744-56. doi: 10.1002/jhm.12893..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Calcaterras SL, Bottner R, Martin M
Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines.
This study evaluated the quality and content of existing guidelines for in-hospital opioid use disorder (OUD) treatment and management. A literature search was done on several databases, websites of relevant societies and advocacy organizations, and selected international search engines. Nineteen guidelines published between January 2010 and June 2020 met the selection criteria. The majority of guidelines were based on observational studies or expert consensus. They recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal.
AHRQ-funded; HS026215.
Citation: Calcaterras SL, Bottner R, Martin M .
Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: a systematic review of existing guidelines.
J Hosp Med 2022 Sep;17(9):679-92. doi: 10.1002/jhm.12908..
Keywords: Opioids, Substance Abuse, Behavioral Health, Evidence-Based Practice, Guidelines, Inpatient Care
Beetham T, Fiellin DA, Busch SH
Physician response to COVID-19-driven telehealth flexibility for opioid use disorder.
This study surveyed physicians who provide opioid use disorder (OUD) treatment on their preferences and practices regarding telehealth that have evolved during the COVID-19 pandemic. A total of 1141 physicians who were publicly listed buprenorphine-prescribing physicians were surveyed. Most respondents found telehealth to be effective, with 54% who found it more effective than expected. Overall, 85% were in favor of temporary telehealth flexibility being permanently extended, and 77% would be likely to use telehealth after the COVID-19 pandemic is over.
AHRQ-funded; HS017589.
Citation: Beetham T, Fiellin DA, Busch SH .
Physician response to COVID-19-driven telehealth flexibility for opioid use disorder.
Am J Manag Care 2022 Sep;28(9):456-63. doi: 10.37765/ajmc.2022.89221..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Opioids, Substance Abuse, Behavioral Health, Medication
Khouja T, Zhou J, Gellad WF
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
This study’s objective was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with dental visit and corresponding opioid prescription from 2011 to 2017 within a nationwide commercial claims database was conducted. As per CDC guidelines, opioid overprescribing was defined as >120 morphine milligram equivalents. Of 633,387 visits, 16.6% had POU and 2.6% experienced an adverse outcome. POU was higher when opioids were overprescribed with visits associated with mild pain and those with substance use disorders having the highest risk of both outcomes.
AHRQ-funded; HS025177.
Citation: Khouja T, Zhou J, Gellad WF .
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
Pain 2022 Aug 1;163(8):1571-80. doi: 10.1097/j.pain.0000000000002545..
Keywords: Opioids, Dental and Oral Health, Substance Abuse, Behavioral Health, Practice Patterns, Pain, Medication, Adverse Drug Events (ADE), Adverse Events
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
AHRQ-funded; HS027910.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N .
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Jakubowski A, Rath C, Harocopos A
Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation.
This article discusses a study that investigated the barriers to and facilitators of implementing syringe service programs (SSPs) for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. The study looked at the program ran by the New York City Department of Health and Mental Hygiene (DOHMH) that funded the creation of nine SSPs that developed “low-threshold” buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. Barriers identified included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring buprenorphine providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Implementation facilitators included receiving technical assistance from DOHMH, having designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Three key recommendations were made including: (1) health departments should provide support for SSPs in training staff, building health service infrastructure, and developing policies and procedures, (2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for frontline staff, and (3) buprenorphine providers should be selected or supported to use a harm reduction approach to buprenorphine treatment.
AHRQ-funded; HS026396.
Citation: Jakubowski A, Rath C, Harocopos A .
Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation.
Harm Reduct J 2022 Jul 10;19(1):75. doi: 10.1186/s12954-022-00654-0..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication
King C, Cook R, Korthuis PT
Causes of death in the 12 months after hospital discharge among patients with opioid use disorder.
This study described causes of death in the year post-discharge among hospitalized patients with Opioid Use Disorder (OUD). Data was analyzed from participants at least 18 years old with Medicaid insurance, who had a diagnosis of OUD during a general hospital admission in Oregon. Findings showed that hospitalized patients with OUD were at high risk of death, from drug and non-drug related causes, in the year after discharge. Recommendations included future research considering not only overdose, but a more comprehensive definition of drug-related death in understanding post-discharge mortality among hospitalized patients with OUD.
AHRQ-funded; HS026370.
Citation: King C, Cook R, Korthuis PT .
Causes of death in the 12 months after hospital discharge among patients with opioid use disorder.
J Addict Med 2022 Jul-Aug;16(4):466-69. doi: 10.1097/adm.0000000000000915..
Keywords: Mortality, Hospital Discharge, Hospitals, Opioids, Substance Abuse, Behavioral Health
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation: Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Jakubowski 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
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
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
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
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