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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 16 of 16 Research Studies Displayed
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.
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
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.
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
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.
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
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.
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
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.
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
Ali MM, McClellan C, West KD
AHRQ Author: McClellan C
Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States.
This study examined whether state medical marijuana laws (MMLs) was associated with lower levels of opioid-related outcomes. Data was drawn from the 2002-2014 National Survey on Drug Use and Health to compare opioid misuse in states with and without MMLs among all women, pregnant women, and parenting women. It also invested the impact of MMLs on marijuana use and marijuana use disorder. There was found to be no association of MMLs with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women and parenting women. However there was a positive correlation with marijuana use and marijuana use disorder among all women and women with children. MMLs were also associated with an increase in the frequency of opioid misuse in pregnant women and a decrease in the frequency of opioid misuse for parenting women.
Citation: Ali MM, McClellan C, West KD . Medical marijuana laws, marijuana use, and opioid-related outcomes among women in the United States. Womens Health Issues 2021 Jan-Feb;31(1):24-30. doi: 10.1016/j.whi.2020.09.003..
Keywords: Women, Opioids, Substance Abuse, Medication, Policy, Practice Patterns
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
Citation: Kuhns LM, Carlino B, Greeley K . A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice. Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Newberry CI, Casazza GC, Pruitt LC
Prescription patterns and opioid usage in sinonasal surgery.
The goal of this study was to identify factors associated with variable opioid usage and to delineate optimal prescription patterns for sinonasal surgery. The researchers found that patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery. They concluded that opioids are overprescribed after sinonasal surgery and that the amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed.
Citation: Newberry CI, Casazza GC, Pruitt LC . Prescription patterns and opioid usage in sinonasal surgery. Int Forum Allergy Rhinol 2020 Mar;10(3):381-87. doi: 10.1002/alr.22478..
Keywords: Opioids, Medication, Pain, Surgery, Respiratory Conditions, Healthcare Utilization, Practice Patterns, Substance Abuse
Abbasi AB, Salisbury-Afshar E, Berberet CE
Opioid prescribing patterns before fatal opioid overdose.
This study examined opioid prescribing patterns the year before death of 1,893 Illinois residents who died of an opioid-related overdose in 2016. Their prescription records were linked in from existing Prescription Monitoring Program records. The majority (1,461) died from illicit opioids and only 309 deaths involved prescription opioids. For the residents who used prescription opioids, 76% filled 10.7 prescriptions per decedent compared with 36% of illicit opioid users totaling 2.6 prescriptions per decedent. Death rates were twice as high for black residents with illicit opioids than white residents. The authors concluded that prescribing patterns alone may be not sufficient to identify patients at high risk for opioid overdose, especially for those using illicit opioids.
Citation: Abbasi AB, Salisbury-Afshar E, Berberet CE . Opioid prescribing patterns before fatal opioid overdose. Am J Prev Med 2020 Feb;58(2):250-53. doi: 10.1016/j.amepre.2019.09.022..
Keywords: Opioids, Substance Abuse, Medication, Practice Patterns
Heins SE, Frey KP, Alexander GC
Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017.
This paper looked at current state-level policies in the United States from January 2007-May 2017 limiting high morphine equivalent daily dose (MEDD) prescribing. State-level threshold policies were reviewed using LexisNexis and Westlaw Next for legislative acts and Google for nonlegislative state-level policies. State websites were also reviewed to identify additional policies. Policies were then independently double-coded on the categories: state, agency/organization, policy type, effective date, threshold level, and policy exceptions. Currently 22 states have at least 1 MEDD policy, most commonly guidelines (14 states). Other states have prior authorizations (4 states), rules/regulations (4 states), legislative acts (3 states), claim denials (2 states), and alert systems/automatic patient reports (2 states). Thresholds vary widely (30-300 mg MEDD), with higher thresholds corresponding to more restrictive policies (claim denial), and lower thresholds corresponding to less restrictive policies (guidelines). The majority of policies exclude patients with terminal illnesses or acute pain.
Citation: Heins SE, Frey KP, Alexander GC . Reducing high-dose opioid prescribing: state-level morphine equivalent daily dose policies, 2007-2017. Pain Med 2020 Feb;21(2):308-16. doi: 10.1093/pm/pnz038..
Keywords: Opioids, Medication, Policy, Practice Patterns, Substance Abuse
Tam CA, Dauw CA, Ghani KR
New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.
The purpose of this study was to measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. The investigators concluded that nearly 1 in 16 opioid-naive patients developed new persistent opioid use after URS. New persistent opioid use was associated with the amount of opioid prescribed at the time of URS. The authors suggest that, given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.
AHRQ-funded; HS024525; HS024728.
Citation: Tam CA, Dauw CA, Ghani KR . New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment. Urology 2019 Dec;134:103-08. doi: 10.1016/j.urology.2019.08.042..
Keywords: Opioids, Medication, Substance Abuse, Surgery, Practice Patterns
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
Citation: Springer R, Marino M,, Bailey SR . Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon. Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Sekhri S, Arora NS, Cottrell H
Probability of opioid prescription refilling after surgery: does initial prescription dose matter?
In this study, the investigators sought to determine the correlation between the probability of postoperative opioid prescription refills and the amount of opioid prescribed, hypothesizing that a greater initial prescription yields a lower probability of refill. The investigators concluded that the probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests.
Citation: Sekhri S, Arora NS, Cottrell H . Probability of opioid prescription refilling after surgery: does initial prescription dose matter? Ann Surg 2018 Aug;268(2):271-76. doi: 10.1097/sla.0000000000002308..
Keywords: Medication, Opioids, Pain, Practice Patterns, Substance Abuse, Surgery
Axeen S, Seabury SA, Menchine M
Emergency department contribution to the prescription opioid epidemic.
The investigators used MEPS data to characterize the relative contribution of emergency departments (EDs) to national opioid prescribing, to estimate trends in opioid prescribing by site of care, and to examine whether higher-risk opioid users receive a disproportionate quantity of their opioids from ED settings. During the study period, they found that the relative contribution of EDs to the prescription opioid problem was modest and declining. They therefore recommended that further efforts to reduce the quantity of opioids prescribed focus on office-based settings.
Citation: Axeen S, Seabury SA, Menchine M . Emergency department contribution to the prescription opioid epidemic. Ann Emerg Med 2018 Jun;71(6):659-67.e3. doi: 10.1016/j.annemergmed.2017.12.007..
Keywords: Behavioral Health, Emergency Department, Medical Expenditure Panel Survey (MEPS), Medication, Opioids, Practice Patterns, Substance Abuse
Cook B, Creedon T, Wang Y
Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.
Electronic health record data from a large healthcare system were used to describe racial/ethnic, sex, and age differences in benzodiazepines (BZD) use and dependence. Among patients with a BZD prescription, the investigators assessed differences in: 1.) the likelihood of subsequently receiving a BZD dependence diagnosis, 2.) the number of BZD prescriptions, 3.) receiving only one BZD prescription, and 4.) receiving 18 or more BZD prescriptions.
Citation: Cook B, Creedon T, Wang Y . Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse. Drug Alcohol Depend 2018 Jun 1;187:29-34. doi: 10.1016/j.drugalcdep.2018.02.011..
Keywords: Medication, Practice Patterns, Racial and Ethnic Minorities, Substance Abuse
Smith RJ, Kilaru AS, Perrone J
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
The authors examined how emergency physicians use Prescription Drug Monitoring Programs (PDMPs), for which patients, and for what reasons. They found that providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians used the databases additionally for improving their ability to facilitate discussions on addiction and for providing patient education. The authors recommended minimizing administrative barriers to PDMP access and suggested that alternative PDMP uses be further studied to determine their appropriateness and potentially expand their role in clinical practice.
Citation: Smith RJ, Kilaru AS, Perrone J . How, why, and for whom do emergency medicine providers use prescription drug monitoring programs? Pain Med 2015 Jun;16(6):1122-31. doi: 10.1111/pme.12700.
Keywords: Decision Making, Emergency Medical Services (EMS), Medication, Practice Patterns, Substance Abuse