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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 43 Research Studies DisplayedAli MM, McClellan C, Mutter R
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
Mackie TI, Schaefer AJ, Palatucci JS
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
The purpose of this sequential multi-method study was to propose a classification for the procedural elements of informed consent policies based upon existing child welfare policies and then explored whether formal state policies across the United States authorized these elements. The researchers conducted interviews with 58 key informants primarily from state child welfare agencies to identify a classification of procedural elements for informed consent of psychotropic medications. A legislative review of the 50 states and D.C. was then conducted to characterize whether formal policies endorsed each procedural element. Key informants reported five procedural elements in policy, and 23 states endorsed relevant legislation. Only two states specified all five procedural elements, and the content of any procedural elements varied considerably across policies.
AHRQ-funded; HS02198501; HS026001
Citation: Mackie TI, Schaefer AJ, Palatucci JS .
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
Adm Policy Ment Health 2022 Nov;49(6):986-1003. doi: 10.1007/s10488-022-01212-3..
Keywords: Children/Adolescents, Vulnerable Populations, Medication, Behavioral Health, Policy
Tzeng HM, Raji MA, Chou LN
Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: a national study in the United States.
The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. The investigators found that the PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018.
AHRQ-funded; HS020642.
Citation: Tzeng HM, Raji MA, Chou LN .
Impact of state nurse practitioner regulations on potentially inappropriate medication prescribing between physicians and nurse practitioners: a national study in the United States.
J Nurs Care Qual 2022 Jan-Mar;37(1):6-13. doi: 10.1097/ncq.0000000000000595..
Keywords: Medication, Medication: Safety, Provider: Nurse, Adverse Drug Events (ADE), Adverse Events, Policy
Cerda M, Wheeler-Martin K, Bruzelius E
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
The authors investigated the impact of pain management clinic laws. They analyzed data on county-level, opioid overdose deaths via the National Vital Statistics System and patients filling long-duration or high-dose opioid prescriptions in the US 2010-2018. Their findings suggested that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raised concerns regarding unintended consequences on heroin/synthetic overdoses.
AHRQ-funded; HS023258.
Citation: Cerda M, Wheeler-Martin K, Bruzelius E .
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
Am J Epidemiol 2021 Dec;190(12):2592-603. doi: 10.1093/aje/kwab192..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Practice Patterns, Policy
Heins SE, Castillo RC
Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population.
The study’s objective was to evaluate the impact of state-level morphine equivalent daily dose (MEDD) policies on opioid prescribing among the privately insured using claims data from 9 policy states and 2 control states and a comparative interrupted time series design. Findings showed that MEDD policies were associated with decreased use of any opioids relative to control states, but with no change in high-dose prescribing. Recommendations included further research to understand the mechanisms through which MEDD policies may influence prescribing behavior.
AHRQ-funded; HS025557.
Citation: Heins SE, Castillo RC .
Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population.
Med Care 2021 Sep;59(9):801-07. doi: 10.1097/mlr.0000000000001587..
Keywords: Opioids, Medication, Policy, Practice Patterns
Mackie TI, Kovacs KM, Simmel C
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
This study utilized a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs, specifically in foster care children. Relevant parties included policymakers (n = 31), foster care alumni (n = 28), caseworkers (n=23), prescribing clinicians (n = 32), and caregivers (n = 18). Participants received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important. Safety indicators ranked among the top three candidate outcomes across respondent groups. Foster care alumni put “antipsychotic treatment reduction” and “increased psychosocial treatment” as the highest ranking. Caseworkers, prescribers, and caregivers gave top priority to “increased follow-up after treatment initiation”. Potential unintended consequences ranked lowest, including increased use of other psychotropic medication classes, increased psychiatric hospital stays, and increased emergency room utilization.
AHRQ-funded; HS026001.
Citation: Mackie TI, Kovacs KM, Simmel C .
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
Health Serv Res 2021 Jun;56(3):418-31. doi: 10.1111/1475-6773.13610..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Policy
Ali MM, McClellan C, West KD
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.
AHRQ-authored.
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
Toce MS, Michelson K, Hudgins J
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies. The purpose of this study was to examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.
AHRQ-funded; HS026503.
Citation: Toce MS, Michelson K, Hudgins J .
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
JAMA Pediatr 2020 Oct;174(10):961-68. doi: 10.1001/jamapediatrics.2020.1980..
Keywords: Children/Adolescents, Opioids, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Policy
Akincigil A, Mackie TI, Cook S
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
This retrospective observation study examined the effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children. Data was analyzed from Medicaid Analytical eXtracts (MAX) with administrative claims from 2006-2011 in Washington State. Within two years of policy implementation, prescription prevalence decreased from 6.17 to 4.04 while the synthetic control group remained stable at 6.47. The results show the effectiveness of the peer review program.
AHRQ-funded; HS026001.
Citation: Akincigil A, Mackie TI, Cook S .
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
Health Serv Res 2020 Aug;55(4):596-603. doi: 10.1111/1475-6773.13297..
Keywords: Children/Adolescents, Medication, Medicaid, Policy
Green TC, Davis C, Xuan Z
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Researchers sought to examine early impacts of laws that require naloxone to be prescribed to patients at increased overdose risk. Data from CVS Pharmacy 90 days before and after the naloxone-prescribing mandates took effect in Arizona, Florida, Rhode Island, Vermont, and Virginia were examined. The researchers concluded that mandating the prescribing of naloxone quickly expands access to this life-saving medication for more people in more places. They recommended that other states consider mandating the co-prescription of naloxone to individuals at increased risk of overdose.
AHRQ-funded; HS024021.
Citation: Green TC, Davis C, Xuan Z .
Laws mandating coprescription of naloxone and their impact on naloxone prescription in five US states, 2014-2018.
Am J Public Health 2020 Jun;110(6):881-87. doi: 10.2105/ajph.2020.305620..
Keywords: Policy, Medication, Substance Abuse, Opioids
Maclean JC, Halpern MT, Hill SC
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
The purpose of this study was to quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data from the Medicaid State Drug Utilization Database was used. Findings showed that Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
AHRQ-authored.
Citation: Maclean JC, Halpern MT, Hill SC .
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
Health Serv Res 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289..
Keywords: Medicaid, Cancer: Breast Cancer, Cancer, Medication, Policy, Women, Healthcare Utilization, Access to Care, Health Insurance
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Tseng CW, Masuda C, Chen R
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
In this study, the investigators examined how patients’ out-of-pocket costs for insulin would have dropped from 2014 to 2019 due to Part D policy changes and whether higher insulin prices offset these potential savings. The authors concluded that efforts to reduce patients’
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
out-of-pocket cost by closing the Medicare Part D coverage gap were largely negated by higher insulin prices.
AHRQ-funded; HS024227.
Citation: Tseng CW, Masuda C, Chen R .
Impact of higher insulin prices on out-of-pocket costs in Medicare Part D.
Diabetes Care 2020 Apr;43(4):e50-e51. doi: 10.2337/dc19-1294..
Keywords: Medication, Healthcare Costs, Medicare, Health Insurance, Policy
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.
AHRQ-funded; HS025557.
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
Solotke MT, Ross JS, Shah ND
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
This study investigated whether Medicare prescription drug plan formulary restrictions were enacted after the FDA issued black box warnings for drugs that are now considered problematic. Investigators looked at drugs that were issued new or updated black box warnings from 2008 to 2015 and found there was only a 3% decrease in drug formularies providing unrestricted prescriptions.
AHRQ-funded; HS025164.
Citation: Solotke MT, Ross JS, Shah ND .
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
J Manag Care Spec Pharm 2019 Nov;25(11):1201-17. doi: 10.18553/jmcp.2019.25.11.1201..
Keywords: Medication, Medicare, Policy
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.
AHRQ-funded; HS024270.
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
Hung A, Mullins CD, Slejko JF
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
This study projected cost savings to the TRICARE program from changes to the antidiabetic formulary and utilization management (UM) policies. Budgetary impacts for 3 years as projected using a Microsoft Excel spreadsheet. This model projected a savings of up to $43 million in the third year from revisions to the payer’s formulary.
AHRQ-funded; HS024857.
Citation: Hung A, Mullins CD, Slejko JF .
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
J Manag Care Spec Pharm 2019 Mar;25(3):342-49. doi: 10.18553/jmcp.2019.25.3.342..
Keywords: Care Management, Elderly, Healthcare Costs, Medication, Policy
Shaker MS, Greenhawt MJ
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
Children experiencing anaphylaxis at school may lack access to a personal epinephrine device, prompting recent legislation permitting undesignated (eg, non-student specific) stock epinephrine autoinjector units at school. However, epinephrine device costs vary, and the cost-effectiveness of undesignated school stock epinephrine is uncharacterized to date. The objective of this study was to define value-based strategies for undesignated school stock epinephrine programs.
AHRQ-funded; HS024599.
Citation: Shaker MS, Greenhawt MJ .
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
JAMA Pediatr 2019 Feb;173(2):169-75. doi: 10.1001/jamapediatrics.2018.4275..
Keywords: Healthcare Costs, Education, Policy, Medication
Rees DI, Sabia JJ, Argys LM
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
This study examined the effect of good Samaritan and naxolone access laws (NALs) on opioid-related mortality. Most states have adopted these laws, and the early adopters had the most negative association between NALs and overdose deaths. There was a negative but not statistically significant effect on opioid-related deaths for states with Good Samaritan laws.
AHRQ-funded; HS025014.
Citation: Rees DI, Sabia JJ, Argys LM .
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
J Law Econ 2019 Feb;62(1). doi: 10.1086/700703..
Keywords: Opioids, Mortality, Policy, Medication
Davis CS, Green TC, Hernandez-Delgado H
Status of US state laws mandating timely reporting of nonfatal overdose.
Timely, actionable, nonfatal overdose data are urgently needed to improve public health response to the overdose crisis. The purpose of this paper was to provide background and catalyze discussion regarding this important issue. The authors briefly report the results of a systematic analysis of state laws mandating reporting of nonfatal overdose, and provide suggestions for improving the collection and use of nonfatal overdose data to improve the public health response to this ongoing epidemic.
AHRQ-funded; HS024021.
Citation: Davis CS, Green TC, Hernandez-Delgado H .
Status of US state laws mandating timely reporting of nonfatal overdose.
Am J Public Health 2018 Sep;108(9):1159-61. doi: 10.2105/ajph.2018.304589..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Opioids, Policy, Public Health, Substance Abuse
Johnston K, Alley L, Novak K
Pharmacists' attitudes, knowledge, utilization, and outcomes involving prescription drug monitoring programs: a brief scoping review.
Researchers sought to identify and synthesize findings from current literature on community pharmacists' attitudes toward, knowledge of, and registration and utilization behaviors regarding prescription drug monitoring programs (PDMPs). While considered studies varied greatly in methodological approach, generally, pharmacists' attitudes and knowledge of PDMPs positively influenced likelihood to register and use state's program. The researchers recommended pharmacist-targeted PDMPs and opioid safety training in order to increase knowledge of and insight into behavioral change.
AHRQ-funded; HS024227.
Citation: Johnston K, Alley L, Novak K .
Pharmacists' attitudes, knowledge, utilization, and outcomes involving prescription drug monitoring programs: a brief scoping review.
J Am Pharm Assoc 2018 Sep - Oct;58(5):568-76. doi: 10.1016/j.japh.2018.06.003..
Keywords: Medication, Provider: Pharmacist, Policy
Baker MA, Butler MG, Seymour S
The impact of FDA regulatory activities on incident dispensing of LABA-containing medication: 2005-2011.
In this study, the authors described the impact of the regulatory activities on incident long-acting beta2-agonist (LABA)-containing medication dispensing. They concluded that the 2005 and 2010 FDA regulatory activities likely had an impact on communicating the safety concerns of LABA products but cautioned that the impact cannot be viewed independent of scientific publications, guidelines for asthma treatment, and other regulatory activities.
AHRQ-funded; HS019669; HS022093.
Citation: Baker MA, Butler MG, Seymour S .
The impact of FDA regulatory activities on incident dispensing of LABA-containing medication: 2005-2011.
J Asthma 2018 Aug;55(8):907-14. doi: 10.1080/02770903.2017.1378355..
Keywords: Medication, Policy
Myerson R, Lu T, Tonnu-Mihara I
Medicaid eligibility expansions may address gaps in access to diabetes medications.
The purpose of this study was to examine the impacts of Medicaid expansion on access to diabetes medications, researchers analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. The researchers found that the increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively.
AHRQ-funded; HS023964.
Citation: Myerson R, Lu T, Tonnu-Mihara I .
Medicaid eligibility expansions may address gaps in access to diabetes medications.
Health Aff 2018 Aug;37(8):1200-07. doi: 10.1377/hlthaff.2018.0154..
Keywords: Access to Care, Diabetes, Policy, Medicaid, Medication
Klara K, Kim J, Ross JS
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
Direct-to-consumer (DTC) advertisements for prescription drugs in the United States are regulated by the Food and Drug Administration (FDA). Off-label promotion, or the advertisement of a drug for an indication not approved by the FDA, is prohibited. The objective of this study was to examine the presence of off-label promotion in broadcast DTC ads and to assess their adherence to FDA guidelines mandating fair balance in presentation of risks and benefits and prohibiting misleading advertisement claims.
AHRQ-funded; HS022882.
Citation: Klara K, Kim J, Ross JS .
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
J Gen Intern Med 2018 May;33(5):651-58. doi: 10.1007/s11606-017-4274-9..
Keywords: Medication, Guidelines, Policy, Communication
Kafali N, Progovac A, Hou SS
Long-run trends in antidepressant use among youths after the FDA black box warning.
This study analyzed long-run trends in antidepressant use among children before and after the black box warning for those with and without severe psychological impairment. It concluded that in the long run (2008-2011), however, there was no statistically significant difference. This return to the rates before the black box warning raises concern that the impact of the warning may have dissipated over time.
AHRQ-funded; HS021486.
Citation: Kafali N, Progovac A, Hou SS .
Long-run trends in antidepressant use among youths after the FDA black box warning.
Psychiatr Serv 2018 Apr;69(4):389-95. doi: 10.1176/appi.ps.201700089.
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Keywords: Medication, Children/Adolescents, Healthcare Utilization, Medical Expenditure Panel Survey (MEPS), Policy
