Drug and alcohol dependence
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Drug Alcohol Depend · Apr 2021
Patient, prescriber, and Community factors associated with filled naloxone prescriptions among patients receiving buprenorphine 2017-18.
Prescribing naloxone to patients at increased opioid overdose risk is a key component of opioid overdose prevention efforts, but little is known about naloxone fills among patients receiving buprenorphine for opioid use disorder, one such high risk group. ⋯ Prescribing naloxone to patients receiving buprenorphine represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, rates of filling naloxone prescriptions remain low among patients dispensed buprenorphine. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.
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Drug Alcohol Depend · Apr 2021
"Doctor and pharmacy shopping": A fading signal for prescription opioid use monitoring?
The term "doctor and pharmacy shopping" colloquially describes patients with high multiple provider episodes (MPEs)-a threshold count of distinct prescribers and/or pharmacies involved in prescription fulfillment. Opioid-related MPEs are implicated in the global opioid crisis and heavily monitored by government databases such as U.S. state prescription drug monitoring programs (PDMPs). We applied a widely-used MPE definition to examine U.S. trends from a large, commercially-insured population from 2010 to 2017. Further, we examined the proportion of enrollees identified as "doctor shoppers" with evidence of a cancer diagnosis to examine the risk of false positives. ⋯ Opioid "shopping" flags are a long-standing but rapidly fading PDMP signal. To avoid unintended consequences, such as identifying legitimate medical encounters requiring high healthcare utilization or opioid treatment, while maintaining vigilance, more nuanced and sophisticated approaches are needed.
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Drug Alcohol Depend · Apr 2021
Behavioral economic demand in opioid treatment: Predictive validity of hypothetical purchase tasks for heroin, cocaine, and benzodiazepines.
Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention. ⋯ This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses.
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Drug Alcohol Depend · Apr 2021
Pharmacists' nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis.
One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists' nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. ⋯ Significant differences in pharmacists' perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.
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Drug Alcohol Depend · Apr 2021
Development and examination of the attribution questionnaire-substance use disorder (AQ-SUD) to measure public stigma towards adolescents experiencing substance use disorders.
Public stigma may significantly impact adolescents with substance use disorders (SUDs), leading to limited treatment accessibility and utilization. However, few measures have been validated to assess public SUD stigma towards adolescents. In this study we developed the Attribution Questionnaire-Substance Use Disorder (AQ-SUD) by modifying the Attribution Questionnaire, a commonly used measure of public mental illness stigma. We examined 1) the psychometric properties of the AQ-SUD with supporting data from other stigma scales and 2) preliminary data on adults' perceptions of public stigma toward adolescents with SUDs. ⋯ This study is the first to modify and validate a measure designed to assess perceptions of public SUD stigma towards adolescents, the AQ-SUD. Preliminary analyses suggest that adults view adolescent marijuana use disorders as less severe compared to other SUDs, which may have implications for adults' motivation to support youth in seeking treatment.