Browsing by Subject "Opioid treatment"

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    The Effect of Cannabis Laws on Access to Pain Medications among Commercially Insured Patients in the United States
    (Elsevier, 2022-12-11) Lozano-Rojas, Felipe; Abraham, Amanda; Gupta, Sumedha; Bradford, David; School of Public and Environmental Affairs
    Chronic pain is a major trigger for opioid prescribing in the U.S. Further, 35 U.S. states and the District of Columbia have adopted medical cannabis laws (MCLs), and chronic pain is the most common condition qualifying for medical cannabis access. Little is known about how legal access to medical cannabis has changed prescribing patterns for commercially insured Americans. In this article, we estimate a series of state-by-state synthetic control case-studies (29 cases, across 22 states in two policy levers for which observable pre-and post- policy timeframe comply with our eligibility criteria), using data from a nationwide comprehensive commercial claims database with approximately 15 – 20 million patients per year. We assess changes in patterns of opioid analgesic and non-opioid pain medications dispensed, capturing both intensive and extensive margins. The methodology allows us to construct a stable counterfactual in the pre-policy period for each case and to accommodate heterogeneity across treated units and their treatment timing. In all except two of the 22 examined states we find reductions in the rate of patients receiving any dispensed prescriptions of opioids (extensive margin) following the implementation of an MCL, the majority of which are statistically significant at conventional levels. We also find a marginally significant reduction in the intensive margin, measured as both the average daily supply of dispensed prescriptions and as the average number of dispensed prescriptions per patient. When we focus on other non-opioid pain medications, we do not find such a clear pattern, with very few significant effects emerging following the introduction of MCLs. Our study highlights the large variation in positive spillovers of MCLs on prescription opioid utilization among commercially insured Americans across U.S. states. Findings suggest that cannabis may offer an alternative for pain management with opioid analgesics. Thus, policymakers should consider MCLs as an alternative tool for pain management, specifically when other policies that constrain supply of opioids might push some Americans to more harmful substances.
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    Variations in the California Emergency Medical Services Response to Opioid Use Disorder
    (eScholarship Publishing, University of California, 2020-04-16) Glober, Nancy K.; Hern, Gene; McBride, Owen; Mercer, Mary P.; Emergency Medicine, School of Medicine
    Introduction: Opioids contributed to over 300,000 deaths in the United States in the past 10 years. Most research on drug use occurs in clinics or hospitals; few studies have evaluated the impact of opioid use on emergency medical services (EMS) or the EMS response to opioid use disorder (OUD). This study describes the perceived burden of disease, data collection, and interventions in California local EMS agencies (LEMSA). Methods: We surveyed medical directors of all 33 California LEMSAs with 25 multiple-choice and free-answer questions. Results were collected in RedCap and downloaded into Excel (Microsoft Corporation, Redmond WA). This study was exempt from review by the Alameda Health System - Highland Hospital Institutional Review Board. Results: Of the 33 California LEMSAs, 100% responded, all indicating that OUD significantly affects their patients. Most (91%) had specific protocols directing care of those patients and repeat naloxone dosing. After naloxone administration, none permitted release to law enforcement custody, 6% permitted patient refusal of care, and 45% directed base hospital contact for refusal of care. Few protocols directed screening or treatment of OUD or withdrawal symptoms. Regular data collection occurred in 76% of LEMSAs, with only 48% linking EMS data with hospital or coroner outcomes. In only 30% did the medical director oversee regular quality improvement meetings. Of respondents, 64% were aware of public health agency-based outreach programs and 42% were aware of emergency department BRIDGE programs (Medication Assisted Treatment and immediate referral). Only 9% oversaw naloxone kit distribution (all under the medical director), and 6% had EMS-based outreach programs. In almost all (94%), law enforcement officers carried naloxone and administered it anywhere from a few times a year to greater than 200 in one LEMSA. Conclusion: This study represents an important description of EMS medical directors' approaches to the impact of OUD as well as trends in protocols and interventions to treat and prevent overdoses. Through this study, we can better understand the variable response to patients with OUD across California.