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Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Seewald L, Bonar E, Bohnert ASB, Carter PM, King CA, Losman ED, Bacon L, Wheeler T, Walton M. Lifetime non-fatal overdose experiences among at-risk adolescents and young adults in the emergency department with past-year opioid use in the USA. Inj Prev 2024:ip-2023-045072. [PMID: 38331586 DOI: 10.1136/ip-2023-045072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Adolescents and young adults with risk factors for opioid misuse and opioid use disorder are at elevated risk for overdose. We examined prior non-fatal overdose experiences among at-risk adolescents/young adults to inform prevention efforts. METHODS Adolescents/young adults (ages 16-30) in two US emergency departments self-reporting past year opioid misuse or opioid use plus a misuse risk factor completed a baseline survey as part of an ongoing randomised controlled trial. We describe baseline factors associated with (a) overall non-fatal overdose experiences and (b) groups based on substance(s) used during the worst overdose experience. RESULTS Among 771 participants (27.9% male), 40.7% reported a non-fatal overdose experience. Compared with those without a prior overdose experience, those with prior overdose experience(s) were less likely to be heterosexual, and more likely to report a prior suicide attempt and greater peer substance misuse. Regarding the worst overdose experience, substance(s) included: 36.6% alcohol only, 28.0% alcohol and cannabis, 22.6% alcohol with other substance(s) and 12.7% other substance(s) only (eg, opioids). Compared with the alcohol only group, the alcohol and cannabis group were younger and less likely to be heterosexual; the alcohol with other substance(s) group were older and had greater peer substance misuse; and the other substance(s) only group were more likely to be male, receive public assistance, screen positive for anxiety and less likely to be heterosexual. CONCLUSIONS Among at-risk adolescents/young adults, findings support the need for tailored overdose prevention efforts based on substance(s) used, with consideration of sexuality, mental health and peer substance use. TRIAL REGISTRATION NUMBER NCT04550715.
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Affiliation(s)
- Laura Seewald
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
| | - Erin Bonar
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy S B Bohnert
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA
- University of Michigan Department of Anesthesiology, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl A King
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Eve D Losman
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Linnea Bacon
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Tiffany Wheeler
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Maureen Walton
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
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Coady JA, Nadal NC. Strengthening Prevention Systems to Address the Overdose Crisis Through the HEAL Prevention Cooperative and HEAL Preventing Opioid Use Disorder Research Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:119-128. [PMID: 37668936 DOI: 10.1007/s11121-023-01579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
The HEAL Prevention Cooperative (HPC), a subset of the HEAL Preventing Opioid Use Disorder (OUD) Research Program, addresses the evidence gap of interventions for populations at higher risk for opioid use initiation, escalation, and disorder. Designed to yield programs that can be scaled up for dissemination, the studies address topics critical to systematic implementation including data harmonization, intervention costs, culturally responsive services, community engagement, working across the continuum of care, and bringing interventions to market. Ideally, interventions found to be effective will be considered for adoption by community stakeholders. However, the introduction and sustained use of evidence-based approaches remain challenging across the prevention field. Using SAMHSA/CSAP's framework for describing a modern and effective prevention system (Early Action, Easy Access, Effective Delivery, and Equitable Opportunities - the 4Es), this commentary describes ways to engage states, jurisdictions, territories, tribes, and communities to apply the lessons learned and pre-position their respective prevention systems for broad-scale implementation of HPC interventions.
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Affiliation(s)
- Jeffrey A Coady
- Substance Abuse and Mental Health Services Administration (SAMHSA), 233 N. Michigan Avenue, Ste. 200, Chicago, IL, 60601, USA
| | - Nelia C Nadal
- SAMHSA's Center for Substance Abuse Prevention (CSAP), 5600 Fishers Lane, 16E89B, MD, 20857, Rockville, USA.
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Ahrens K, Blackburn N, Aalsma M, Haggerty K, Kelleher K, Knight DK, Joseph E, Mulford C, Ryle T, Tolou-Shams M. Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:99-110. [PMID: 37393415 PMCID: PMC10961647 DOI: 10.1007/s11121-023-01566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
Youth involved in the legal system (YILS) experience rates of opioid and substance use disorders (OUD/SUDs) and overdose that is well above those in the general population. Despite the dire need, and the existing programs that focus on treatment of these problems in YILS, research on opioid initiation, and OUD prevention, including feasibility and sustainability, are severely limited. We present four studies testing interventions that, while not necessarily novel as SUD treatments, test novel structural and interpersonal strategies to prevent opioid initiation/OUD precursors: (1) ADAPT (Clinical Trial No. NCT04499079) provides real-time feedback using community-based treatment information system data to create a more effective mental health and SUD treatment cascade to prevent opioid use; (2) HOME (Clinical Trial No. NCT04135703) provides youth experiencing homelessness, including YILS, with direct access to shelter in independent living without prerequisites as an opioid initiation prevention strategy; (3) LeSA (Clinical Trial No. NCT04678960) uses the Trust-Based Relational Intervention® to equip YILS and their caregivers with self-regulatory and communication skills during the transition from secure confinement to reduce opioid initiation/re-initiation; and (4) POST (Clinical Trial No. NCT04901312) tests two interventions integrating interpersonal/drinking and drug refusal skills, case management, and goal setting among YILS in transitioning out of secure detention as opioid initiation prevention strategies. We discuss early implementation barriers and facilitators, including complexities of prevention research with YILS and adaptations due to COVID-19. We conclude by describing anticipated end products, including implementation of effective prevention interventions and integration of data from multiple projects to address larger, multi-site research questions.
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Affiliation(s)
- Kym Ahrens
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
| | | | - Matthew Aalsma
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin Haggerty
- University of Washington Social Development Research Group, Seattle, WA, USA
| | | | - Danica K Knight
- Texas Christian University Karyn Purvis Institute of Child Development, Fort Worth, TX, USA
| | - Elizabeth Joseph
- Texas Christian University Institute of Behavioral Research, Fort Worth, TX, USA
| | | | - Ted Ryle
- Washington State Dept. of Children, Youth and Families/Juvenile Rehabilitation, Olympia, WA, USA
| | - Marina Tolou-Shams
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, CA, USA
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Andersen SL, Fishbein DH. Commentary: Improving the Effectiveness and Utility of the Helping to End Addiction Long-Term (HEAL) Prevention Cooperative: A Full Translational Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:111-118. [PMID: 36580206 PMCID: PMC9797884 DOI: 10.1007/s11121-022-01477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
The Helping to End Addiction Long-term (HEAL) Prevention Collaborative (HPC) is designed to expedite the development of programs aimed at preventing opioid misuse and opioid use disorder (OUD) in older adolescents and young adults (ages 16-30). Funded by the National Institutes of Health Office of the Director (ODP-NIH), the HPC includes ten outcome studies that focus on distinct interventions to determine their effectiveness and real-world applicability. Also included is a coordinating center at RTI International that supports the individual projects. This commentary highlights the scientific and practical significance of this cooperative and its promise for facilitating the production and implementation of successful interventions. Attributes such as novel program designs, advanced methodologies, addressing unique characteristics of diverse populations, and real-time analysis of data and costs make this cooperative highly innovative. We note, however, that papers in this Supplemental Issue did not specifically address the persistent need to obtain stronger effect sizes than those achieved to date. Existing data captured earlier in development (< 16 years of age) are uncovering interactive neurocognitive and social-contextual mechanisms underlying the phenomena we wish to prevent. HPC projects could be guided by this information to incorporate developmentally appropriate measures of mechanisms shown previously to be influential in targeted outcomes and determine how they are impacted by specific components of their interventions. This mechanistic information can provide a roadmap for constructing interventions that are more precision-based and, thus, more likely to yield greater benefits for a larger number of recipients. Furthermore, an understanding of underlying mechanism(s) promises to shed light on the sources of heterogeneity in outcomes for further intervention refinement. It is quite possible, if not probable, that meaningful measures of underlying processes will reveal subtypes-some with very high effect sizes and others that are much lower-directly enabling program refinements to more directly target mechanisms that portend and explain less favorable outcomes. Described herein is a full-spectrum translational approach which promises to significantly boost effect sizes, a key objective that should be reached prior to scaling.
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Affiliation(s)
- Susan L Andersen
- Harvard Medical School, Boston, MA, 02478, USA
- The National Prevention Science Coalition to Improve Lives, Oakland, CA, 94609, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina, 105 Smith Level Road, Chapel Hill, NC, 27599, USA.
- Human Development and Family Studies, The Pennsylvania State University, State College, PA, 16802, USA.
- The National Prevention Science Coalition to Improve Lives, Oakland, CA, 94609, USA.
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