Center for Opioid Epidemiology & Policy Newsletter
NYU Langone’s Center for Opioid Epidemiology and Policy publishes the Epidemiology and Policy Updates Newsletter periodically to showcase significant findings in opioid-related research and recent developments in opioid-related policy. To stay up to date, please join our mailing list.
Opioid Epidemiology Updates
Our most recent issue explores the impact of pregnancy and insurance status on access to opioid use disorder treatment, and the challenges to the treatment of opioid use disorder in the emergency department amidst the 2019 coronavirus disease (COVID-19) pandemic.
Pregnancy and Insurance Status Affect a Woman’s Ability to Obtain an Appointment with an Opioid Use Disorder Treatment Clinician
Although medication for opioid use disorder (MOUD) is associated with a reduction in the risk of adverse neonatal and pregnancy outcomes, significant barriers exist to accessing treatment. A cross sectional “secret shopper” study used random assignment of clinicians and simulated-patient callers in 10 states to understand whether pregnancy and insurance status were associated with a woman’s ability to obtain an appointment for treatment for opioid use disorder. Pregnant women were less likely than non-pregnant women to be given an appointment with a buprenorphine-waivered prescriber. Cost may also play a role in access to MOUD, since many clinicians did not accept insurance and required cash payment for an appointment. The study findings suggest a number of priorities to reduce barriers to affordable care for opioid use disorder, including third party payer coverage of MOUD for pregnant women, incentivizing clinicians to accept insurance to pay for MOUD, and training clinicians specialized in women’s health on the provision of buprenorphine to treat opioid use disorder.
—Adapted by Emmanuella Kobara for the NYU Center for Opioid Epidemiology and Policy. Read the paper “Association of pregnancy and insurance status with treatment access for opioid use disorder" in JAMA Network Open, published August 14, 2020.
Challenges to the Treatment of Opioid Use Disorder in the Emergency Department
This paper discusses how the COVID-19 pandemic posed challenges for patients with opioid use disorder (OUD), such as delayed care generally received in an emergency department (ED) setting in the U.S. From March to April 2020, due to the pandemic and stay-at-home orders, visits to the University of Alabama at Birmingham ED plummeted by approximately 60 percent for people with OUD. The authors hypothesized that stay-at-home orders were interpreted as instructions not to seek care unrelated to COVID-19. Patients with OUD have been impacted by abrupt healthcare system changes due to the pandemic, and risk severe depression and anxiety, among other effects, if left untreated. Prior to the pandemic, emergency departments had protocols in place for treatment of patients with OUDs. These protocols were halted as the pandemic ensued, partially due to fewer patients in the emergency department, but also due to the concern that emergency physicians’ capacity to help may be significantly reduced even when a patient with OUD reaches out for help.
—Adapted by Emmanuella Kobara for the NYU Center for Opioid Epidemiology and Policy. Read the article "Opioid use disorder in the emergency department amid COVID-19" in Journal of Addiction Medicine, published August 4, 2020.
Opioid Policy Updates
Our most recent issue explores the future of prescription drug monitoring programs in the U.S. and the steps needed to improve telehealth treatment for people who have substance use disorder.
The Future of Prescription Drug Monitoring Programs in the United States
A recent paper describes the factors that will affect the future of prescription drug monitoring programs (PDMPs) within the United States, especially concerning the state to state variations in its use and roles. The author shares that two factors will affect the future of these programs. First, the market for state PDMPs is centralizing toward a single supplier. Shifting to uniform platforms could potentially produce constraints in addressing state specific needs. Second, each state legislature decides their PDMP’s policy details such as the schedule of drugs covered and frequency of data collection. Such features can impact the utility of programs for public health surveillance, clinical decision making, and law enforcement. The author mentions that although continued state-to-state PDMP variance can be assumed, as more states link and share their data, this variation will need to be addressed through the creation of uniform standards for reporting between states.
—Adapted by Emmanuella Kobara for the NYU Center for Opioid Epidemiology and Policy. Read the paper “State policymaking and prescription drug–monitoring programs: A look ahead” in American Journal of Public Health, published on August 1, 2020.
Ways to Improve Telehealth Treatment of Substance Use Disorder
The COVID-19 pandemic has produced a demand for expanding access to substance use disorder (SUD) treatment through telehealth, according to a commentary piece on policies to improve SUD treatment during the COVID-19 pandemic and after. To ensure that the transition to tele-SUD treatment options is successful for patients, policies need to be enacted to expand these treatment for patients that may need them. It is necessary to invest in telehealth infrastructure to enable health care providers and patients to use telehealth effectively. Training and equipping healthcare professionals to provide SUD treatments through telehealth is necessary along with the technological capacity. Patients must then be provided with the financial and social support needed to use telehealth. Perhaps most importantly, temporary changes to telehealth laws and regulations should be made permanent. The authors state that these factors will ensure that SUD treatments can reach those who have not yet had access to them, as well as make it easier to continue treatment for existing patients.
—Adapted by Emmanuella Kobara for the NYU Center for Opioid Epidemiology and Policy. Read the article “Policies to improve substance use disorder treatment with telehealth during the COVID-19 pandemic and beyond” in Journal of Addiction Medicine, published on August 18, 2020.