National Healthcare Quality and Disparities Report
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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 25 of 154 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
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
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
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
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
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
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
Ali MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
AHRQ-authored.
Citation: Ali MM, McClellan C, Mutter R .
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
AHRQ-funded; HS027389.
Citation: Toseef MU, Durfee J, Podewils LJ .
Total cost of care associated with opioid use disorder treatment.
Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Carlile 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
Wei YJ, Chen C, Cheng TD
Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study’s objectives were to examine the association between incident injury after prescription opioid initiation and subsequent risk of opioid-related adverse events (ORAEs) and to assess whether the association differs by recency of injury among older patients. The researchers observed that incident diagnosis of injury following opioid initiation was associated with subsequent increased risk of ORAEs, and the risk was only significant among patients with injury in the month before the index date. They recommended regular monitoring for injury in order to identify older opioid users at high risk for ORAEs.
AHRQ-funded; HS027230.
Citation: Wei YJ, Chen C, Cheng TD .
Association of injury after prescription opioid initiation with risk for opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
PLoS Med 2022 Sep;19(9):e1004101. doi: 10.1371/journal.pmed.1004101..
Keywords: Opioids, Medication, Adverse Drug Events (ADE), Substance Abuse, Elderly, Adverse Events
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