Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality

Beetham, Tamara; Saloner, Brendan; Wakeman, Sarah E.; Gaye, Marema; Barnett, Michael L.

doi:10.7326/m18-3457

Cited by 89 publications

(69 citation statements)

References 26 publications

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“…The effects of structural stigma on undermining treatment of OUDs can be observed in how care is financed and delivered. Treatment is generally covered by state Medicaid programs [98], but prior authorization requirements and arbitrary lifetime treatment limits impose significant barriers to care [99][100][101][102], and many physicians who have obtained the waiver to prescribe buprenorphine do not accept thirdparty payments [103][104][105]. The 2010 Patient Protection and Affordable Care Act, among its many functions, sought to transform substance use treatment financing and delivery by mandating that effective treatments for substance use disorders be covered by third-party payers and integrated into mainstream healthcare systems [106,107].…”

Section: Structural Stigmamentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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• The current United States opioid overdose crisis is a complex, multifaceted, public health emergency that urgently requires the implementation of evidence-based primary, secondary, and tertiary preventive interventions. We develop a typology of the stigma related to opioid use, showing how multiple dimensions of stigma continue to fundamentally hinder the response to the crisis. • Public stigma is driven by stereotypes about people with opioid use disorders, such as their perceived dangerousness or perceived moral failings, which translate into negative attitudes toward people with opioid use disorders. • Enacted stigma describes the behavioral manifestations of public stigma, including discrimination and social distancing. Public and enacted stigma, in turn, lead to delivery of suboptimal care and undermine access to treatment and harm reduction services. • Public stigma and enacted stigma can become structural stigma when they become encoded in cultural norms, laws, and institutional policies. Collectively, these forms of stigma run at cross purposes to-and reduce public support for-public health-oriented policies to address the opioid overdose crisis.

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Section: Structural Stigmamentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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“…The number of providers has grown somewhat in recent years, but many areas still do not have an adequate supply of providers, 189 and most treatment is not "on demand." 190 Expanding treatment across the United States that could achieve widespread public health benefits would require substantial change. It would require the confluence of at least three elements: stigma reduction, increased financing, and regulatory change.…”

Section: Treatmentmentioning

confidence: 99%

“…Although buprenorphine is available in primary care settings in the United States, it is limited to providers who have obtained a federal waiver. The number of providers has grown somewhat in recent years, but many areas still do not have an adequate supply of providers, 189 and most treatment is not “on demand.” 190 …”

Section: Opening Doors To De‐escalate Risk: Six Strategiesmentioning

confidence: 99%

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Park

Rouhani

Beletsky³

et al. 2020

Milbank Quarterly

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110

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This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug‐related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. Context Drug overdose is the leading cause of injury‐related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. Methods In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The “continuum of overdose risk” framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. Findings De‐escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. Conclusions Without recognizing the full drug‐use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

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“…23 The interventions targeting opioid prescribing (ie, state-controlled substance monitoring programmes) likely contributed to the decline in rates of opioid prescriptions between 2012 and 2017, but did not rectify the disparities associated with drug-poisoning deaths. Persistent disparities in opioid prescription rates may be attributed to higher prevalence of comorbidities and disability in deprived areas, 24 difficulty accessing medication for opioid use disorder 25 and a different experience of pain in the setting of lower health literacy 26 and socioeconomic distress. Further efforts should focus on identifying alternative pain management strategies that are effective, affordable and accessible to all who need them, irrespective of where they live.…”

Section: Open Accessmentioning

confidence: 99%

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Kurani

McCoy²,

Inselman

et al. 2020

BMJ Open

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ObjectiveTo identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality.Design, setting and participantsFor this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex.Primary outcome measuresCounty-level opioid prescription fills and drug-poisoning mortality.ResultsBetween 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001).DiscussionCounties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.

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Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality

Abstract: Background-Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment.

Cited by 89 publications

References 26 publications

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

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