Background:Despite recent declines in fatal overdoses in the United States, the overdose crisis remains a persistent public health challenge. We modeled hypothetical scenarios of short-term increases or decreases in opioid-involved overdose rates among individuals with opioid use disorder (OUD) and estimated overdose-related outcomes, costs, and prevention efforts to counteract potential increases in fatal overdoses. Methods:We updated a previously validated simulation model of the US population with OUD using 2021-2024 data. Fatal and nonfatal overdoses, individuals with OUD and in remission, and estimated economic costs were projected between 2025 and 2028 under baseline conditions and hypothetical scenarios assuming annual 5% increases or decreases in fatal overdose rates. We quantified prevention efforts to counteract increases in overdose across four prevention strategies aimed at improving access to medications for OUD (MOUD) and reducing fatal overdose. Findings:The baseline scenario estimated 97,000 fatal and 3.4 million nonfatal opioid-involved overdoses among individuals with OUD, and an economic burden of $3.94 trillion between 2025 and 2028. Assuming decreased fatal overdose rates, we estimated 14.1% fewer fatal overdoses, and $202 billion in reduced economic burden. Conversely, assuming fatal overdose rates increased, we estimated an additional 16.5% fatal overdoses and $236 billion in economic burden. Model simulations estimated increasing annual MOUD initiation to 62.6% and naloxone administration to 14.2% could independently prevent additional lives lost. Interpretation:The economic burden of overdose and OUD highlights the importance of continued investments in overdose prevention. Increased prevention efforts, such as naloxone use and increased MOUD initiation, could help counteract potential increases in fatal overdose rates. Funding:This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

This cohort study analyzes factors associated with abandonment of newly prescribed buprenorphine among US adults from 2020 to 2024.

Although several opioid prescribing recommendations and guidelines have been published since 2016, patterns of postoperative opioid prescribing for specific procedures among Medicaid beneficiaries and guideline concordance remain unclear. This study examined and compared patterns of procedure-specific opioid prescribing for postoperative pain during 2016-2017 and 2021-2022. This study used MarketScan Multi-State Medicaid database to identify patients aged 0-64 years without a diagnosis of cancer who underwent one of 24 common surgical procedures between October 2016-September 2017 (n=267,142) and October 2021-September 2022 (n=223,647). For each procedure, 1) opioid dispensing rate; 2) days' supply of the opioid prescription; and 3) prescribed daily dosage in morphine milligram equivalents (MMEs) were measured. A total of 274,031 common surgical procedures were identified among Medicaid beneficiaries in 2016-2017 (n=267,142, 84.9% female, 78.5% aged 19-64, 52.3% White, 30.0% Black, 4.3% Hispanic) and 229,514 procedures in 2021-2022 (n=223,647, 84.7% female, 85.0% adults aged 19-64, 54.3% White, 27.1% Black, 8.3% Hispanic). Compared to procedure-specific opioid dispensing rates in 2016-2017 (range: 30.7%-94.5%), rates in 2021-2022 decreased across all procedures (range: 8.1%-84.4%). Mean days' supply of opioids for all procedures was shorter in 2021-2022 (range: 3.7-6.7 days) than in 2016-2017 (range: 4.2-9.2 days). Mean daily dosage of opioids decreased among 23 procedures. Only tonsillectomy had a lower mean daily dosage in 2016-2017. Overall, dispensing rates of opioids decreased in 2021-2022 compared to 2016-2017 across all procedures. In 2021-2022, both the mean day's supply and mean daily dosage of postoperative opioids for all 24 procedures were more concordant with recommendations in clinical guidelines. PERSPECTVE: This study examines and compares opioid prescribing for postoperative pain among Medicaid beneficiaries undergoing 24 common surgical procedures in 2016-2017 and 2021-2022. The observed decrease in opioid dispensing rates, days' supply, and daily dosages in 2021-2022 may indicate clinicians followed clinical guidelines more closely and improved postoperative opioid use safety.

Drug overdose deaths remain a major public health concern in the United States. Although buprenorphine is approved by the Food and Drug Administration to treat opioid use disorder and reduces overdose risk and deaths, the medication remains underused in the United States, and many persons who could benefit from treatment lack access. This report describes 2019-2025 trends in buprenorphine dispensing by pharmacies, treatment initiation among persons newly receiving buprenorphine, treatment retention, pharmacy availability, and emergency department (ED) administration by urban-rural county classification using IQVIA data on buprenorphine dispensed by pharmacies and the Premier Healthcare Database. Dispensing rates increased from 2019 to 2021, before declining thereafter, and remained consistently higher in rural counties than in urban counties. The number of patients per prescriber and prescriptions per prescriber declined in both urban and rural counties. Initiation and retention were higher in rural counties; initiation declined in urban counties, and retention declined over time in both urban and rural counties. Pharmacy availability of buprenorphine increased in both urban and rural counties. Adoption and administration of ED buprenorphine increased in both urban and rural counties but remained lower in rural counties. These findings highlight differences between urban and rural areas in buprenorphine access and treatment, with more reliance on pharmacies dispensing buprenorphine in rural counties and higher ED-based administration in urban counties. Opportunities to improve access include use of a low threshold for prescribing buprenorphine, strengthening pharmacy availability of buprenorphine, and (particularly in rural areas) supporting ED-based treatment and sustaining telehealth flexibilities.

INTRODUCTION:Although supply-side barriers to naloxone have been reduced, receipt remains low in the U.S. Demand-side barriers, such as out-of-pocket costs, may contribute to low receipt. This study evaluated the association between health plan design and receipt of naloxone, leveraging a natural experiment arising from the passage of a naloxone coprescribing law in New York state. METHODS:This study used administrative claims data on naloxone and opioid dispensing for the commercially insured population in New York from the Merative MarketScan Database from January 2021 to March 2023. Difference-in-difference models were estimated, comparing codispensed naloxone between individuals enrolled in high-deductible healthcare plans and those enrolled in non-high-deductible healthcare plans before and after New York's passage of the law on December 30, 2021. Data were collected and analyzed in 2025. RESULTS:The policy change was associated with a 4.6 percentage point (95% CI=4.1, 5.0) and 1.3 percentage point (95% CI=0.3, 2.1) increase in the probability of being codispensed naloxone for non-high-deductible healthcare plan and high-deductible healthcare plan groups, respectively, equating to a 131% and 39% increase from their respective baselines. This change in probability among high-deductible healthcare plan enrollees was 3.4 percentage point (95% CI= -4.4, -2.4) lower than that among non-high-deductible healthcare plans enrollees. CONCLUSIONS:Individuals facing higher out-of-pocket costs were less likely to fill naloxone prescriptions than those facing lower out-of-pocket costs after the naloxone coprescribing mandate. Supply-side naloxone access policies may be unevenly distributed across patient populations owing to variations in insurance design and associated financial barriers. Addressing demand-side barriers to naloxone uptake may be an important overdose prevention strategy.

This cross-sectional study describes the level of naloxone information and availability and general attitudes about illicit drug use across different demographic groups in the US.

OBJECTIVES:Buprenorphine can decrease opioid use disorder and mortality risk but remains underutilized. This study evaluates changes in monthly buprenorphine dispensing associated with federal policy changes in the United States from 2018 to 2023. METHODS:This study used interrupted time series analysis comparing the monthly rate of patients dispensed buprenorphine after the implementation of telehealth flexibilities in March 2020, relaxation of training requirements in April 2021, and removal of waiver requirements in December 2022. Buprenorphine formulated for opioid use disorder was included from the IQVIA Total Patient Tracker. RESULTS:Before March 2020, the monthly rate of individuals dispensed buprenorphine was increasing. The rate of increase slowed after each policy change: -0.69 (95% CI=-1.00 to -0.39) after telehealth flexibilities were initiated, -0.60 (95% CI=-0.92 to -0.27) after relaxing training requirements, and -0.49 (95% CI=-0.73 to -0.24) after waiver elimination. After the elimination of the waiver, declines were observed across several specialty groups, including pain medicine, emergency medicine, and primary care, while the rate increased among addiction medicine specialists. CONCLUSIONS:After each policy change, the rate of individuals dispensed buprenorphine increased at a slower rate than before each policy change. These findings suggest that the removal of the waiver, while important, may not be sufficient on its own to meaningfully expand buprenorphine prescribing. Individual and systems-level strategies may be needed to fully optimize the impact of these policy changes focusing on reducing patient, clinician, and institutional stigma, addressing clinician barriers, implementing systems-level improvements, and strengthening payment policies that incentivize prescribing.

Importance Stimulants are increasingly prescribed for US adults. Whether such prescribing is associated with misuse and prescription stimulant use disorder (PSUD) is less understood. Objectives To examine (1) sex- and age-specific trends in the number of persons dispensed stimulants and trends in dispensed prescription stimulants by prescriber specialty in 2019 through 2022; (2) prevalence of misuse and PSUD by use of prescription amphetamine-type stimulants (hereafter referred to as amphetamines ) and methylphenidate; and (3) PSUD prevalence and sociodemographic and behavioral health correlates among persons using prescription stimulants with and without prescription stimulant misuse. Design, Setting, and Participants This cross-sectional survey study used the 2019-2022 IQVIA Total Patient Tracker and National Prescription Audit New to Brand databases and the 2021-2022 National Surveys on Drug Use and Health (NSDUH) (community-dwelling 18- to 64-year-old individuals). Data analysis was performed from March to April 2024. Exposure Past-year use of prescription stimulants. Main Outcomes and Measures PSUD using DSM-5 criteria. Results Of the sampled 83 762 adults aged 18 to 64 years, 33.8% (unweighted) were aged 18 to 25 years, 53.0% (unweighted) were aged 26 to 49 years, and 56.0% (unweighted) were women. Among those using prescription stimulants, 25.3% (95% CI, 23.8%-26.8%) reported misuse, and 9.0% (95% CI, 8.0%-10.0%) had PSUD. Among those with PSUD, 72.9% (95% CI, 68.3%-77.6%) solely used their own prescribed stimulants, 87.1% (95% CI, 82.3%-90.8%) used amphetamines, 42.5% (95% CI, 36.6%-48.5%) reported no misuse, and 63.6% (95% CI, 56.8%-69.8%) had mild PSUD. Individuals using amphetamines, compared with those using methylphenidate, had higher prevalence ratios of misuse (3.1 [95% CI, 2.2-4.3]) and PSUD (2.2 [95% CI, 1.3-3.8]). The largest increase in the number of individuals dispensed prescription stimulants was among women aged 35 to 64 years, from 1.2 million in quarter 1 of 2019 to 1.7 million in quarter 4 of 2022 (average quarterly percentage change, 2.6% [95% CI, 2.1%-3.1%]). The prevalence of prescription stimulant misuse was lower among women aged 35 to 64 years using these medications (13.7% [95% CI, 11.1%-16.8%]) than other sex- and age-specific subgroups (ranging from 22.0% [95% CI, 17.9%-26.7%] for men aged 35-64 years to 36.8% [95% CI, 32.6%-41.2%] for women aged 18-25 years). Conclusions and Relevance High prevalence of prescription stimulant misuse and PSUD (regardless of misuse status) suggests the importance of ensuring clinically appropriate use and of screening for and treating PSUD among all adults prescribed stimulants, especially those using amphetamines. Findings may suggest potential progress in addressing the mental health care gap for middle-aged women and the need for evidence-based clinical guidance and training on benefits and risks of prescription stimulants for adults.

This study examines the impact of the MAT Act on trends in pharmacist-prescribed buprenorphine from US retail pharmacies from 2019 to 2024.

Background: Chronic pain affects more than 1 in 5 adults in the United States. Understanding the economic burden of chronic pain can inform interventions and strategies to improve the quality of life for individuals with chronic pain. Objective: To estimate the economic cost of chronic pain in the United States in 2021. Research Design: A cross-sectional analysis estimating the economic costs of chronic pain in 2021. Subjects: In 2021, 6445 (representing 65.8 million) adults with chronic pain were identified using ICD-10-CM codes from the nationally representative Medical Expenditure Panel Survey. Measures: Direct medical costs were examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity from employment disability and missed workdays. We evaluated the economic burden of chronic pain by estimating excess costs among individuals with chronic pain compared with individuals without chronic pain using multivariable regression. Results: Individuals with chronic pain had additional total annual medical expenditures of $8068 and additional lost productivity of $2923 per person compared with individuals without chronic pain. In 2021, the economic costs of chronic pain in the United States were estimated to be $722.8 billion, including $530.6 billion in medical care costs and $192.2 billion in lost work productivity. Conclusions: The economic costs of chronic pain are substantial, resulting in excess health care expenditures and lost productivity costs. These findings highlight the importance of interventions and strategies aimed at providing high-quality, accessible, low-barrier, cost-effective pain care to improve quality of life and reduce disruptions in work among adults with chronic pain.

INTRODUCTION:Gabapentin and pregabalin (gabapentinoids) are increasingly prescribed to children and adolescents off label for various conditions despite limited data and concerns for adverse outcomes including misuse and overdose. The extent of gabapentinoid use in children and adolescents is unknown. METHODS:Nationally representative retail pharmacy dispensing data from IQVIA was used to describe trends in gabapentinoid dispensing to children and adolescents aged ≤19 years from April 2017 through September 2023. The analysis was performed in 2024. Trends by patient age and sex and by prescriber specialty are presented along with median quarterly rates (MQR) and quarterly percentage changes (QPC). RESULTS:Over the study period, the gabapentinoid dispensing rate was 4534.9/100,000 individuals. The MQR was 168.9/100,000. Between Q2 2017 and Q2 2021, the QPC was not significant (QPC=0.08; 95% CI= -2.9, 0.8) but became significant between Q2 2021 and Q3 2023 (QPC=2.8; 95% CI=1.2, 8.4). Dispensing rates were highest for adolescents aged 10-19 years (MQR=267.3/100,000) and females (MQR=187.6/100,000). Nurse practitioners prescribed the highest percent of gabapentinoids dispensed (17.8%). The total number of gabapentinoids dispensed increased from 2018 to 2022 across all specialties except psychiatry (-14.8%) and internal medicine (-9.2%), with nurse practitioners (48.2%), surgical specialists (48.0%), and addiction medicine specialists (51.2%) representing the largest increases. CONCLUSIONS:Gabapentinoid receipt among U.S. children and adolescents has increased. Future research can explore factors associated with prescribing including changing epidemiology of pain and psychiatric diagnoses in children and adolescents. Prescribing clinicians should carefully consider the potential risks and benefits of gabapentinoids in clinical practice.

Introduction: In 2016, the Centers for Disease Control and Prevention released the Guideline for Prescribing Opioids for Chronic Pain (2016 Centers for Disease Control and Prevention Guideline) to improve opioid prescribing while minimizing associated risks. This analysis sought to understand guideline-concordant knowledge and self-reported practices among primary care physicians. Methods: Data from Spring DocStyles 2020, a cross-sectional, web-based survey of practicing U.S. physicians, were analyzed in 2022 and 2023. Demographic, knowledge, and practice characteristics of primary care physicians overall (N=1,007) and among specific subsets—(1) primary care physicians who provided care for patients with chronic pain (n=600), (2) primary care physicians who did not provide care for patients with chronic pain (n=337), and (3) primary care physicians who reported not obtaining or seeking a buprenorphine waiver (n=624)—were examined. Results: A majority of physicians (72.6%) were unable to select a series of options consistent with diagnostic criteria for opioid use disorder; of those physicians, almost half (47.9%) reported treating at least 1 patient with medications for opioid use disorder. A minority of physicians (17.5%) reported having a buprenorphine prescribing waiver. Among physicians who prescribed opioids for chronic pain (88.5%), 54.4% concurrently prescribed benzodiazepines. About one third (33.5%) reported not taking patients with chronic pain. Conclusions: There were critical practice gaps among primary care physicians related to 2016 Centers for Disease Control and Prevention Guideline topics. Increasing knowledge of the Centers for Disease Control and Prevention's opioid prescribing recommendations can benefit physician practice, patient outcomes, and public health strategies in addressing the opioid overdose crisis and implementing safer and more effective pain care.

BACKGROUND:Opioid use disorder (OUD) affects millions of individuals each year in the United States. Patient retention in medications for opioid use disorder (MOUD) treatment is suboptimal. This study examines and quantifies the associations between each additional month of buprenorphine or methadone use and nonprescribed opioid use. METHODS:Data were obtained from an 18-month longitudinal, observational cohort study of patients (age ≥ 18 years) treated for OUD. Patients completed a baseline self-reported questionnaire between March 2018 and December 2019 and were asked to complete follow-up questionnaires at approximately 3-, 6-, 12-, and 18-months post-baseline until May 2021. Patients treated with buprenorphine or methadone, without taking other MOUD at least 12 months prior to baseline, were included. Outcomes included past 30-day use of prescription opioids nonmedically, heroin, or illegally made fentanyl. A multivariable, multilevel regression model with a binomial distribution and a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS:This study included 353 patients taking buprenorphine (mean [standard deviation, SD] age 39 [11] years; 226 [64%] female), and 785 patients taking methadone (mean [SD] age 42 [12] years; 392 [50%] female). Each additional month of MOUD treatment was associated with a 25% decrease in the odds of past 30-day nonprescribed opioid use for patients taking buprenorphine (aOR [95% CI] = 0.75 [0.68-0.83]), and a 17% decrease for patients taking methadone (aOR = 0.83 [0.79-0.87]). The COVID-19 pandemic (aOR = 9.29 [2.96-29.17]; aOR = 3.19 [1.74-5.86]) and MOUD adverse reaction experiences (aOR = 3.07 [1.11-8.48]; aOR = 2.51 [1.01-6.22]) were significantly associated with higher odds of nonprescribed opioid use among buprenorphine and methadone groups. CONCLUSION:Among patients treated with buprenorphine or methadone, with each additional treatment month since baseline, those who continued with treatment appeared to be more likely to report 17% to 25% decreased odds of past 30-day nonprescribed opioid use. Our findings can be used by clinicians in the shared decision-making process with patients, emphasizing the value of sustained retention in MOUD.