Adverse effects of regulation on buprenorphine prescribing and its impact on the treatment of opioid use disorder

2021 ◽  
Vol 17 (7) ◽  
pp. 133-139
Author(s):  
Daniel M. Strickland, MD, FACOG ◽  
John Sorboro, MD, DABPN, FASAM
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Federal Law ◽  
Opioid Use ◽  
The Us ◽  
Main Driver ◽  
The Face ◽  
State Oversight ◽  
Overdose Deaths

Problem: Drug addiction and misuse is a medical and societal problem that has exacted a heavy toll on the United States, and, indeed, the world. In the United States, opioids are currently the main driver of drug overdose deaths. Despite the proven safety and efficacy of medically assisted therapy (MAT) using buprenorphine for the treatment of opioid use disorder (OUD), as well as the fact that its use is regulated by US Federal Law, many states have enacted separate and often burdensome regulations that restrict the prescribing of buprenorphine beyond those required by the US Drug Enforcement Agency (DEA) under the provisions of the DATA 2000 Act, and unnecessarily reduce the availability of effective treatment of OUD in those states.Purpose: The purpose of this article is to review the pharmacology of both buprenorphine (and naloxone as an additive) and the risks associated with the misuse of buprenorphine products and to consider if such additional state oversight and restrictions improves or is deleterious to public safety in the face of this national epidemic.Conclusion: We conclude that the placing of unnecessary and unscientific restraints on the treatment of patients with OUD is inconsistent with the principles of harm reduction, and such restraints should be removed unless/until they can be supported by real evidence. 

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.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

scholarly journals Cross-state variation in opioid use disorder among a privately insured nonelderly population in the United States

2020 ◽  
Author(s):  
Bibo Jiang ◽  
Li Wang ◽  
Douglas Leslie
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Prescription Drug Monitoring Programs ◽  
The Us ◽  
State Variation ◽  
Demographic Patterns ◽  
Privately Insured

Abstract Background: Although cross-state variation of the opioid epidemic in the United States are well documented in general, little are known about the epidemic in privately insured individuals. Objectives: To describe cross-state variation in Opioid Use Disorder (OUD) among privately insured individuals in the US for the years 2005-2015 and investigate demographic differences of OUD patients between a group of hard-hit states and the rest states. Methods: The MarketScan Commercial Claims and Encounters database was used to calculate prevalence of opioid use disorder for the 50 states in the US, respectively. We analyzed level and change of OUD prevalence in each state from 2005 to 2015 and identified the states which were affected most by the epidemic. One-sided exact fisher test was used to analyze demographic difference of the epidemic in the hard-hit states and the remaining states. Results: Cross-state variations of the opioid epidemic among privately insured population were substantial, both in terms of severity and acceleration of the epidemic. Demographic patterns of the epidemic were similar across states. The 18-34 age group was the most affected group with the highest prevalence. The 55-64 group experienced the most rapid increase of OUD prevalence, especially in states that suffered most in the epidemic. Conclusions: Results can assist policy makers to design better clinical and policy interventions on the opioid epidemic, especially on privately insured individuals. Drastic increase of OUD prevalence among the 55-64 group might indicate the need to improve prescription drug monitoring programs for chronic pain, especially in states more affected by the epidemic.

scholarly journals 1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S717-S718
Author(s):  
Michael Lowry ◽  
Christina Fiske ◽  
Peter F Rebeiro
Keyword(s):  
United States ◽  
Substance Use ◽  
Bacterial Infections ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Discharge Data ◽  
Serious Infections ◽  
The Us

Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p< 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures

scholarly journals Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? (Preprint)

2020 ◽  
Author(s):  
Samuel W Stull ◽  
Erin R McKnight ◽  
Andrea E Bonny
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Drop Out ◽  
Mobile Technologies ◽  
Opioid Use ◽  
The Face ◽  
One Step ◽  
Clinician Perspectives ◽  
Receive Treatment

UNSTRUCTURED Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term.

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.

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