scholarly journals Rise and Regional Disparities in Buprenorphine Utilization in the United States

2019 ◽  
Author(s):  
Amir Azar R. Pashmineh ◽  
Alexandra Cruz-Mullane ◽  
Jaclyn C. Podd ◽  
Warren S. Lam ◽  
Suhail H. Kaleem ◽  
...  
Keyword(s):  
United States ◽  
Partial Agonist ◽  
Strong Association ◽  
The United States ◽  
Regional Disparities ◽  
Opioid Use ◽  
Policy Changes ◽  
Drug Enforcement ◽  
Drug Enforcement Administration ◽  
The Us

AbstractAimsBuprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution.MeasurementsBuprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined.FindingsBuprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018.ConclusionsAlthough buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

scholarly journals Methadone Distribution Trends from 2017-2019 in the United States

2020 ◽  
Author(s):  
John A. Furst ◽  
Nicholas J. Mynarski ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Rhode Island ◽  
Distribution Patterns ◽  
The United States ◽  
Opioid Use Disorder ◽  
Primary Objective ◽  
Treatment Programs ◽  
Opioid Use ◽  
Drug Enforcement ◽  
The Us

AbstractObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

Use of Buprenorphine for the Treatment of Opioid Use Disorder

2020 ◽  
pp. 155-168
Author(s):  
Paul J. Fudala ◽  
Anne Cramer Andorn
Keyword(s):  
Opioid Dependence ◽  
Addiction Treatment ◽  
Partial Agonist ◽  
The United States ◽  
Opioid Use Disorder ◽  
Sublingual Administration ◽  
Opioid Use ◽  
The Us ◽  
Monthly Administration ◽  
Drug Addiction Treatment

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.

Overview

2020 ◽  
pp. 121-138
Author(s):  
Yngvild Olsen ◽  
Anika A. H. Alvanzo ◽  
Jarratt D. Pytell
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Health Impacts ◽  
Opioid Use ◽  
The Us ◽  
Significant Public Health ◽  
History Of ◽  
Opioid Use Disorders ◽  
Barriers To Use

Substance use disorders (SUDs) are a significant cause of morbidity and mortality in the United States. In spite of the significant public health impacts of SUDs, medications approved by the US Food and Drug Administration (FDA) are underutilized for the treatment of SUDs. This chapter reviews the history of FDA-approved medications for alcohol, nicotine, and opioid use disorders and provides some background on barriers to use of these medications to treat patients with SUDs. Suggestions are provided to guide clinicians on a path forward to reduce these barriers and increase the use of FDA-approved medications for the treatment of SUDs.

scholarly journals Get waivered remote: Nationwide, remote DEA-x waiver course in response to COVID-19

2021 ◽  
Vol 7 ◽  
pp. 205520762110489
Author(s):  
Alister Martin ◽  
Joshua P. Raber ◽  
Desiree Shayer ◽  
Deborah Lai ◽  
Adam Goodcoff ◽  
...  
Keyword(s):  
Low Cost ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Drug Enforcement ◽  
Drug Enforcement Administration ◽  
Learning Platform ◽  
Traditional Drug ◽  
Educational Delivery ◽  
Remote Learning

Problem As of 2020, less than 5% of physicians in the United States have a drug enforcement administration-X waiver to prescribe buprenorphine. The coronavirus-2019 pandemic restricted in-person gatherings, including traditional drug enforcement administration-X waiver courses. As a result, in-person conferences have needed to adopt remote formats. Many programs identified a gap between educational delivery and the faculty skills required to deliver content remotely. Approach To address the need for high-quality remote learning, Get Waivered designed and implemented a novel experience for clinicians, called Get Waivered Remote. An educational session was live-streamed via Zoom™. To foster interactivity, like in-person didactic conferences, participants were polled to facilitate discussion among presenters, learners, and facilitators during the broadcast Outcomes The RE-AIM framework was used for evaluation. Our program had a Reach encompassing 814 users that participated during the live-streamed event; Effectiveness with 73.79% reporting being somewhat familiar or very familiar with the practice of opioid dependency treatment with approved buprenorphine medications; Adoption with 95.15% reporting a favorable experience and 92.23% reporting it was similar or more enjoyable than their usual teaching; Implementation with 450 messages sent by 281 users to engage with presenters and other learners via Zoom chat in real time. Next steps Get Waivered Remote provides a proof-of-concept that a broadcast with a concurrent, interactive remote learning platform is feasible, low cost, and simple to execute. Further study is required to assess the ability of our group to maintain this innovation and also to measure its impact on the treatment of opioid use disorder.

scholarly journals Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions from 2006 to 2019

2020 ◽  
Author(s):  
Brian Piper ◽  
Kenneth McCall ◽  
Lori Kogan ◽  
Peter Hellyer
Keyword(s):  
United States ◽  
Longitudinal Study ◽  
Clinical Relevance ◽  
Teaching Practice ◽  
The United States ◽  
Educational Institutions ◽  
Drug Enforcement ◽  
Drug Enforcement Administration ◽  
Controlled Substance ◽  
Over Time

Objective: To evaluate the changing pattern of distribution of Schedule II and III opioids, barbiturates, and stimulants to veterinary educational institutions in the United States. Design: Longitudinal study. Sample: Veterinary teaching institutions that use Schedule II and III drugs. Procedures: Distribution of controlled substances to veterinary teaching institutions was obtained from the Drug Enforcement Administration&rsquo;s Automated Reports and Consolidated Orders System (ARCOS) for opioids (e.g. methadone, fentanyl, codeine), barbiturates (pentobarbital, butalbital), and stimulants (amphetamine, methylphenidate, lisdexamfetamine) from 2006 - 2019. Opioids were converted to their morphine milligram equivalents (MME) for evaluation over time. Results: Controlled substance distribution to veterinary schools exhibited dynamic, and agent specific, changes. The total MME for eleven opioids peaked in 2013 and decreased by 17.3% in 2019. Methadone accounted for two-fifths (42.3%) and fentanyl over one-third (35.4%) of the total MME in 2019. Pentobarbital distribution was greatest by weight of all substances studied and peaked in 2011 at 69.4 kg. Stimulants underwent a pronounced decline and were very modest by 2014. Conclusions and Clinical Relevance: Opioids by total MME in veterinary teaching practice have undergone more modest changes than opioids used with humans. Hydrocodone, codeine and recently fentanyl use have declined while methadone increased. Stimulant distribution decreased to become negligible. Together, this pattern of findings warrant continued monitoring.

scholarly journals Decline, and Regional Disparities, in Medical Cocaine Usage in the United State

2020 ◽  
Author(s):  
Youngeun C Armbuster ◽  
Brian N Banas ◽  
Kristen D Feickert ◽  
Stephanie E England ◽  
Erik J Moyer ◽  
...  
Keyword(s):  
United States ◽  
South Dakota ◽  
Health Care Professionals ◽  
Drug Distribution ◽  
Descriptive Study ◽  
The United States ◽  
Drug Enforcement ◽  
Cocaine Use ◽  
The Us ◽  
Average State

Purpose: Cocaine is a stimulant with a complex history that is used in otorhinolaryngological surgeries as a local anesthetic and vasodilator. There is extensive regulation in the United States for the storage and disposal of this Schedule II drug, potentially incentivizing health care professionals to avoid use. This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution from 2002-2017 in units of grams of weight was extracted for each state from the Drug Enforcement Administrations Automation of Reports and Consolidated Orders System database, which reports on medical, research, and analytical-chemistry use. The percent of buyers (hospitals, pharmacies, providers) was obtained. Use per state, corrected for population, was determined. Available data on cocaine use, as reported by the Medicare and Medicaid programs for 2013 to 2017, also were examined. Results: Medical cocaine use in the US, measured on the basis of mass, decreased 62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies nationwide carrying cocaine dropped by 69.4% to 206. The percent of all US hospitals, practitioners, and pharmacies that carried cocaine in 2017 was 38.4%, 2.3%, and 0.3%, respectively. There was a seven-fold difference in distribution per state in 2002 (South Dakota = 76.1 mg/100 persons, Delaware = 10.1 mg/100 persons). Similarly, there was a ten-fold regional disparity observed for 2017. Relative to the average state, those reporting the highest values (Montana = 20.1 and North Dakota = 24.1 mg/100 persons), were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Conclusion: Medical cocaine use across the United States exhibited a pronounced decline over a fifteen-year period. If this pattern continues, licit cocaine will soon become an obscure pharmacological relic of interest only to analytical chemists and medical historians.

Decline and Pronounced Regional Disparities in Medical Cocaine Usage in the United States

2021 ◽  
pp. 875512252110355
Author(s):  
Youngeun C. Armbuster ◽  
Brian N. Banas ◽  
Kristen D. Feickert ◽  
Stephanie E. England ◽  
Erik J. Moyer ◽  
...  
Keyword(s):  
United States ◽  
Health Care Providers ◽  
Drug Distribution ◽  
The United States ◽  
Distribution Data ◽  
Care Providers ◽  
Cross Sectional ◽  
Drug Enforcement ◽  
Cocaine Use ◽  
Drug Enforcement Administration

Background: Cocaine is a stimulant and Schedule II drug used as a local anesthetic and vasoconstrictor. Objective: This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution data from 2002 to 2017 were extracted for each state from the Drug Enforcement Administration, which reports on medical, research, and analytical chemistry use. The percentage of buyers (pharmacies, hospitals, and providers) was obtained. Use per state, corrected for population, was determined. Available cross-sectional data on cocaine use as reported by the Medicare and Medicaid programs for 2013-2017 and electronic medical records were examined. Results: Medical cocaine use decreased by −62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies carrying cocaine dropped by −69.4%. The percentages of hospitals, practitioners, and pharmacies that carried cocaine in 2017 were 38.4%, 2.3%, and 0.3%, respectively. There was a 7-fold difference in 2002 (South Dakota, 76.1 mg/100 persons; Delaware, 10.1 mg/100 persons). Relative to the average state in 2017, those reporting the highest values (Montana, 20.1; North Dakota, 24.1 mg/100 persons) were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Cocaine use within the Geisinger system was rare from 2002 to 2007 (<4 orders/100 000 patients per year) but increased to 48.7 in 2018. Conclusion and Relevance: If these pharmacoepidemiological patterns continue, licit cocaine may soon become a historical relic. The pharmacology and pharmacotherapeutics education of health care providers may need to be adjusted accordingly.

Quest for Integrity: The Mexican-US Drug Issue in the 1980s

1992 ◽  
Vol 34 (3) ◽  
pp. 89-154 ◽  
Author(s):  
Peter Reuter ◽  
David Ronfeldt
Keyword(s):  
United States ◽  
The United States ◽  
Domestic Demand ◽  
Drug Enforcement ◽  
Dominant Source ◽  
Drug Enforcement Administration ◽  
Us Government ◽  
Mexican Government

The Flow of drugs from Mexico to the United States has been a source of trouble in US-Mexican relations for at least two decades. The dominant view in Mexico is that the problem arises from the inability of the United States to control its domestic demand for heroin, cocaine, and marijuana. The dominant US view has been that the Mexican government has failed to make effective efforts to control the supply of drugs. At times — in particular after the killing of Enrique Camarena, an agent of the Drug Enforcement Administration (DEA), in 1985 — US government anger at Mexico's alleged failure to maintain the integrity of its anti-drug efforts has been the dominant source of friction between the two nations.

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