The Need for Balance in Evaluating Opioid-Prescribing Policies

• Published in: American journal of public health (1971) Vol. 112; no. S1; pp. S28 - S29
• Main Author: Hoffmann, Diane E
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01-02-2022
• Subjects: Analgesics, Opioid - adverse effects; Buprenorphine; Chronic pain; Clinical outcomes; Datasets; Design; Disease control; Disease prevention; Drug abuse; Drug addiction; Drug dosages; Drug overdose; Drug Prescriptions; Drug use; Drugs; Ethnicity; Health care policy; Health disparities; Health Policy; Heroin; Humans; Independent variables; Medicaid; Medical education; Minority & ethnic groups; Narcotics; Opinions, Ideas, & Practice; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Opioids; Other Chronic Disease; Other Race/Ethnicity; Other Statistics/Evaluation/Research; Pain; Pain management; Patients; Policies; Policy; Policy making; Prescription drugs; Public health; Race; Research design; Sickle cell disease; State policies; Substance abuse treatment; Substance use; Substance use disorder; Success; Treatment programs; Variables; United States > US; Baltimore Maryland
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2021.306696

In "Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018," Pro et al. (p. S66) explore associations between (1) individual characteristics as well as state-level policies and characteristics, and (2) success in a substance use treatment program for opioid use disorder (OUD). Individual characteristics include race, ethnicity, age, and primary drug of choice at admission to a drug treatment program. Statelevel policies and characteristics include:1.whether the state where the patient was treated implemented Medicaid expansion,2.how the state ranks on a distressed community index,3.the number of opioid prescriptions per 100 state residents,4.the number of treatment facilities in a state accepting Medicaid payment,5.the percentage ofastate'streatment facilities offering buprenorphine,6.whether the state has continuing medical education requirements for pain management, and7.whether the state has any statutory limits on opioid prescriptions.Pro et al. determined success in an OUD treatment program by reduction in use of opioids between admission and discharge. The authors further analyzed the data to determine whether the independent variables had a different impact on outcomes based on race or ethnicity.As a proponent of evidence-based drug control policies, I applaud the authors for their efforts to link state policies related to opioid prescribing with OUD treatment outcomes. There are few well-designed, rigorous studies with adequate sample sizes that can inform policymakers on which policies are effective in this arena. Additionally, the effort to identify policies that might have a different impact on outcomes based on race or ethnicity contributes valuable data to the literature on health disparities. However, from the perspective of an advocate for chronic pain patients, the article and research design have some notable omissions.