Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012–2017

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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.

Original languageEnglish
Article number107606
JournalDrug and Alcohol Dependence
Volume205
DOIs
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
This project was supported by Grant No. 2017-PM-BX-K026 ( Data-Driven Responses to Prescription Drug Misuse in Kentucky ) awarded by the Bureau of Justice Assistance (BJA) to the Kentucky Injury Prevention and Research Center as bona fide agent for the Kentucky Department for Public Health. The BJA is a component of the Department of Justice’s Office of Justice Program, which includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office of Victims Crime, and the SMART Office. Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice.

Funding Information:
This project was supported by Grant No. 2017-PM-BX-K026 (Data-Driven Responses to Prescription Drug Misuse in Kentucky) awarded by the Bureau of Justice Assistance (BJA) to the Kentucky Injury Prevention and Research Center as bona fide agent for the Kentucky Department for Public Health. The BJA is a component of the Department of Justice's Office of Justice Program, which includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office of Victims Crime, and the SMART Office. Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice.

Publisher Copyright:
© 2019 Elsevier B.V.

Keywords

  • Buprenorphine/Naloxone
  • High-dose opioid analgesic prescribing
  • Methadone
  • Opioid use disorder
  • Prescription drug monitoring program

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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