Citation

Luu H, Slavova S, Freeman PR, Lofwall M, Browning S, Slade E, Bush H. Drug Alcohol Depend. 2019; 205: e107606.

Affiliation

Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2019.107606

PMID

31606590

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.

Copyright © 2019 Elsevier B.V. All rights reserved.

Language: en

Keywords

Buprenorphine/Naloxone; High-dose opioid analgesic prescribing; Methadone; Opioid use disorder; Prescription drug monitoring program