Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder

Jones, Christopher M.; McCance‐Katz, Elinore F.

doi:10.1111/add.14436

Cited by 129 publications

(132 citation statements)

References 30 publications

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“…In fact, providing medications for OUD for individuals in the criminal justice system, particularly those in the high‐risk postincarceration period, shows promise in reducing overdose death rates . Yet, the lack of available medication treatment remains a serious gap in the system of care for OUD …”

Section: Public Health Responsesmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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The roots of the remarkably lethal U.S. opioid crisis are complex and inextricably entangled with healthcare, especially in its treatment of another serious health problem: pain. Failures of the healthcare system—including lack of both training in pain management and caution in using an addictive class of medications—precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host–agent–environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the “vector” to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host–agent–vector–environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical‐related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.

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Section: Public Health Responsesmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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“…Induced by the healthcare system: The barriers include lack of full or proper insurance coverage (e.g., in the California Medicaid program, naloxone is covered as an FFS medication, and managed care plans like capitation do not cover the drug), high costs of medications, limited number of providers/counselors resulting in a dearth of programs or long waiting lists, a low percentage of licensed physicians having a secured waiver that is required to provide MAT or the majority of counties lacking a treatment-waivered physician, insufficient education among pharmacists (this can be resolved by educational materials through improved FDA-approved formulations), the short-term period of opioid substitution programs, and bureaucratic requirements for program entry/enrollment [ 73 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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“…28 Increasing the share of primary care providers who have waivers from the Drug Enforcement Administration to prescribe buprenorphine for OUD (estimated to be just 3.0% of primary care physicians in 2012) 29 and addressing deficits in clinician education about SUDs and associated treatment 30 and institutional and financial barriers for providing treatment, including MAT, could also help reduce OUD and SUD treatment gaps among parents. 31 In addition, treatment initiation can be impeded by lack of insurance coverage and by insurance-related barriers such as prior authorization and cost sharing. 32 Addressing these issues could increase the share of parents with OUD and other SUDs who are receiving evidence-based treatment, which in turn could improve the health and functioning of parents and their children, protect child welfare, and preserve or reunify families.…”

Section: Discussionmentioning

confidence: 99%

Opioid and Substance Use Disorder and Receipt of Treatment Among Parents Living With Children in the United States, 2015-2017

et al. 2019

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PURPOSE Little is known about the prevalence of opioid use disorder (OUD) among parents who are living with children and their receipt of treatment, which could reduce the harmful effects of OUD on families. METHODS We used 2015-2017 cross-sectional national survey data to estimate prevalence and treatment of opioid use disorder and other substance use disorders (SUD) among parents living with children. RESULTS An estimated 623,000 parents with opioid use disorder are living with children, and less than one-third of these parents received treatment for illicit drug or alcohol use at a specialty facility or doctor's office. Treatment rates were even lower among the more than 4,000,000 parents estimated to have other SUDs. CONCLUSION Many parents in both groups have concurrent mental health issues, including suicidal thoughts and behavior. Primary care practices can play a critical role in screening and facilitating treatment initiation.

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Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder

Abstract: US clinicians recently waivered to prescribe buprenorphine for opioid use disorder treatment appear to prescribe well below their patient limit, and many do not prescribe at all.

Cited by 129 publications

References 30 publications

Epidemiology of the U.S. opioid crisis: the importance of the vector

Epidemiology of the U.S. opioid crisis: the importance of the vector

Misalignment of Stakeholder Incentives in the Opioid Crisis

Opioid and Substance Use Disorder and Receipt of Treatment Among Parents Living With Children in the United States, 2015-2017

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