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Association Between Buprenorphine/Naloxone and High-Dose Opioid Analgesic Prescribing in Kentucky, 2012-2017

NCJ Number
Drug and Alcohol Dependence Volume: 205 Issue: 1 Dated: December 2019
Huong Luu; Svetla Slavova; Patricia R Freeman; Michelle Lofwall; Steven Browning; Emily Slade; Heather Bush
Date Published
December 2019
10 pages
This study investigated the relationships between buprenorphine/naloxone prescribing and high-dose opioid analgesic prescribing (HDOAP) over time.
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 current longitudinal study used 2012-2017 Kentucky All Schedule Prescription Electronic Reporting data and cross-lagged structural equation analysis. For each quarter's 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. On average, HDOAP rates in Kentucky decreased by more than 10 percent (p<.0001) and buprenorphine/naloxone prescribing rates increased by just over 5 percent (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). Study findings show 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 consider this bi-directional association in the context of longitudinal data and evaluate for public health benefits beyond the reduction of HDOAP. (publisher abstract modified)