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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 257 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
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
Kelm JD, Aubry ST, Cain-Nielsen AH
Impact of state opioid laws on prescribing in trauma patients.
In this cross-sectional study, researchers compared oral morphine equivalents prescribed at discharge before and after the implementation of Michigan's Public Act 251, which established a state-wide policy that limited opioid prescriptions for acute pain to a 7-day supply. Subjects were adult patients who received oral opioids at discharge from a Level 1 trauma center. The findings indicated that prescription amounts for opioids in trauma patients decreased by approximately one-half following the implementation of Public Act 251; there was no compensatory increase in subsequent refill prescriptions. The researchers concluded that further work is needed to evaluate the effect of such policies on pain management and functional recovery after injury.
AHRQ-funded; HS028672; HS027788.
Citation: Kelm JD, Aubry ST, Cain-Nielsen AH .
Impact of state opioid laws on prescribing in trauma patients.
Surgery 2023 Nov; 174(5):1255-62. doi: 10.1016/j.surg.2023.08.006..
Keywords: Opioids, Policy, Medication
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
Yan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
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
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns
Rolfzen ML, Wick A, Mascha EJ
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
This study tested the hypothesis that a decision-support tool embedded in electronic health records (EHRs) leads clinicians to prescribe fewer opioids at discharge after inpatient surgery. Over 21,000 surgical inpatient discharges in a cluster randomized multiple crossover trial in four Colorado hospitals were included. The results indicated that within the context of vigorous opioid education and awareness efforts a decision-support tool incorporated into EHRs did not reduce discharge opioid prescribing for postoperative patients. The authors concluded that opioid prescribing alerts might be valuable in other contexts.
AHRQ-funded; HS027795.
Citation: Rolfzen ML, Wick A, Mascha EJ .
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
Anesthesiology 2023 Aug 1; 139(2):186-96. doi: 10.1097/aln.0000000000004607..
Keywords: Opioids, Medication, Surgery, Inpatient Care, Clinical Decision Support (CDS), Health Information Technology (HIT)
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
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
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
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
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
Goodhope NR, Anderson TS, Jung Y
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
Despite the high number of people suffering from opioid addiction in the USA, access to treatment remains limited, with only a fraction of those in need receiving life-saving medications for opioid use disorder (MOUD). The current healthcare system and policies create unnecessary barriers to care, exacerbating treatment and illness burdens. This study proposes the use of a minimally disruptive medicine (MDM) framework to reduce disruptions in patients' lives, improve healthcare quality and delivery, and save lives. To achieve this, the authors suggest policy changes that expand MOUD to all healthcare settings, promote flexible and patient-centered medication choices, reduce treatment requirements, and address systemic disparities and inequities. By adopting an MDM approach, clinicians, health systems, and policymakers can create a more patient-centered and accessible care system for those battling opioid addiction.
AHRQ-funded; HS026216.
Citation: Goodhope NR, Anderson TS, Jung Y .
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
J Gen Intern Med 2023 Feb; 38(3):824-27. doi: 10.1007/s11606-022-07874-x..
Keywords: Elderly, Opioids, Medication, Dementia, Hospital Discharge
Nguyen T, Meille G, Buchmueller T
AHRQ Author: Meille G
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
This AHRQ-authored study examined how overlapping benzodiazepine and opioid prescription rates changed after Kentucky implemented a PDMP mandate in July 2012 in response to the opioid epidemic. The authors conducted an interrupted time series analysis using monthly data from Kentucky's PDMP from 2010 to 2016. They also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect. The PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. A single provider was responsible for approximately half of the immediate effect in level terms who was writing overlapping benzodiazepine and opioid prescriptions. Their longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %, with effects of the policy being largest for women and men aged 36-50.
AHRQ-authored.
Citation: Nguyen T, Meille G, Buchmueller T .
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
Drug Alcohol Depend 2023 Feb 1; 243:109759. doi: 10.1016/j.drugalcdep.2022.109759..
Keywords: Opioids, Medication, Practice Patterns
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
Varady NH, Worsham CM, Chen AF
Inappropriate prescribing of opioids for patients undergoing surgery.
This study examined inappropriate prescribing of opioids for patients undergoing surgery, in this instance prescribing them to a patient’s spouse. Among 450,125 opioid-naïve couples with commercial insurance studied, for patients who did not fill perioperative opioid prescriptions themselves, the rate of spousal fills on the day of surgery (DOS) was 2.39 fills per 1,000 surgeries compared with 0.44 fills on all other perioperative days. Increases in spousal fills were not present for patients that filled opioid prescriptions themselves.
AHRQ-funded; HS026753.
Citation: Varady NH, Worsham CM, Chen AF .
Inappropriate prescribing of opioids for patients undergoing surgery.
Proc Natl Acad Sci U S A 2022 Dec 6;119(49):e2210226119. doi: 10.1073/pnas.2210226119..
Keywords: Opioids, Medication, Surgery, Practice Patterns, Provider: Physician
Fry BT, Howard RA, Gunaseelan V
Association of postoperative opioid prescription size and patient satisfaction.
The purpose of this prospective cohort study was to assess the relationship between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. The researchers included 1,520 opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The main outcome was patient satisfaction measured on a scale of 0 to 10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). The study found that 84.1% of patients were highly satisfied and 15.9% were not highly satisfied. There was no significant association between opioid prescription size and satisfaction. The researchers concluded that in a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
AHRQ-funded; HS023313.
Citation: Fry BT, Howard RA, Gunaseelan V .
Association of postoperative opioid prescription size and patient satisfaction.
Ann Surg 2022 Dec 1;276(6):e1064-e69. doi: 10.1097/sla.0000000000004784..
Keywords: Opioids, Surgery, Medication, Patient Experience
Parikh MA, Fabiyi C, Mistry KB
AHRQ Author: Fabiyi C, Mistry KB
Factors associated with postprocedure opioid prescribing and persistent opioid use among opioid-naive patients: A nationally representative sample.
This study’s objective was to examine factors associated with postprocedure opioid receipt and persistent opioid use among opioid-naive patients in a nationally representative sample. The authors used panels 18-20 in MEPS between the years 2013 and 2015. They found that younger age, Western location, and a high-school degree were associated with higher odds of postprocedure opioid receipt. Patients who had procedures in an inpatient, outpatient, and dental setting; or musculoskeletal diagnoses and injuries were more likely to have postprocedure opioid receipt. Persistent opioid use was associated with Midwest and Northeast location, musculoskeletal diagnosis, public insurance, and positive depression screening.
AHRQ-authored.
Citation: Parikh MA, Fabiyi C, Mistry KB .
Factors associated with postprocedure opioid prescribing and persistent opioid use among opioid-naive patients: A nationally representative sample.
Ann Surg 2022 Dec 1;276(6):e706-e13. doi: 10.1097/sla.0000000000004630..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Medication, Practice Patterns, Pain
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
Howard R, Gunaseelan V, Brummett C
New persistent opioid use after inguinal hernia repair.
The purpose of this retrospective cross-sectional study was to characterize the risk factors and incidence of new persistent use of opioids after inguinal hernia repair. During the study period of 208-2016, 59,795 patients met the inclusion criteria. The study found that 1.5% of patients continued filling their opioids prescriptions at least 3 months after their surgery. The greatest risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery. Other risk factors for new persistent opioid use after surgery included having a major postoperative complication, receiving a larger opioid prescription, having more comorbidities, and having certain mental health disorders or pain disorders.
AHRQ-funded; HS025778.
Citation: Howard R, Gunaseelan V, Brummett C .
New persistent opioid use after inguinal hernia repair.
Ann Surg 2022 Nov 1;276(5):e577-e83. doi: 10.1097/sla.0000000000004560..
Keywords: Opioids, Surgery, Medication, Pain