scholarly journals Identifying Priority Areas for Increasing the Supply of Medication-Assisted Treatments for Opioid Use Disorder: A Geospatial Approach

10.36469/9787 ◽  
2018 ◽  
Vol 6 (1) ◽  
pp. 75-83
Author(s):  
Michael Topmiller ◽  
Peter J. Mallow ◽  
Aaron T. Vissman ◽  
Jene Grandmont
Keyword(s):  
Unmet Need ◽  
Analytical Framework ◽  
The United States ◽  
Opioid Use ◽  
Data Set ◽  
Treatment Need ◽  
Priority Areas ◽  
Number Of Patients ◽  
The Us ◽  
Unmet Treatment Need

Background: The opioid epidemic has disproportionately affected several areas across the United States (US), with research indicating that these areas may be underserved and lack access to sufficient medication-assisted treatment (MAT) options. The objective of this study was to introduce a geospatial analytical framework for identifying sub-state priority areas to target federal allocation of MAT training and resources. Methods: We used a geospatial analytical framework, which integrated multiple substance use measures and layers of geographic information. Measures included estimates of illicit drug dependence and unmet treatment need from the National Survey on Drug Use and Health (NSDUH), opioid-related admissions from the Treatment Episode Data Set: Admissions (TEDs-A), and Drug Enforcement Agency (DEA) waiver practitioner data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Analyses included standard deviation outlier mapping, local indicators of spatial autocorrelation (LISA), and map overlays. Results: We identified twenty-nine opioid dependence priority areas, eleven unmet treatment need priority areas, and seven low MAT capacity priority areas, located across the US, including southeastern Ohio, western Indiana, the District of Columbia, New England, and northern and southern California. Conclusions: This study identified several areas across the US that have unmet need for MAT. Targeting these areas will allow for the most effective deployment of cost-effective MAT resources to aid the greatest number of patients with opioid use disorders.

scholarly journals Prevalence of Hepatic Encephalopathy from a Commercial Medical Claims Database in the United States

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Aniruddha Potnis ◽  
Susan VanMeter ◽  
Jan Stange
Keyword(s):  
United States ◽  
Hepatic Encephalopathy ◽  
General Population ◽  
The United States ◽  
Ammonia Level ◽  
Data Set ◽  
Claims Database ◽  
Number Of Patients ◽  
The Us ◽  
Serum Ammonia

Introduction. Hepatic encephalopathy (HE), a complication of cirrhosis, is associated with increased healthcare resource utilization and mortality, and impaired quality of life. Information on the prevalence of HE in the US general population is limited. Methods. Prevalence of HE was estimated by sequential stepwise data analysis of the Symphony Health anonymized patient-level data (APLD) claims database. First, patients ≥ 18 years with International Classification of Diseases ninth/tenth edition, clinical modification (ICD-9/10-CM), and codes for cirrhosis from 2018 medical and hospital claims were used to estimate prevalence of cirrhosis within the data set and number of patients with cirrhosis in the US general population. Second, patients diagnosed with cirrhosis in the APLD data set from 2015–2016 with an HE ICD-9/10-CM code within 1 year of cirrhosis diagnosis were used to deduce the prevalence of HE within the data set and estimate the number of patients with HE in the US general population. Last, US DiagnosticSource data on serum ammonia level laboratory results measured within ±2 days of a confirmed HE event were merged with the APLD HE data set, then applied to the US general population. Results. Medical and hospital claims data were available for 272,256 patients with cirrhosis in 2018. An estimated 536,856 US adults had a diagnosis of cirrhosis (prevalence of 0.21%) in 2018. This proportion applied to the estimated number of patients with cirrhosis in the United States resulted in a prevalence estimate of 201,858 cirrhosis patients with HE in 2018. When factoring in serum ammonia data, prevalence was conservatively estimated as approximately 196,000 cirrhosis patients with HE and serum ammonia levels > 21   μ mol / L . Conclusions. In this longitudinal cohort–based study, it was estimated that ≈202,000 patients had HE in the United States in 2018, representing a considerable burden to society and payers.

scholarly journals Methadone Distribution Trends from 2017-2019 in the United States

2020 ◽  
Author(s):  
John A. Furst ◽  
Nicholas J. Mynarski ◽  
Kenneth L. McCall ◽  
Brian J. Piper
Keyword(s):  
United States ◽  
Rhode Island ◽  
Distribution Patterns ◽  
The United States ◽  
Opioid Use Disorder ◽  
Primary Objective ◽  
Treatment Programs ◽  
Opioid Use ◽  
Drug Enforcement ◽  
The Us

AbstractObjectiveMethadone is an evidence based treatment for opioid use disorder and is also employed for acute pain. The primary objective of this study was to explore methadone distribution patterns between the years 2017 and 2019 across the United States (US). This study builds upon previous literature that has analyzed prior years of US distribution patterns, and further outlines regional and state specific methadone trends.MethodsThe Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) was used to acquire the number of narcotic treatment programs (NTPs) per state and methadone distribution weight in grams. Methadone distribution by weight, corrected for state populations, and number of NTPs were compared from 2017 to 2019 between states, within regions, and nationally.ResultsBetween 2017 and 2019, the national distribution of methadone increased 12.30% for NTPs but decreased 34.57% for pain, for a total increase of 2.66%. While all states saw a decrease in distribution for pain, when compared regionally, the Northeast showed a significantly smaller decrease than all other regions. Additionally, the majority of states experienced an increase in distribution for NTPs and most states demonstrated a relatively stable or increasing number of NTPs, with an 11.49% increase in NTPs nationally. The number of NTPs per 100K in 2019 ranged from 2.08 in Rhode Island to 0.00 in Wyoming.ConclusionAlthough methadone distribution for OUD was increasing in the US, there were pronounced regional disparities.

Use of Buprenorphine for the Treatment of Opioid Use Disorder

2020 ◽  
pp. 155-168
Author(s):  
Paul J. Fudala ◽  
Anne Cramer Andorn
Keyword(s):  
Opioid Dependence ◽  
Addiction Treatment ◽  
Partial Agonist ◽  
The United States ◽  
Opioid Use Disorder ◽  
Sublingual Administration ◽  
Opioid Use ◽  
The Us ◽  
Monthly Administration ◽  
Drug Addiction Treatment

Buprenorphine is a mu-opioid partial agonist that was first developed as a parenteral analgesic and subsequently as a treatment for opioid dependence. In the United States, the first two products approved by the US Food and Drug Administration (in 2002) for the latter indication were buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone) tablet formulations for sublingual administration. Since that time, additional products for both sublingual and buccal administration have also been approved, as well as a subcutaneous injection for once-monthly administration for the treatment of moderate or severe opioid use disorder (OUD) and a subdermal implant for the maintenance treatment of opioid dependence that delivers buprenorphine over a 6-month period. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified practitioners may apply for waivers to treat opioid dependence/OUD with approved buprenorphine products in any setting in which they are qualified to practice. Like other opioids, buprenorphine has the potential for being misused and abused.

scholarly journals Problems and Prospects in Early Childhood Education Provisioning in Turkey and South Africa

2015 ◽  
Vol 52 (4) ◽  
pp. 444-457
Author(s):  
Corinne Meier ◽  
Eleanor Lemmer ◽  
Demet Gören Niron
Keyword(s):  
South Africa ◽  
Early Childhood ◽  
Early Childhood Development ◽  
Systems Approach ◽  
Analytical Framework ◽  
The United States ◽  
Childhood Development ◽  
Policy And Practice ◽  
The Us ◽  
Made In

The benefits of early childhood development (ECD) programmes are strongly supported by evidence of reduced school dropout and repetition rates. However, the literature on ECD is primarily grounded in research based in the United States (US); in the light of this gap in the literature, this paper provides a comparative overview of ECD policy and practice from outside of the US, namely in South Africa and Turkey. As a theoretical framework the paper has followed the World Bank’s Systems Approach for Better Education Results (SABER)-ECD Analytical Framework. Findings indicate that both countries have established an enabling policy environment for ECD but implementation and the setting of and compliance to standards for quality is still emerging, in spite of massive strides made in this field during the past fifteen years.

scholarly journals Increasing Trends in Opioid Use From 2010 to 2018 in the Region of Valencia, Spain: A Real-World, Population-Based Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Isabel Hurtado ◽  
Aníbal García-Sempere ◽  
Salvador Peiró ◽  
Gabriel Sanfélix-Gimeno
Keyword(s):  
Health And Safety ◽  
Fold Increase ◽  
The United States ◽  
Population Based ◽  
Annual Number ◽  
World Population ◽  
Opioid Use ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Number Of Patients

Background: The opioid epidemic has been extensively documented in the United States and Canada, but fewer data are available for Europe.Aim: To describe the trends in opioid use—volume of prescriptions, dosage and number of patients treated—in a Spanish population with more than 4.2 million inhabitants aged 18 years and older.Patients and Methods: Population-based cross-sectional analysis of opioid prescription in adults (≥18 years) from January 1, 2010 to December 31, 2018 in the region of Valencia, Spain. Outcomes were estimated on an annual basis: number of prescriptions, prescription rate per 100 inhabitants, dosage per capita (morphine mg equivalents, MME/c) and volume of patients treated (overall and by drug).Results: Over the study period, 2,107,756 unique patients were prescribed more than 35 million total treatments. The yearly number of treatments doubled, and total MME/c showed almost a threefold increase. Fentanyl MME/c more than tripled, accounting for 34.4% of the total MME/c in 2018. Oxycodone MME/c showed a 10-fold increase, while tapentadol, launched in 2011, showed the highest growth rates. The annual number of patients receiving at least one opioid prescription more than doubled, from 335,379 in 2010 to 722,838 in 2018.Conclusions: Even if proportions still seem far from epidemic, urgent research is warranted on the observed patterns of use, their appropriateness and their association with health and safety outcomes, especially for high-use and high-strength drugs.

scholarly journals Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study (Preprint)

2019 ◽  
Author(s):  
Benjamin H Slovis ◽  
John Kairys ◽  
Bracken Babula ◽  
Melanie Girondo ◽  
Cara Martino ◽  
...  
Keyword(s):  
The United States ◽  
Opioid Use ◽  
Duration Of Treatment ◽  
Record System ◽  
Opioid Prescription ◽  
Increased Risk ◽  
The Us ◽  
Control And Prevention ◽  
Opioid Medications

BACKGROUND The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. OBJECTIVE The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. METHODS We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. RESULTS We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%, <i>P</i>&lt;.001) but did not eliminate it. CONCLUSIONS Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence.

scholarly journals 515. Evolution of Treatment Patterns for Patients Hospitalized with COVID-19 in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S359-S360
Author(s):  
Kelly Zalocusky ◽  
Shemra Rizzo ◽  
Devika Chawla ◽  
Yifeng Chia ◽  
Tripthi Kamath ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
The United States ◽  
Hospitalized Patients ◽  
Invasive Ventilation ◽  
Data Set ◽  
Diagnostic Codes ◽  
Dramatic Decline ◽  
The Us ◽  
Optimal Patient Care ◽  
Procedure Codes

Abstract Background COVID-19 remains a threat to public health, with over 30 million cases in the US alone. As understanding of optimal patient care has improved, treatment guidelines have continued to evolve. This study characterized real-world trends in treatment for US patients hospitalized with COVID-19, stratified by whether patients required invasive ventilation. Methods US patients diagnosed and hospitalized with COVID-19 between March 23 and December 31, 2020, in the Optum de-identified COVID-19 electronic health record (EHR) data set were identified. Both drug and procedure codes were used to ascertain medications, and both procedure and diagnostic codes were used to detect invasive ventilation during hospitalization. Medication trends were estimated by computing proportions of hospitalized patients receiving each drug weekly during the study period. Results In this cohort of 71,366 hospitalized patients, the largest observed change in care was related to chloroquine/hydroxychloroquine (HCQ) (Figure). HCQ usage peaked at 87% of patients receiving invasive ventilation (54% without ventilation) in the first week of this study (March 23-29), but declined to &lt; 5% of patients, regardless of ventilation status, by the end of May. In contrast, dexamethasone usage was 10% at baseline in patients receiving ventilation (1% without ventilation) and increased to a steady state of &gt;85% of patients receiving ventilation ( &gt;50% without ventilation) by the end of June. Similarly, remdesivir usage increased sharply from a baseline of 2% of patients and continued to rise to a peak of 79% of patients receiving invasive ventilation (44% without ventilation) in November before declining. Conclusion Meaningful shifts in treatments for US patients hospitalized with COVID-19 were observed from March through December 2020. A dramatic decline was observed for HCQ use, likely owing to safety concerns, while usage of dexamethasone and remdesivir increased as evidence of their efficacy mounted. Across medications, usage was substantially more prevalent among patients requiring invasive ventilation compared with patients with less severe cases. Disclosures Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Yifeng Chia, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Tripthi Kamath, PhD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee) Larry Tsai, MD, F. Hoffmann-La Roche Ltd (Shareholder)Genentech, Inc. (Employee)

scholarly journals Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

2021 ◽  
Author(s):  
Celia Stafford ◽  
Wesley Marrero ◽  
Rebecca B. Naumann ◽  
Kristen Hassmiller Lich ◽  
Sarah Wakeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Geographic Region ◽  
Influential Factors ◽  
Opioid Use ◽  
Living Situation ◽  
Data Set ◽  
Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

scholarly journals Disparities in Opioid Use Disorder Treatment Admissions in the United States

2020 ◽  
Vol 7 (1) ◽  
pp. 85-93
Author(s):  
Peter Mallow ◽  
Michael Mercado ◽  
Michael Topmiller
Keyword(s):  
United States ◽  
Wait Time ◽  
The United States ◽  
Opioid Use Disorder ◽  
P Value ◽  
Opioid Use ◽  
Data Set ◽  
Significant Difference ◽  
Receive Treatment ◽  
To Receive

Objectives: The Cincinnati region has been at the epicenter of the nation’s unfolding opioid epidemic. The objectives of this study were twofold: (1) to compare the Cincinnati region to the United States in length of time to obtain treatment and planned medication-assisted therapy for the treatment for opioid use disorder (OUD); and (2) to assess racial disparities within the Cincinnati region in wait time and type of treatment. Methods: The 2017 Treatment Episode Data Set: Admissions (TEDS-A) from the Substance Abuse and Mental Health Services Administration (SAMHSA) was used to identify a cohort of eligible individuals with a primary substance use of opioids, including opioid derivatives. Logistic regression models were performed to assess the differences for treatment wait time and type of planned treatment. Model covariates included patient demographics and socioeconomic characteristics. Three different models were performed to assess the influence of covariates of the outcomes. Results: There were 678 766 US and 3298 Cincinnati region individuals admitted for OUD treatment in 2017. The rate per 1000 for treatment admissions was 2.08 and 1.51 (P value < 0.0001) for the United States and Cincinnati, respectively. The fully saturated regression results found that the odds of Cincinnati individuals receiving planned medication-assisted therapy were 0.497 (95% CI, 0.451–0.546; P value < 0.001). The odds of waiting longer for treatment in Cincinnati were higher than in the United States as a whole: 2.33 (95% CI, 2.19–2.48; P value < 0.001). In Cincinnati, there were 3102 Caucasian, 123 African American, and 73 Other admissions. The fully saturated model results found that Caucasians and Other had an increased likelihood of receiving planned medication-assisted therapy (OR 1.89, P value 0.039; OR 7.07, P value 0.002, respectively) compared to African Americans. Within Cincinnati, there was not a statistically significant difference in the likelihood of waiting time to receive treatment by race. Conclusion: Individuals seeking treatment for OUD in Cincinnati were less likely to receive planned medication-assisted therapy and were more likely to wait longer than individuals in the United States as a whole. These results suggest that the demand for treatment is greater than the supply in Cincinnati. Within Cincinnati, there does not appear to be a racial disparity in treatment type or length of time to receive treatment for OUD.

scholarly journals Measuring Job Creation, Growth, and Survival among the Universe of Start-ups in the United States Using a Combined Start-up Panel Data Set

ILR Review ◽  
2019 ◽  
Vol 72 (5) ◽  
pp. 1262-1277 ◽  
Author(s):  
Robert W. Fairlie ◽  
Javier Miranda ◽  
Nikolas Zolas
Keyword(s):  
United States ◽  
Panel Data ◽  
The United States ◽  
Future Research ◽  
Data Set ◽  
Growth And Survival ◽  
Start Up ◽  
The Us ◽  
Start Ups ◽  
The Universe

The field of entrepreneurship is growing rapidly and expanding into new areas. This article presents a new compilation of administrative panel data on the universe of business start-ups in the United States, which will be useful for future research in entrepreneurship. To create the US start-up panel data set, the authors link the universe of non-employer firms to the universe of employer firms in the Longitudinal Business Database (LBD). Start-up cohorts of more than five million new businesses per year, which create roughly three million jobs, can be tracked over time. To illustrate the potential of the new start-up panel data set for future research, the authors provide descriptive statistics for a few examples of research topics using a representative start-up cohort.

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