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

Huong Luu; Svetla Slavova; Patricia R. Freeman; Michelle Lofwall; Steven Browning; Emily Slade; Heather Bush

doi:10.1016/j.drugalcdep.2019.107606

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

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1 Scopus citations

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 language	English
Article number	107606
Journal	Drug and Alcohol Dependence
Volume	205
DOIs	https://doi.org/10.1016/j.drugalcdep.2019.107606
State	Published - Dec 1 2019

Bibliographical note

Publisher Copyright:
© 2019 Elsevier B.V.

Funding

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. 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.

Funders
Department of Justice's Office of Justice Program
Kentucky Department for Public Health
US Department of Justice
Bureau of Justice Assistance
National Institute of Justice
Office of Juvenile Justice and Delinquency Prevention
Kentucky Injury Prevention and Research Center
Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking
Office for Victims of Crime
Bureau of Justice Statistics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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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10.1016/j.drugalcdep.2019.107606

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title = "Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012{\textendash}2017",

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{\textendash}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.",

keywords = "Buprenorphine/Naloxone, High-dose opioid analgesic prescribing, Methadone, Opioid use disorder, Prescription drug monitoring program",

author = "Huong Luu and Svetla Slavova and Freeman, \{Patricia R.\} and Michelle Lofwall and Steven Browning and Emily Slade and Heather Bush",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = dec,

day = "1",

doi = "10.1016/j.drugalcdep.2019.107606",

language = "English",

volume = "205",

}

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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

PY - 2019/12/1

Y1 - 2019/12/1

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.

AB - 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.

KW - Buprenorphine/Naloxone

KW - High-dose opioid analgesic prescribing

KW - Methadone

KW - Opioid use disorder

KW - Prescription drug monitoring program

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DO - 10.1016/j.drugalcdep.2019.107606

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VL - 205

JO - Drug and Alcohol Dependence

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M1 - 107606

ER -

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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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