National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (12)
- Adverse Drug Events (ADE) (24)
- Adverse Events (15)
- Alcohol Use (3)
- Ambulatory Care and Surgery (7)
- Antibiotics (1)
- Arthritis (1)
- Asthma (1)
- Back Health and Pain (4)
- Behavioral Health (57)
- Cancer (7)
- Cancer: Breast Cancer (2)
- Cancer: Lung Cancer (2)
- Cardiovascular Conditions (1)
- Caregiving (2)
- Care Management (12)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (16)
- Chronic Conditions (44)
- Clinical Decision Support (CDS) (3)
- Clinician-Patient Communication (5)
- Communication (7)
- Community-Based Practice (2)
- Comparative Effectiveness (7)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (5)
- Critical Care (1)
- Dementia (1)
- Dental and Oral Health (9)
- Depression (2)
- Digestive Disease and Health (1)
- Disparities (7)
- Education: Continuing Medical Education (1)
- Education: Curriculum (1)
- Education: Patient and Caregiver (2)
- Elderly (24)
- Electronic Health Records (EHRs) (1)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (20)
- Emergency Medical Services (EMS) (3)
- Evidence-Based Practice (17)
- Falls (1)
- Family Health and History (1)
- Guidelines (13)
- Healthcare Cost and Utilization Project (HCUP) (10)
- Healthcare Costs (8)
- Healthcare Delivery (6)
- Healthcare Utilization (10)
- Health Information Technology (HIT) (11)
- Health Insurance (6)
- Health Literacy (2)
- Hepatitis (2)
- Hospital Discharge (7)
- Hospitalization (14)
- Hospital Readmissions (4)
- Hospitals (5)
- Human Immunodeficiency Virus (HIV) (8)
- Implementation (7)
- Infectious Diseases (4)
- Injuries and Wounds (5)
- Inpatient Care (6)
- Long-Term Care (4)
- Medicaid (13)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (7)
- Medicare (7)
- Medication (257)
- Medication: Safety (27)
- Mortality (15)
- Neurological Disorders (1)
- Newborns/Infants (4)
- Nursing Homes (3)
- Obesity (3)
- Obesity: Weight Management (1)
- (-) Opioids (303)
- Orthopedics (8)
- Outcomes (9)
- Pain (91)
- Palliative Care (2)
- Patient-Centered Healthcare (4)
- Patient-Centered Outcomes Research (17)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (2)
- Patient Experience (2)
- Patient Safety (25)
- Patient Self-Management (1)
- Policy (20)
- Practice Patterns (68)
- Pregnancy (6)
- Prevention (10)
- Primary Care (31)
- Primary Care: Models of Care (4)
- Provider (17)
- Provider: Clinician (3)
- Provider: Nurse (1)
- Provider: Pharmacist (12)
- Provider: Physician (7)
- Provider: Physician Assistant (1)
- Public Health (3)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality of Care (4)
- Quality of Life (1)
- Racial and Ethnic Minorities (10)
- Respiratory Conditions (3)
- Risk (15)
- Rural/Inner-City Residents (2)
- Rural Health (14)
- Screening (5)
- Sepsis (1)
- Sex Factors (2)
- Shared Decision Making (5)
- Sickle Cell Disease (2)
- Social Determinants of Health (3)
- Social Media (1)
- Social Stigma (4)
- Stroke (1)
- Substance Abuse (154)
- Surgery (35)
- Teams (2)
- Telehealth (3)
- Tools & Toolkits (1)
- Training (3)
- Transitions of Care (2)
- Treatments (4)
- Vulnerable Populations (4)
- Women (5)
- Young Adults (4)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 303 Research Studies DisplayedFoot C, Korthuis PT, Tsui JI
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
The objective of this secondary analysis of data from two clinical trials comparing buprenorphine and extended-release naltrexone was to estimate the effect of ongoing stimulant use on return to illicit opioid use after initiation of medication for opioid use disorder (MOUD). The findings indicated that people on medication for opioid use disorder who subsequently used stimulants appeared more likely to return to non-prescribed opioids use compared with those without stimulant use; this association appeared stronger among patients who initiated buprenorphine compared with those who initiated extended-release naltrexone.
AHRQ-funded; HS026370.
Citation: Foot C, Korthuis PT, Tsui JI .
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
Addiction 2024 Jan; 119(1):149-57. doi: 10.1111/add.16334..
Keywords: Opioids, Substance Abuse, Medication, Behavioral Health
Goyal NK, Sood E, Gannon MA
Priorities for well child care of families affected by parental opioid use disorder.
This study’s objective was to explore priorities for well childcare (WCC) visit content for women in treatment with opioid use disorder to inform primary care recommendations for this population. Eligible participants had children 2 years or younger and were English speaking. Among the 30 parent participants, they were overwhelmingly White (83%) and unmarried (90%). Thirteen clinicians participated, of whom 9 were attending physicians. Interviews were conducted with parents and clinicians which led to five emerging themes: (1) improving knowledge and confidence related to child development, behavior, and nutrition; (2) mitigating safety concerns; (3) addressing complex health and subspecialty needs through care coordination; (4) acknowledging parental health and wellbeing in the pediatric encounter; and (5) supporting health education and care related to neonatal opioid withdrawal syndrome. These issues were expressed as hard to address by parents and clinicians due to time constraints, social determinants of health, and significant informational needs.
AHRQ-funded; HS027399.
Citation: Goyal NK, Sood E, Gannon MA .
Priorities for well child care of families affected by parental opioid use disorder.
J Addict Med 2024 Jan-Feb; 18(1):48-54. doi: 10.1097/adm.0000000000001243..
Keywords: Opioids, Substance Abuse, Behavioral Health, Caregiving, Children/Adolescents
Hughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
Goyal N, Gannon M, Sood E
Group well child care for mothers with opioid use disorder: framework for implementation.
The purpose of this study was to utilize an implementation science framework to examine barriers and facilitators to group well child care (WCC) interventions for parents with opioid use disorder and their children. The researchers conducted a qualitative study using structured phone interviews as a component of the planning phase of a trial of group WCC. Eligible parents were English speaking and had a child less than two years old. Thirty-one parents and 13 pediatric clinicians participated in the interviews. 68% of parents reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. The researchers found 6 themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes including loss of privacy. Six themes emerged as implementation facilitators: 1. focus on parental OUD and recovery, 2. peer support, 3. accessibility and coordination of care, 4. clinician skill and expertise in parental OUD, 5. increased time for patient care, and 6. continuity of care.
AHRQ-funded; HS027399.
Citation: Goyal N, Gannon M, Sood E .
Group well child care for mothers with opioid use disorder: framework for implementation.
Matern Child Health J 2023 Dec; 27(suppl 1):75-86. doi: 10.1007/s10995-023-03762-w..
Keywords: Children/Adolescents, Women, Substance Abuse, Opioids, Behavioral Health
Liebschutz JM, Subramaniam GA, Stone R
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
This article described the Subthreshold Opioid Use Disorder Prevention (STOP) Trial, a cluster randomized controlled trial designed to study the efficacy of the STOP intervention to reduce risky opioid use and to prevent progression to moderate/severe opioid use disorder (OUD) in adult primary care patients with subthreshold OUD. The STOP intervention consisted of a nurse care manager providing patient-participant education and primary care provider support, brief advice delivered to patient participants about health risks of opioid misuse, and up to six sessions of telephone health coaching to motivate and support behavioral change. The authors concluded that the STOP Trial offers a potential blueprint for feasible and effective improvement of outcomes for adult subthreshold OUD patients.
AHRQ-funded; HS026120.
Citation: Liebschutz JM, Subramaniam GA, Stone R .
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
Addict Sci Clin Pract 2023 Nov 18; 18(1):70. doi: 10.1186/s13722-023-00424-8..
Keywords: Opioids, Substance Abuse, Behavioral Health, Prevention
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
Kelm JD, Aubry ST, Cain-Nielsen AH
Impact of state opioid laws on prescribing in trauma patients.
In this cross-sectional study, researchers compared oral morphine equivalents prescribed at discharge before and after the implementation of Michigan's Public Act 251, which established a state-wide policy that limited opioid prescriptions for acute pain to a 7-day supply. Subjects were adult patients who received oral opioids at discharge from a Level 1 trauma center. The findings indicated that prescription amounts for opioids in trauma patients decreased by approximately one-half following the implementation of Public Act 251; there was no compensatory increase in subsequent refill prescriptions. The researchers concluded that further work is needed to evaluate the effect of such policies on pain management and functional recovery after injury.
AHRQ-funded; HS028672; HS027788.
Citation: Kelm JD, Aubry ST, Cain-Nielsen AH .
Impact of state opioid laws on prescribing in trauma patients.
Surgery 2023 Nov; 174(5):1255-62. doi: 10.1016/j.surg.2023.08.006..
Keywords: Opioids, Policy, Medication
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Yan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Button D, Levander XA, Cook RR
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
This study evaluated how technology access (cell phone use and access to the Internet) affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The authors used data from the Rural Opioid Initiative (January 2018-March 2020), which was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. They found that out of 3,026 participants, 71% used heroin and 76% used methamphetamine with 35% having no cell phone and 10% having no prior 30-day Internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use and a higher likelihood of SUD counseling in the prior 30 days. Lack of cell phone was associated with decreased days of MOUD and a lower likelihood of prior 30-day SUD counseling.
AHRQ-funded; HS026370.
Citation: Button D, Levander XA, Cook RR .
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
J Rural Health 2023 Sep; 39(4):772-79. doi: 10.1111/jrh.12737..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Telehealth, Health Information Technology (HIT), Opioids, Rural/Inner-City Residents
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns
Rolfzen ML, Wick A, Mascha EJ
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
This study tested the hypothesis that a decision-support tool embedded in electronic health records (EHRs) leads clinicians to prescribe fewer opioids at discharge after inpatient surgery. Over 21,000 surgical inpatient discharges in a cluster randomized multiple crossover trial in four Colorado hospitals were included. The results indicated that within the context of vigorous opioid education and awareness efforts a decision-support tool incorporated into EHRs did not reduce discharge opioid prescribing for postoperative patients. The authors concluded that opioid prescribing alerts might be valuable in other contexts.
AHRQ-funded; HS027795.
Citation: Rolfzen ML, Wick A, Mascha EJ .
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
Anesthesiology 2023 Aug 1; 139(2):186-96. doi: 10.1097/aln.0000000000004607..
Keywords: Opioids, Medication, Surgery, Inpatient Care, Clinical Decision Support (CDS), Health Information Technology (HIT)
Miller-Rosales C, Busch SH, Meara ER
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
This study examined the extent of screening for opioid use and availability of medications for opioid use disorder (MOUD) in a national cross-section of multi-physician primary care and multispecialty practices. The authors found that a total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Offering of MOUD in a practice was associated with having advanced HIT functionality, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Busch SH, Meara ER .
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
Med Care Res Rev 2023 Aug; 80(4):410-22. doi: 10.1177/10775587231162681..
Keywords: Opioids, Substance Abuse, Behavioral Health, Screening, Medication, Practice Patterns
Decker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Bunting AM, Schwartz RP, Wu LT
A brief screening and assessment tool for opioid use in adults: results from a validation study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.
The objective of this secondary analysis was to evaluate opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care The findings showed that TAPS opioid items could be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings. The researchers noted that further testing in a larger population sample might be warranted, given the brevity, simplicity, and accuracy of self-administration.
AHRQ-funded; HS026120.
Citation: Bunting AM, Schwartz RP, Wu LT .
A brief screening and assessment tool for opioid use in adults: results from a validation study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool.
J Addict Med 2023 Jul-Aug; 17(4):471-73. doi: 10.1097/adm.0000000000001139..
Keywords: Opioids, Screening, Substance Abuse, Behavioral Health, Primary Care
Thakrar AP, Faude S, Perrone J
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
This study’s aim was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal. The study was conducted in 3 emergency departments in an urban, academic health system from January 1, 2020, to December 31, 2021. It included patients with opioid use disorder, detectable urine fentanyl or norfentanyl, and Clinical Opiate Withdrawal Scale (COWS) recorded within 6 hours of urine drug testing. Primary exposure measured was urine fentanyl concentration stratified as high (>400 ng/mL), medium (40-399 ng/mL), or low (<40 ng/mL). COWS was used to measure opioid withdrawal severity within 6 hours before or after urine specimen collection. A total of 1127 patients were included in the sample, with a mean age (SD) of 40.0 (10.7), 384 (34.1%) identified as female, 332 (29.5%) reported their race/ethnicity as non-Hispanic Black, and 658 (58.4%) reported their race/ethnicity as non-Hispanic White. For patients with high urine fentanyl concentrations, the adjusted mean COWS was 4.4 (3.9-4.8) compared with 5.5 (5.1-6.0) among those with medium and 7.7 (6.8-8.7) among those with low fentanyl concentrations.
AHRQ-funded; HS026372.
Citation: Thakrar AP, Faude S, Perrone J .
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
J Addict Med 2023 Jul-Aug; 17(4):447-53. doi: 10.1097/adm.0000000000001155..
Keywords: Opioids, Medication, Emergency Department, Substance Abuse
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Short VL, Abatemarco DJ, Sood E
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Group-based well child care is a shared medical appointment where families join as a group to receive pediatric primary care. Prior research indicates that this method of receiving care increases patient-reported satisfaction and adherence to recommended care. There is little evidence supporting the use of group well child care for mothers with opioid use disorder. The purpose of the Child Healthcare at MATER Pediatric Study (CHAMPS) is to assess a group model of well child care for mothers with opioid use disorder and their children to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care. A total of 108 mother-child dyads will be enrolled into the study. In the intervention branch, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control branch will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study branches will be followed for 18 months, and their resulting data will be compared. Primary outcomes will include well child care quality and utilization, child health knowledge, and parenting quality.
AHRQ-funded; HS027399.
Citation: Short VL, Abatemarco DJ, Sood E .
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Trials 2023 May 17; 24(1):333. doi: 10.1186/s13063-023-07357-2..
Keywords: Children/Adolescents, Opioids, Substance Abuse, Behavioral Health
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Short VL, Gannon M, Sood E
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
The objectives of this qualitative study were to gather in-depth information regarding maternal and clinician-reported factors that facilitate or hinder well-child care (WCC) engagement as well as information from mothers' experiences during WCC visits. Thirty mothers in treatment for parental opioid use disorder (OUD) and 13 clinicians working at a pediatric primary care clinic participated by completing one telephone session which involved a brief questionnaire followed by a semi-structured interview. Facilitators identified by mothers and clinicians, included continuity of care, addressing material needs, and clinician OUD training and knowledge. Barriers to WCC included: stigma toward mothers with OUD, gaps in basic parenting knowledge, competing specialized health care needs, and insufficient time to address concerns.
AHRQ-funded; HS027399.
Citation: Short VL, Gannon M, Sood E .
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
Acad Pediatr 2023 Mar;23(2):425-33. doi: 10.1016/j.acap.2022.07.013.
Keywords: Children/Adolescents, Family Health and History, Opioids, Substance Abuse, Behavioral Health, Caregiving, Patient and Family Engagement
Cook RR, Foot C, Arah OA
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
The co-use of stimulants and opioids is increasing rapidly. Medications for opioid use disorder (MOUD) have demonstrated efficacy in randomized clinical trials (RCTs), but stimulant use may decrease the likelihood of initiating MOUD treatment. Moreover, trial participants may not represent "real-world" populations who would benefit from treatment. The study analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The study found that in RCTs, stimulant use reduced the likelihood of MOUD initiation by 32%. Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment and adults entering OUD treatment. The association was more pronounced, but still non-significant among rural people injecting drugs. Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population. The researchers concluded that stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, particularly among rural people injecting drugs, who already face limited access to MOUD.
AHRQ-funded; HS026370.
Citation: Cook RR, Foot C, Arah OA .
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
Addict Sci Clin Pract 2023 Feb 14; 18(1):11. doi: 10.1186/s13722-023-00364-3..
Keywords: Substance Abuse, Behavioral Health, Opioids, Medication