What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size

Keyes, Katherine M.; Rutherford, Caroline; Hamilton, Ava; Barocas, Joshua A.; Gelberg, Kitty H.; Mueller, Peter P.; Feaster, Daniel J.; El‐Bassel, Nabila; Cerdá, Magdalena

doi:10.1016/j.dadr.2022.100052

Cited by 87 publications

(53 citation statements)

References 56 publications

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“…The overdose crisis continues to be driven by opioid-involved deaths, with approximately 75% of all drug overdose deaths in 2020 involving opioids 1(pp2-2) . The prevalence of opioid use disorder (OUD) remains high, with 6-7 million Americans affected in 2019 2 . One of the most significant reasons rates of OUD persist is the lack of availability and access to effective treatment 3 , such as medications for OUD (MOUD).…”

Section: The Association Of Medical Providers' Attitudes About Naloxo...mentioning

confidence: 99%

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

Winograd¹,

Coffey²,

Nance³

et al. 2022

Preprint

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Opioid-involved overdose deaths continue to climb, in part because of suboptimal access to and retention on medications for opioid use disorder (MOUD), including buprenorphine. “Low barrier” buprenorphine treatment aims to reduce or eliminate the threshold for getting and staying on medication by providing immediate and long-term access to buprenorphine without strict rules or requirements. This study examines associations between medical providers’ beliefs about people with opioid use disorder (OUD) and naloxone access with their self-reported “low-barrier” buprenorphine prescribing practices. We surveyed providers (N=123) who completed X-waiver courses in Missouri between March 2017 and September 2019. The survey included questions about buprenorphine prescribing behaviors as well as the Naloxone-Related Risk Compensation Beliefs (NaRCC-B) scale and Attitudes toward Patients with OUD scale. Analyses consisted of a series of linear and logistic regressions with the NaRCC-B and OUD Attitudes scales predicting various domains of “low-threshold” prescribing behaviors (such as length of buprenorphine treatment and requirements for drug testing). Findings indicate medical providers’ beliefs about people with OUD are associated with their practice of addiction medicine, with individuals with more favorable views being more likely to endorse “low-threshold” buprenorphine prescribing practices than those with less favorable views. Providers’ beliefs about naloxone being enabling were less related to their buprenorphine practices but strongly related to their likelihood of providing naloxone. Though findings are correlational and not causal, these associations suggest future prescriber trainings aiming to increase positive interactions with and attitudes toward people with OUD, as well as encouragement of flexible and “low barrier” buprenorphine prescribing practices, may help increase patients’ access to and retention on maintenance buprenorphine.

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Section: The Association Of Medical Providers' Attitudes About Naloxo...mentioning

confidence: 99%

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

Winograd¹,

Coffey²,

Nance³

et al. 2022

Preprint

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show abstract

“…One out of four patients receiving long-term opioid therapy in primary care have OUD, 3 and 4.7% of all pain patients prescribed an opioid will develop prescription OUD. 4 About 6 to seven million persons in the United States suffer from OUD, not limited to prescription opioids, 5 Among the commercially insured, the annual rate of OUD is approximately 0.4%. 6 Screening tools and urine drug screens (UDS) can be used to identify patients with OUD.…”

Section: Introductionmentioning

confidence: 99%

Predicting opioid use disorder before and after the opioid prescribing peak in the United States: A machine learning tool using electronic healthcare records

Banks

Nguyen

Uhlmann

et al. 2023

Health Informatics J

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Existing predictive models of opioid use disorder (OUD) may change as the rate of opioid prescribing decreases. Using Veterans Administration’s EHR data, we developed machine-learning predictive models of new OUD diagnoses and ranked the importance of patient features based on their ability to predict a new OUD diagnosis in 2000–2012 and 2013–2021. Using patient characteristics, the three separate machine learning techniques were comparable in predicting OUD, achieving an accuracy of >80%. Using the random forest classifier, opioid prescription features such as early refills and length of prescription consistently ranked among the top five factors that predict new OUD. Younger age was positively associated with new OUD, and older age inversely associated with new OUD. Age stratification revealed prior substance abuse and alcohol dependency as more impactful in predicting OUD for younger patients. There was no significant difference in the set of factors associated with new OUD in 2000–2012 compared to 2013–2021. Characteristics of opioid prescriptions are the most impactful variables that predict new OUD both before and after the peak in opioid prescribing rates. Predictive models should be tailored to age groups. Further research is warranted to determine if machine learning models perform better when tailored to other patient subgroups.

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“…The number of fatal opioid overdoses in the US continues to soar, and an estimated 1.6 million individuals in the country have an opioid use disorder (OUD) . Medication treatment for opioid use disorder (MOUD) is considered the standard of care, improving quality of life and decreasing fatal overdose rates .…”

Section: Introductionmentioning

confidence: 99%

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

et al. 2023

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ImportanceExpanding the use of buprenorphine for treating opioid use disorder is a critical component of the US response to the opioid crisis, but few studies have examined how state policies are associated with buprenorphine dispensing.ObjectiveTo examine the association of 6 selected state policies with the rate of individuals receiving buprenorphine per 1000 county residents.Design, Setting, and ParticipantsThis cross-sectional study used 2006 to 2018 US retail pharmacy claims data for individuals dispensed buprenorphine formulations indicated for treating opioid use disorder.ExposuresState implementation of policies requiring additional education for buprenorphine prescribers beyond waiver training, continuing medical education related to substance misuse and addiction, Medicaid coverage of buprenorphine, Medicaid expansion, mandatory prescriber use of prescription drug monitoring programs, and pain management clinic laws were examined.Main Outcomes and MeasuresThe main outcome was buprenorphine treatment months per 1000 county residents as measured using multivariable longitudinal models. Statistical analyses were conducted from September 1, 2021, through April 30, 2022, with revised analyses conducted through February 28, 2023.ResultsThe mean (SD) number of months of buprenorphine treatment per 1000 persons nationally increased steadily from 1.47 (0.04) in 2006 to 22.80 (0.55) in 2018. Requiring that buprenorphine prescribers receive additional education beyond that required to obtain the federal X-waiver was associated with significant increases in the number of months of buprenorphine treatment per 1000 population in the 5 years following implementation of the requirement (from 8.51 [95% CI, 2.36-14.64] months in year 1 to 14.43 [95% CI, 2.61-26.26] months in year 5). Requiring continuing medical education for physician licensure related to substance misuse or addiction was associated with significant increases in buprenorphine treatment per 1000 population in each of the 5 years following policy implementation (from 7.01 [95% CI, 3.17-10.86] months in the first year to 11.43 [95% CI, 0.61-22.25] months in the fifth year). None of the other policies examined was associated with a significant change in buprenorphine months of treatment per 1000 county residents.Conclusions and RelevanceIn this cross-sectional study of US pharmacy claims, state-mandated educational requirements beyond the initial training required to prescribe buprenorphine were associated with increased buprenorphine use over time. The findings suggest requiring education for buprenorphine prescribers and training in substance use disorder treatment for all controlled substance prescribers as an actionable proposal for increasing buprenorphine use, ultimately serving more patients. No single policy lever can ensure adequate buprenorphine supply; however, policy maker attention to the benefits of enhancing clinician education and knowledge may help to expand buprenorphine access.

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What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size

Cited by 87 publications

References 56 publications

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

The Association of Medical Providers’ Attitudes About Naloxone and People with Opioid Use Disorder and Their Self-Reported “Low-Barrier” Treatment Practices

Predicting opioid use disorder before and after the opioid prescribing peak in the United States: A machine learning tool using electronic healthcare records

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

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