Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky

Cooper, Hannah L.F.; Cloud, David H.; Freeman, Patricia R.; Fadanelli, Monica; Green, Travis; Meter, Connor Van; Beane, Stephanie; Ibragimov, Umedjon; Young, April M.

doi:10.1016/j.drugpo.2020.102701

Cited by 78 publications

(96 citation statements)

References 59 publications

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“…Furthermore, the lack of privacy from household members during telehealth visits may discourage patients from disclosing or seeking help for sensitive issues, such as intimate partner violence. Finally, telehealth visits also do not address known barriers to filling buprenorphine products at rural pharmacies, further complicating the impact these policy changes may have had 21,22 …”

Section: Discussionmentioning

confidence: 99%

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

Hughes

Verrastro

Fusco

et al. 2021

The Journal of Rural Health

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Purpose Tracking changes in care utilization of medication for opioid use disorder (MOUD) services before, during, and after COVID‐19‐associated changes in policy and service delivery in a mixed rural and micropolitan setting. Methods Using a retrospective, open‐cohort design, we examined visit data of MOUD patients at a family medicine clinic across three identified periods: pre‐COVID, COVID transition, and COVID. Outcome measures include the number and type of visits (in‐person or telehealth), the number of new patients entering treatment, and the number of urine drug screens performed. Distance from patient residence to clinic was calculated to assess access to care in rural areas. Goodness‐of‐Fit Chi‐Square tests and ANOVAs were used to identify differences between time periods. Findings Total MOUD visits increased during COVID (436 pre vs. 581 post, p < 0.001), while overall new patient visits remained constant (33 pre vs. 29 post, p = 0.755). The clinic's overall catchment area increased in size, with new patients coming primarily from rural areas. Length of time between urine drug screens increased (21.1 days pre vs. 43.5 days post, p < 0.001). Conclusions The patterns of MOUD care utilization during this period demonstrate the effectiveness of telehealth in this area. Policy changes allowing for MOUD to be delivered via telehealth, waiving the need for in‐person initiation of MOUD, and increased Medicaid compensation for MOUD may play a valuable role in improving access to MOUD during the COVID‐19 pandemic and beyond.

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Section: Discussionmentioning

confidence: 99%

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

Hughes

Verrastro

Fusco

et al. 2021

The Journal of Rural Health

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“…Rather, our findings suggest that prescribers make the decision to query on a drug‐by‐drug basis. With buprenorphine, this may represent stigma laden views toward patients in treatment for opioid use disorder 18 . If the decision to use the PMP was grounded in misuse potential and no other characteristics, then providers would view codeine and buprenorphine products with the same misuse potential and there would be no difference in the odds of query between the two substances.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the use of the prescription monitoring program by prescribers and pharmacists in Texas

Thornton

Varisco

Downs

2021

Pharmacoepidemiology and Drug

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Purpose To describe Texas Prescription Monitoring Program (PMP) use and identify predictors of PMP query for opioid and benzodiazepine prescriptions by prescribers and pharmacists. Methods Dispensation and query records from the Texas PMP for opioid and benzodiazepine medications dispensed between October 1, 2016 and December 31, 2018 were linked using common patient identifiers. Autoregressive linear regression was used to assess trends in utilization. Hierarchical logistic models were specified to identify factors associated with provider and pharmacist query of opioid and benzodiazepine prescriptions. Results Despite a significant increase in the total number of pharmacists (β = 169.85, p < 0.0001) and prescribers (β = 301.59, p < 0.0001) who used the PMP every month, the ratio of active to registered pharmacists (β = −0.0001, p = 0.75) and prescribers (β = −0.0015, p = 0.10) did not change. Pharmacists and prescribers were significantly more likely to query opioid and benzodiazepine prescriptions of 14 days or more, and those issued to patients new to their practice. Pharmacists were most likely to query opioid prescriptions for oxycodone (aOR = 4.51, 95%CI = 4.42–4.60) and prescribers were most likely to query prescriptions for buprenorphine (aOR = 2.24, 95%CI = 2.15–2.35) compared to codeine. Conclusion Changes in PMP utilization between October 2016 and December 2018 were driven by increasing registration, not increasing frequency of use among registered users. Use of the PMP is inconsistent and dependent upon patient characteristics thus limiting the utility of the PMP as a decision support tool. These results support the need for policy mandating PMP use in Texas and provide a useful baseline and framework to evaluate the effectiveness of mandate implementation.

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“…For example, a recent survey of pharmacies in a rural area with high opioid overdose rates found that 80% limited buprenorphine dispensing, often because of concerns regarding potential violations of federal law. ( Cooper et al., 2020 )…”

Section: Buprenorphine For Opioid Use Disordermentioning

confidence: 99%

Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19

Davis

Samuels

2021

International Journal of Drug Policy

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Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky

Cited by 78 publications

References 59 publications

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

Factors associated with the use of the prescription monitoring program by prescribers and pharmacists in Texas

Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19

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