Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019”

Krawczyk, Noa; Rivera, Bianca; Jent, Victoria; Keyes, Katherine M.; Jones, Christopher M.; Cerdá, Magdalena

doi:10.1016/j.drugpo.2022.103786

Cited by 174 publications

(100 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In recent years the epidemic has been fueled by potent synthetic opioids (fentanyl and analogues), often surreptitiously mixed with heroin, which have become the main driver of opioid overdose deaths (Ochalek et al, 2019;Jones et al, 2020). Recent adjusted estimates suggest past-year OUD affected 7,6 million Americans aged 12 or older in 2019, with approximately 86.6% of those not receiving treatment for OUD (Krawczyk et al, 2022). Lately, the opioid crisis has been compounded by the coronavirus disease 2019 (COVID-19) pandemic as well as co-use or contamination of psychostimulants with illicitly manufactured fentanyl or heroin (Jones et al, 2020;Niles et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Buprenorphine exposure levels to optimize treatment outcomes in opioid use disorder

et al. 2022

View full text Add to dashboard Cite

The severity of the ongoing opioid crisis, recently exacerbated by the COVID-19 pandemic, emphasizes the importance for individuals suffering from opioid use disorder (OUD) to have access to and receive efficacious, evidence-based treatments. Optimal treatment of OUD should aim at blocking the effects of illicit opioids while controlling opioid craving and withdrawal to facilitate abstinence from opioid use and promote recovery. The present work analyses the relationship between buprenorphine plasma exposure and clinical efficacy in participants with moderate to severe OUD using data from two clinical studies (39 and 504 participants). Leveraging data from placebo-controlled measures assessing opioid blockade, craving, withdrawal and abstinence, we found that buprenorphine plasma concentrations sustained at 2–3 ng/ml (corresponding to ≥70% brain mu-opioid receptor occupancy) optimized treatment outcomes in the majority of participants, while some individuals (e.g., injecting opioid users) needed higher concentrations. Our work also included non-linear mixed effects modeling and survival analysis, which identified a number of demographic, genetic and social factors modulating treatment response and retention. Altogether, these findings provide key information on buprenorphine plasma levels that optimize clinical outcomes and increase the likelihood of individual treatment success. NLM identifiers: NCT02044094, NCT02357901.

show abstract

Section: Introductionmentioning

confidence: 99%

Buprenorphine exposure levels to optimize treatment outcomes in opioid use disorder

et al. 2022

View full text Add to dashboard Cite

show abstract

“…1, 2 Due to the stigma associated with addiction, it is extremely difficult to even quantify how many OUD patients are in the US with estimates as high as 7.6 million. 43 Clearly, further efforts to increase MOUD availability and reduce barriers are pressing public health needs.…”

Section: Discussionmentioning

confidence: 99%

Pronounced State Level Disparities in Medicaid Prescribing of Buprenorphine for Opioid Use Disorder (2019-2020)

Dana

Nichols²,

McCall

et al. 2022

Preprint

View full text Add to dashboard Cite

Objective: To analyze buprenorphine prescription distribution across states in Medicaid patients during 2019-2020. Methods: Buprenorphine prescriptions per Medicaid enrollee per state was calculated for 2019 and 2020. The totals of monoproduct buprenorphine were divided over the total of combination buprenorphine/naloxone in 2019 and 2020 to obtain the ratio of mono/combo. Data analysis was conducted with generic and brand name formulations of buprenorphine, and transmucosal buprenorphine/ naloxone combinations FDA- approved for OUD using Microsoft Excel. Formulations of buprenorphine indicated for pain were excluded. States outside 95% confidence intervals (mean +1.96*SD) were considered statistically significant. Results: The overall change in buprenorphine prescribing between 2019 and 2020 was modest (+3.6%) but highly variable with > 10% increases in 17 states (Iowa = +100.5%, p < 0.05) but > 10% decrease in nine states (Alabama = -68.5%, p < 0.05). Total amount reimbursed in 2019 increased (+9.9%) to $1.42 billion in 2020. Branded formulations accounted for two-fifths (39.5%) of prescribing but over two-thirds (66.8%) of spending in 2020. There was a 50-fold difference in prescribing between the highest (Vermont = 219.5 prescription / 1,000 enrollees, p < 0.05) and lowest (Texas = 4.4) states in 2019. This disparity increased in 2020 resulting in a 278-fold difference. Conclusions: The COVID-19 pandemic exacerbated state-level disparities in buprenorphine prescribing for OUD among Medicaid patients. Legislation on buprenorphine waivered providers and Medicaid expansion may explain the statistically significant percent changes in state buprenorphine prescriptions. Keywords Medication for OUD; pharmacoepidemiology; COVID-19; medication policy

show abstract

“…The American Society of Addiction Medicine (ASAM) National Practice Guidelines recommend using a patient-centered, evidence-based treatment approach with FDA-approved MOUD in addition to psychosocial counseling for the treatment of OUD [9]. However, 2019 adjusted estimates suggest past-year OUD affected 7,631,804 individuals in the US (2,773 per 100,000 adults 12 years or older), relative to only 1,023,959 individuals who received MOUD (365 per 100,000 adults 12 years or older) [10]. This implies that approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it [10].…”

Section: Introductionmentioning

confidence: 99%

“…However, 2019 adjusted estimates suggest past-year OUD affected 7,631,804 individuals in the US (2,773 per 100,000 adults 12 years or older), relative to only 1,023,959 individuals who received MOUD (365 per 100,000 adults 12 years or older) [10]. This implies that approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it [10]. Treatment with MOUD increased across most states from 2010 to 2019, but many regions still experience wide gaps between OUD prevalence and treatment with MOUD [10].…”

Section: Introductionmentioning

confidence: 99%

“…This implies that approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it [10]. Treatment with MOUD increased across most states from 2010 to 2019, but many regions still experience wide gaps between OUD prevalence and treatment with MOUD [10]. Based on a survey assessing barriers for use of MOUD among current and future primary care physicians (PCPs) in South Carolina (SC), cost, insurance authorizations, and lack of PCP education and MOUD awareness limited the utilization of MOUD in practice [11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of medications for opioid use disorder on healthcare resource utilization and costs for patients served by a state Medicaid program: An exploratory retrospective matched-cohort analysis of South Carolina Medicaid claims data

Lunacsek

2022

View full text Add to dashboard Cite

Objectives: Although evidence-based recommendations from treatment guidelines support the use of medications for opioid use disorder (MOUD) in addition to psychosocial counseling, about 86.6% of patients diagnosed with opioid use disorder (OUD) do not receive MOUD and several barriers still restrict access to MOUD in the United States. This study assesses the impact of MOUD on healthcare resource utilization (HCRU) and costs for Medicaid beneficiaries.Methods: An exploratory retrospective matched-cohort analysis was performed among Medicaid patients not concurrently enrolled in Medicare using anonymized claims data from South Carolina Medicaid between 7/1/2016 and 12/31/2019. Patients newly diagnosed with OUD who received MOUD were matched based on age, gender, and race to patients who did not receive MOUD to evaluate HCRU and costs in the 6 months prior to and 12 months following initial OUD diagnosis.Results: A total of 397 matched pairs of MOUD and non-MOUD patients were identified for this analysis. A significantly lower percentage of patients had emergency department visits (63.2% vs 74.3%; P=0.0005) and hospitalizations (21.9% vs 37.8%; P<0.

show abstract

Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019”

Cited by 174 publications

References 32 publications

Buprenorphine exposure levels to optimize treatment outcomes in opioid use disorder

Buprenorphine exposure levels to optimize treatment outcomes in opioid use disorder

Pronounced State Level Disparities in Medicaid Prescribing of Buprenorphine for Opioid Use Disorder (2019-2020)

Impact of medications for opioid use disorder on healthcare resource utilization and costs for patients served by a state Medicaid program: An exploratory retrospective matched-cohort analysis of South Carolina Medicaid claims data

Contact Info

Product

Resources

About