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Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017.
Drug Alcohol Depend 2019; 205:107606DA

Abstract

INTRODUCTION

Buprenorphine/naloxone treatment is a highly effective treatment for opioid use disorder decreasing illicit opioid use and both all-cause and opioid-involved overdose mortality. The purpose of this study was to investigate the relationships between buprenorphine/naloxone prescribing and high-dose opioid analgesic prescribing (HDOAP) over time.

METHODS

This longitudinal study used 2012-2017 Kentucky All Schedule Prescription Electronic Reporting data and cross-lagged structural equation analysis. For each quarter-county observation, HDOAP rate (per 1,000 residents with opioid analgesic prescriptions) was used to predict buprenorphine/naloxone prescribing rate at the next quarter, and simultaneously buprenorphine/naloxone prescribing rate was used to predict HDOAP at the next quarter, accounting for baseline socioeconomic status, medical needs for opioid analgesics, and heroin availability.

RESULTS

On average, HDOAP rates in Kentucky decreased by more than 10% (p < .0001) and buprenorphine/naloxone prescribing rates increased by more than 5% (p < .0001) per quarter over the study period. Every one-per-thousand higher HDOAP rate in an earlier quarter was associated with a 0.01/1,000 increase in the buprenorphine/naloxone prescribing rate in a later quarter (p = .009). Conversely, a one-unit higher buprenorphine/naloxone prescribing rate in an earlier quarter was associated with a 0.01/1,000 reduction in the HDOAP rate in a subsequent quarter (p = .017).

CONCLUSIONS

Our results indicate a significant reciprocal relationship between HDOAP and buprenorphine/naloxone prescribing and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing HDOAP. Future studies on buprenorphine/naloxone treatment expansion should take into account this bi-directional association in the context of longitudinal data and evaluate for public health benefits beyond the reduction of HDOAP.

Authors+Show Affiliations

Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA.Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA. Electronic address: ssslav2@email.uky.edu.Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA; Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA.Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA.Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31606590

Citation

Luu, Huong, et al. "Association Between Buprenorphine/naloxone and High-dose Opioid Analgesic Prescribing in Kentucky, 2012-2017." Drug and Alcohol Dependence, vol. 205, 2019, p. 107606.
Luu H, Slavova S, Freeman PR, et al. Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017. Drug Alcohol Depend. 2019;205:107606.
Luu, H., Slavova, S., Freeman, P. R., Lofwall, M., Browning, S., Slade, E., & Bush, H. (2019). Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017. Drug and Alcohol Dependence, 205, p. 107606. doi:10.1016/j.drugalcdep.2019.107606.
Luu H, et al. Association Between Buprenorphine/naloxone and High-dose Opioid Analgesic Prescribing in Kentucky, 2012-2017. Drug Alcohol Depend. 2019 Oct 3;205:107606. PubMed PMID: 31606590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017. AU - Luu,Huong, AU - Slavova,Svetla, AU - Freeman,Patricia R, AU - Lofwall,Michelle, AU - Browning,Steven, AU - Slade,Emily, AU - Bush,Heather, Y1 - 2019/10/03/ PY - 2019/02/22/received PY - 2019/07/13/revised PY - 2019/07/16/accepted PY - 2019/10/14/pubmed PY - 2019/10/14/medline PY - 2019/10/14/entrez KW - Buprenorphine/Naloxone KW - High-dose opioid analgesic prescribing KW - Methadone KW - Opioid use disorder KW - Prescription drug monitoring program SP - 107606 EP - 107606 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 205 N2 - INTRODUCTION: Buprenorphine/naloxone treatment is a highly effective treatment for opioid use disorder decreasing illicit opioid use and both all-cause and opioid-involved overdose mortality. The purpose of this study was to investigate the relationships between buprenorphine/naloxone prescribing and high-dose opioid analgesic prescribing (HDOAP) over time. METHODS: This longitudinal study used 2012-2017 Kentucky All Schedule Prescription Electronic Reporting data and cross-lagged structural equation analysis. For each quarter-county observation, HDOAP rate (per 1,000 residents with opioid analgesic prescriptions) was used to predict buprenorphine/naloxone prescribing rate at the next quarter, and simultaneously buprenorphine/naloxone prescribing rate was used to predict HDOAP at the next quarter, accounting for baseline socioeconomic status, medical needs for opioid analgesics, and heroin availability. RESULTS: On average, HDOAP rates in Kentucky decreased by more than 10% (p < .0001) and buprenorphine/naloxone prescribing rates increased by more than 5% (p < .0001) per quarter over the study period. Every one-per-thousand higher HDOAP rate in an earlier quarter was associated with a 0.01/1,000 increase in the buprenorphine/naloxone prescribing rate in a later quarter (p = .009). Conversely, a one-unit higher buprenorphine/naloxone prescribing rate in an earlier quarter was associated with a 0.01/1,000 reduction in the HDOAP rate in a subsequent quarter (p = .017). CONCLUSIONS: Our results indicate a significant reciprocal relationship between HDOAP and buprenorphine/naloxone prescribing and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing HDOAP. Future studies on buprenorphine/naloxone treatment expansion should take into account this bi-directional association in the context of longitudinal data and evaluate for public health benefits beyond the reduction of HDOAP. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/31606590/Association_between_buprenorphine/naloxone_and_high-dose_opioid_analgesic_prescribing_in_Kentucky,_2012-2017 L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(19)30383-7 DB - PRIME DP - Unbound Medicine ER -