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Article ; Online: Trends in Out-of-Pocket Costs for and Characteristics of Pharmacy-Dispensed Naloxone by Payer Type.

Jiang, Xinyi / Strahan, Andrea E / Zhang, Kun / Guy, Gery P

2024 Volume 331, Issue 8, Page(s) 700–702

MeSH term(s)	Humans ; Costs and Cost Analysis ; Drug Overdose/drug therapy ; Drug Overdose/economics ; Health Expenditures/trends ; Naloxone/economics ; Naloxone/therapeutic use ; Narcotic Antagonists/economics ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/economics ; Pharmacies/economics ; Pharmacies/trends ; Pharmacy/trends ; Insurance, Health/economics ; United States
Chemical Substances	Naloxone (36B82AMQ7N) ; Narcotic Antagonists
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2023.26969
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Article ; Online: Substance Use Disorder and Health Outcomes in COVID-19-The Need for a Better Research Method to Determine Substance Use Exposure-Reply.

Schieber, Lyna Z / Lopes-Cardozo, Barbara / Guy, Gery P

JAMA psychiatry

2023 Volume 80, Issue 9, Page(s) 968–969

MeSH term(s)	Humans ; COVID-19 ; Substance-Related Disorders ; Outcome Assessment, Health Care
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701203-7
ISSN	2168-6238 ; 2168-622X
ISSN (online)	2168-6238
ISSN	2168-622X
DOI	10.1001/jamapsychiatry.2023.2116
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Article ; Online: Buprenorphine Dispensing Among Youth Aged ≤19 Years in the United States: 2015-2020.

Terranella, Andrew / Guy, Gery P / Mikosz, Christina

Pediatrics

2023 Volume 151, Issue 2

Abstract: Background and objectives: Opioid related overdose among adolescents and young adults in the United States is rising. Medications for opioid use disorder (MOUD), including buprenorphine can reduce the risk of overdose, however they are underutilized. A ... ...

Abstract	Background and objectives: Opioid related overdose among adolescents and young adults in the United States is rising. Medications for opioid use disorder (MOUD), including buprenorphine can reduce the risk of overdose, however they are underutilized. A better understanding of buprenorphine prescribing to youth will help inform interventions to expand access to treatment. Methods: We used IQVIA data to examine buprenorphine dispensing trends among youth aged ≤19 years from 2015 to 2020. Dispensing was examined by prescriber specialty, age, and sex. Data were weighted to provide national estimates. Results: The rate of buprenorphine dispensed to youth decreased 25% over the study period, from 0.84 to 0.63 prescriptions per 1000 youth per year. The proportion of youth dispensed buprenorphine also decreased 45%, from 7.6 to 4.2 persons per 100 000 per year. Over the same time, the proportion of adults aged ≥20 years dispensed buprenorphine increased 47%, from 378 to 593 persons per 100 000. Differences in dispensing by sex and temporal trends were also noted. Pediatricians accounted for less-than 2% of all prescriptions dispensed. Conclusions: Buprenorphine dispensing to youth is low and declining in recent years. Given rates of opioid use disorder among youth, these findings suggest that many youth who could benefit from MOUD are not receiving it. Pediatricians could play a role in expanding access to MOUD for this high-risk population. Efforts to expand access to MOUD for adolescents could include improving training in opioid use disorder treatment of pediatricians and encouraging all clinicians who care for adolescents and young adults to obtain waivers to prescribe buprenorphine for MOUD.
MeSH term(s)	Young Adult ; Humans ; Adolescent ; United States/epidemiology ; Buprenorphine/therapeutic use ; Analgesics, Opioid/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Drug Overdose ; Prescriptions ; Opiate Substitution Treatment
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2022-058755
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Article ; Online: Reply to Chang et al.

Rikard, S Michaela / Nataraj, Nisha / Zhang, Kun / Strahan, Andrea / Mikosz, Christina A / Guy, Gery P

Pain

2024 Volume 165, Issue 4, Page(s) 960

Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000003179
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Article ; Online: Urban-Rural Differences in Opioid Dispensing, U.S., 2019-2021.

Schieber, Lyna Z / Rikard, S Michaela / Strahan, Andrea E / Losby, Jan L / Guy, Gery P

American journal of preventive medicine

2024 Volume 66, Issue 6, Page(s) 1071–1074

MeSH term(s)	Humans ; Analgesics, Opioid/administration & dosage ; United States ; Rural Population/statistics & numerical data ; Urban Population/statistics & numerical data ; Female ; Male ; Middle Aged ; Adult ; Practice Patterns, Physicians'/statistics & numerical data ; Opioid-Related Disorders/epidemiology
Language	English
Publishing date	2024-02-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2024.01.013
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Article ; Online: Trends in Out-of-Pocket Costs for and Characteristics of Pharmacy-Dispensed Buprenorphine Medications for Opioid Use Disorder Treatment by Type of Payer, 2015 to 2020.

Strahan, Andrea E / Desai, Shaina / Zhang, Kun / Guy, Gery P

JAMA network open

2023 Volume 6, Issue 2, Page(s) e2254590

Abstract: Importance: Buprenorphine has been approved for opioid use disorder treatment, yet remains underutilized. Cost may present a barrier; little is known about how out-of-pocket costs vary.: Objective: To determine if out-of-pocket costs and prescription ...

Abstract	Importance: Buprenorphine has been approved for opioid use disorder treatment, yet remains underutilized. Cost may present a barrier; little is known about how out-of-pocket costs vary. Objective: To determine if out-of-pocket costs and prescription characteristics for buprenorphine varied by type of payer. Design, setting, and participants: This cross-sectional study used all-payer data on retail pharmacy-dispensed buprenorphine prescriptions from January 1, 2015, through December 31, 2020, for adults (aged ≥18 years) in the US, excluding formulations primarily used to treat pain. Data were analyzed from July 2021 to June 2022. Exposures: Type of payer (private and commercial, self-pay, Medicaid, Medicare, assistance, and unknown) for dispensed prescription. Main outcomes and measures: All outcomes are prescription-level. Mean and median daily out-of-pocket costs were calculated overall and by payer type. Prescription characteristics (days supplied, patient age and sex, generic vs name brand formulations, and prescriber's location) were examined by payer type. Results: Although mean daily out-of-pocket costs decreased overall from $4.79 (95% CI, $4.79-$4.80) in 2015 (7 375 508 prescriptions) to $1.91 (95% CI, $1.90-$1.91) in 2020 (13 486 822 prescriptions), out-of-pocket costs continued to vary by payer in 2020. Medicaid had the lowest mean daily out-of-pocket cost across all years-$0.18 (95% CI, $0.18-$0.18) in 2015, and $0.10 (95% CI, $0.10-$0.10) in 2020. Private and commercial paid prescriptions fell from $4.80 (95% CI, $4.79-$4.81) per day in 2015 to $1.82 (95% CI, $1.82-$1.83) in 2020. Self-pay and assistance categories had the highest mean daily out-of-pocket costs across study years ($9.76 [95% CI, $9.74-$9.78] and $8.72 [95% CI, $8.71-$8.73], respectively, in 2015; $8.44 [95% CI, $8.43-$8.46] and $6.31 [95% CI, $6.30-$6.31], respectively, in 2020). Medicaid paid prescriptions had a mean supply of 15.59 days (95% CI, 15.58-15.59 days) and the lowest percentage of generic prescriptions (57.88%; 95% CI, 57.84%-57.92%). Out-of-pocket cost varied by prescriber location and patient characteristics; mean costs were highest for prescriptions written in the South ($2.91; 95% CI, $2.90-$2.91), metropolitan counties ($1.93; 95% CI, $1.93-$1.93), and for individuals aged 35 to 44 years ($2.10; 95% CI, $2.09-$2.10). Conclusions and relevance: This cross-sectional study found that mean daily out-of-pocket costs for buprenorphine were lower in 2020 than in 2015, but variation by payer existed in all study years. Financial barriers to accessing and maintaining buprenorphine for opioid use disorder treatment may exist and differ by type of prescription coverage. Future research could monitor costs and identify potential barriers that may impact access and retention in care.
MeSH term(s)	Adult ; Humans ; Aged ; United States ; Adolescent ; Buprenorphine/therapeutic use ; Health Expenditures ; Cross-Sectional Studies ; Medicare ; Pharmacy ; Drugs, Generic ; Opioid-Related Disorders/drug therapy
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Drugs, Generic
Language	English
Publishing date	2023-02-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.54590
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Article ; Online: Chronic Pain Among Adults - United States, 2019-2021.

Rikard, S Michaela / Strahan, Andrea E / Schmit, Kristine M / Guy, Gery P

MMWR. Morbidity and mortality weekly report

2023 Volume 72, Issue 15, Page(s) 379–385

Abstract: Chronic pain (i.e., pain lasting ≥3 months) is a debilitating condition that affects daily work and life activities for many adults in the United States and has been linked with depression (1), Alzheimer disease and related dementias (2), higher suicide ... ...

Abstract	Chronic pain (i.e., pain lasting ≥3 months) is a debilitating condition that affects daily work and life activities for many adults in the United States and has been linked with depression (1), Alzheimer disease and related dementias (2), higher suicide risk (3), and substance use and misuse (4). During 2016, an estimated 50 million adults in the United States experienced chronic pain, resulting in substantial health care costs and lost productivity (5,6). Addressing chronic pain and improving the lives of persons living with pain is a public health imperative. Population research objectives in the National Pain Strategy, which was released in 2016 by the Interagency Pain Research Coordinating Committee, call for more precise estimates of the prevalence of chronic pain and high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities) in the general population and within various population groups to guide efforts to reduce the impact of chronic pain (3). Further, a 2022 review of U.S. chronic pain surveillance systems identified the National Health Interview Survey (NHIS) as the best source for pain surveillance data (7). CDC analyzed data from the 2019-2021 NHIS to provide updated estimates of the prevalence of chronic pain and high-impact chronic pain among adults in the United States and within population groups defined by demographic, geographic, socioeconomic, and health status characteristics. During 2021, an estimated 20.9% of U.S. adults (51.6 million persons) experienced chronic pain, and 6.9% (17.1 million persons) experienced high-impact chronic pain. New findings from this analysis include that non-Hispanic American Indian or Alaska Native (AI/AN) adults, adults identifying as bisexual, and adults who are divorced or separated are among the populations experiencing a higher prevalence of chronic pain and high-impact chronic pain. Clinicians, practices, health systems, and payers should vigilantly attend to health inequities and ensure access to appropriate, affordable, diversified, coordinated, and effective pain management care for all persons (8).
MeSH term(s)	Adult ; Humans ; United States/epidemiology ; Chronic Pain/epidemiology ; Prevalence ; Health Status ; American Indian or Alaska Native ; Pain Management ; Population Surveillance
Language	English
Publishing date	2023-04-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7215a1
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Article ; Online: Prevalence of Pharmacologic and Nonpharmacologic Pain Management Therapies Among Adults With Chronic Pain-United States, 2020.

Rikard, S Michaela / Strahan, Andrea E / Schmit, Kristine M / Guy, Gery P

Annals of internal medicine

2023 Volume 176, Issue 11, Page(s) 1571–1575

MeSH term(s)	Adult ; Humans ; United States/epidemiology ; Chronic Pain/drug therapy ; Pain Management ; Prevalence
Language	English
Publishing date	2023-11-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M23-2004
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Article ; Online: Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes.

Guy, Gery P / Adams, E Kathleen / Redd, Sara K / Dunlop, Anne L

Women's health issues : official publication of the Jacobs Institute of Women's Health

2023 Volume 34, Issue 2, Page(s) 125–134

Abstract: Introduction: Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low ...

Abstract	Introduction: Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes. Materials and methods: We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008-2009) and two post-periods (2012-2013; 2017-2019). We identified those likely eligible for P4HB in Georgia (n = 1,967) and 10 comparison states (n = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling. Results: P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (p < .01) and an 11.4 pp decrease in the later post-period (p < .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (p < .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (p < .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (-3.9 pp; p < .05) but not for mothers of other races/ethnicities. Discussion: Medicaid family planning waivers are an important structural policy intervention that can improve reproductive health care, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.
MeSH term(s)	Pregnancy ; Female ; United States ; Humans ; Infant, Newborn ; Family Planning Services ; Medicaid ; Georgia ; Premature Birth ; Contraception
Language	English
Publishing date	2023-12-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1085396-0
ISSN	1878-4321 ; 1049-3867
ISSN (online)	1878-4321
ISSN	1049-3867
DOI	10.1016/j.whi.2023.11.004
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Article ; Online: Changes in Opioid Dispensing by Medical Specialties After the Release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

Salvatore, Phillip P / Guy, Gery P / Mikosz, Christina A

Pain medicine (Malden, Mass.)

2022 Volume 23, Issue 11, Page(s) 1908–1914

Abstract: Objective: To identify changes in opioid prescribing across a diverse array of medical specialties after the release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.: Design: Interrupted time-series analysis of data from a ... ...

Abstract	Objective: To identify changes in opioid prescribing across a diverse array of medical specialties after the release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Design: Interrupted time-series analysis of data from a commercial prescribing database. Subjects: De-identified recipients of opioid prescriptions dispensed at U.S. retail pharmacies between 2015 and 2019. Methods: Opioid dispensing data were obtained from the IQVIA Longitudinal Prescription (LRx) database, representing more than 800 million opioid prescriptions. Monthly dispensing rates, dosage in morphine milligram equivalents (MME), and mean prescription duration were calculated across 29 medical specialties. Changes in dispensing after the release of the 2016 CDC Guideline were assessed through interrupted time-series analysis. Results: Declining trends in opioid dispensing accelerated in 24 of 29 specialty groups after the release of the CDC Guideline (P < 0.05 for 15 groups). Decreases were greatest among family medicine clinicians, where declines accelerated by 4.4 prescriptions per month per 100,000 persons (P = 0.005), and surgeons, where declines accelerated by 3.6 prescriptions per month per 100,000 (P = 0.003). Conclusions: These results illustrate that clinicians likely to provide primary care exhibited the greatest decreases in opioid dispensing. However, specialties outside the scope of the CDC Guideline (e.g., surgery) also exhibited accelerated decreases in prescribing. These declines illustrate that specialties beyond primary care could have interest in evaluating opioid prescribing practices, supporting the importance of specialty-specific guidance that balances the individualized risks and benefits of opioids and the role of non-opioid treatments.
MeSH term(s)	Humans ; United States ; Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Practice Patterns, Physicians' ; Centers for Disease Control and Prevention, U.S. ; Medicine ; Drug Prescriptions
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-04-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1093/pm/pnac068
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