Days Of Prescription Research Articles

Association between cannabis laws and opioid prescriptions among privately insured adults in the US

We examine the association between opioid prescription patterns in privately insured adults and changes in state cannabis laws among five age groups (18–25, 26–35 36–45, 46–55 and 56–64 years). Using the 2016 Clinformatics Data Mart, a nationwide commercial health insurance database, we performed a cross-sectional analysis of two types of opioid prescribing (>30-day and >90-day prescriptions) among all adults aged 18–64 based on the stringency of cannabis laws. We found a significant interaction between age and cannabis law on opioid prescriptions. Age-stratified multilevel multivariable analyses showed lower opioid prescription rates in the four younger age groups only in states with medical cannabis laws, when considering both >30 day and >90 day opioid use [>30 day adjusted odds ratio (aOR) = 0.56, in 18–25, aOR = 0.67 in 26–35, aOR = 0.67 in 36–45, and aOR = 0.76 in 46–54 years; >90 day aOR = 0.56, in 18–25, aOR = 0.68 in 26–35, aOR = 0.69 in 36–45, and aOR = 0.77 in 46–54 years, P < 0.0001 for all]. This association was not significant in the oldest age group of 55–64 years. There was no significant association between opioid prescriptions and other categories of cannabis laws (recreational use and decriminalization) in any of the age groups studied.

PDG58 CLOSING THE MEDICARE PART D COVERAGE GAP: TRENDS IN DRUG UTILIZATION AND EXPENDITURES, 2008- 2015

Under the Affordable Care Act (ACA), the Medicare Part D coverage gap has been phasing out gradually since 2011. This study analyzes trends in prescription drug utilization and expenditures from 2008 to 2015. Data on non-disabled Part D seniors who did not receive the Low-Income Subsidy were obtained from the 2008-2015 Medicare Current Beneficiary Survey. Drug utilization was measured using the mean annual number of 30-day prescription drug fills per person. Drug expenditures were measured at two levels: mean annual total and out-of-pocket spending per person. All analyses were conducted separately for four different populations: all beneficiaries, those not reaching the coverage gap, those entering the coverage gap without reaching the catastrophic threshold, and those reaching the catastrophic threshold. Overall, the use of prescription drugs increased after the ACA, although no significant changes were among those reaching the catastrophic threshold. Total drug spending steadily increased after the ACA except for those not reaching the coverage gap; the largest increase was among those reaching the catastrophic threshold (43% increase from 2009 to 2015). However, out-of-pocket drug spending significantly decreased in the post-ACA period with the largest decrease in those not entering the coverage gap. For those reaching the catastrophic threshold, out-of-pocket spending incurred during the catastrophic coverage phase significantly increased. Despite increasing utilization and total costs of prescription drugs after the ACA, out-of-pocket drug costs significantly decreased. Our findings provide evidence the ACA’s coverage gap reform has helped to reduce financial barriers to prescription drugs for Part D beneficiaries. However, the findings of substantial increases in total drug spending over time, especially among those reaching the catastrophic threshold, may indicate a growing burden on the Medicare program. Potential changes to the Part D program and drug pricing models may be needed to reduce the growing total spending.

Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study.

Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and ≥10 medications), which are defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used ≥10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for ≥10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to ≥10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children.

3334 Insurance Generosity and Inflammatory Bowel Disease: Does Higher Patient Cost-Sharing Result in Suboptimal Medication Habits and Inferior Clinical Outcomes?

OBJECTIVES/SPECIFIC AIMS: Our primary objectives were to examine the impact of biologic cost sharing on 1) adherence to biologics and 2) persistence on biologics in inflammatory bowel disease (IBD) patients. Our secondary objective was to assess the effect of biologic cost sharing on clinical IBD outcomes, including rates of hospitalization, abdominal surgery, and corticosteroid treatment. METHODS/STUDY POPULATION: This retrospective cohort analysis used a national insurance claims database (Optum Clinformatics DataMart) to assess adult IBD patients enrolled in medium or large private insurance plans from 2007-2016. Patients were followed for one year of continuous enrollment after their index biologic claim. We assessed adherence to biologic medications (medication possession ratio &gt;0.8) dependent on patient cost sharing, as measured by an employer-plan’s average out-of-pocket biologic medication cost. We also examined the effects of patient cost sharing for biologics on need for hospitalization, abdominal surgery, or corticosteroid treatment. We used multivariate logistic regression models adjusting for clinical and demographic characteristics. We estimated the effect of cost sharing on biologic therapy persistence using repeated measures proportional hazard survival models. RESULTS/ANTICIPATED RESULTS: We identified 2,193 adult IBD patients who initiated biologic therapy and met study criteria (Crohn’s disease 66.1% vs. ulcerative colitis 24.9%, mean age 40.8 years, mean Charlson index 0.50). Median [IQR] out-of-pocket cost per 30-day biologic prescription was $62 [$34 - $157]. 66.9% of patients were adherent to biologic therapy. Higher out-of-pocket costs for biologics were associated with increased odds of nonadherence; patients with ulcerative colitis were more price-responsive than patients with Crohn’s disease or indeterminate colitis (Figure 1). However, higher out-of-pocket biologic costs were not associated with increased odds of all-cause or IBD-related hospitalization, IBD-related surgery, or corticosteroid prescriptions for IBD flares. Patients whose out-of-pocket costs were less than $10 per 30-day biologic prescription persisted on biologic therapy for significantly longer than patients who paid &gt;$10 (Figure 2). DISCUSSION/SIGNIFICANCE OF IMPACT: Nonadherence to biologics increases when IBD patients face higher out-of-pocket costs, particularly for ulcerative colitis patients. However, this is not associated with worse clinical outcomes. Patients with cost-sharing&lt;$10 persisted on biologics longer than patients whose cost sharing exceeded $10.

A latent class analysis of the past-30-day substance use patterns among lifetime cocaine users: Findings from a community sample in North Central Florida

ObjectivesCocaine use is increasing and many cocaine users engage in polysubstance use. Within polysubstance use, relationships among use of individual substances are necessarily complex. To address this complexity, we used latent class analysis (LCA) to identify patterns of polysubstance use among lifetime cocaine users and examine associations among these patterns, demographics, and risk profiles. MethodsMembers of HealthStreet, an ongoing community engagement program, were asked about lifetime and past 30-day use of cocaine, alcohol, tobacco, marijuana, and prescription medications, mental health conditions, recent Emergency Department (ED) visits and demographics. LCA was used to identify classes of past 30-day polysubstance use among individuals who endorsed lifetime cocaine use. Multinomial logistic regression identified factors associated with these classes. ResultsAmong 1797 lifetime cocaine users, a five-class LCA model was identified: 1) past 30-day tobacco use only (45%), 2) past 30-day alcohol, marijuana and tobacco use (31%), 3) past 30-day tobacco, prescription opioid and sedative use (13%), 4) past 30-day cocaine, alcohol, marijuana and tobacco use (9%), 5) past 30-day cocaine and multiple polysubstance use (2%). Demographics, ED visits and mental health conditions were associated with class membership. ConclusionsApproximately 11% of lifetime cocaine users used cocaine in the past 30 days with two different concurrent substance use patterns. Prescription medication (opioids and sedatives) and complex polysubstance use patterns were stronger indicators of negative outcomes than current cocaine use. Cocaine was not used frequently with other stimulants. In addition to polysubstance use, prescription medication use should be targeted for intervention among lifetime cocaine users.

Duration of Insulin Supply in Type 1 Diabetes: Are 90 Days Better or Worse Than 30 Days?

There have been few studies regarding the duration of insulin prescriptions and patient outcomes. This study evaluated whether A1C varied with the duration of insulin prescription in patients with type 1 diabetes. We conducted a longitudinal investigation (from 2001 to 2015) within a nationwide private health insurer. A cohort study was first used to compare A1C after 30-day only, 90-day only, and a combination (30-day and 90-day) of insulin prescriptions. Second, a self-controlled case series was used to compare A1C levels after 30-day versus 90-day prescriptions for the same person. In the cohort study, there were 16,725 eligible patients. Mean A1C was 8.33% for patients with 30-day prescriptions compared to 7.69% for those with 90-day prescriptions and 8.05% for those who had a combination of 30- and 90-day prescriptions (P <0.001). Results were similar when stratified by age and sex. Mean A1C was 7.58% when all prescriptions were mailed versus 8.21% when they were not. In the self-controlled case series, there were 1,712 patients who switched between 30- and 90-day prescriptions. Mean A1C was 7.87% after 30-day prescriptions and 7.69% after 90-day prescriptions (P <0.001). Results were similar when stratified by sex. For this within-person comparison, the results remained significant for those ≥20 years of age (n = 1,536, P <0.001), but not for youth (n = 176, P = 0.972). There was a statistically significant but clinically modest decrease in A1C with 90-day versus 30-day insulin prescriptions in adults. A mailed 90-day insulin prescription may be a reasonable choice for adults with type 1 diabetes.

Prescription opioid misuse and comorbid substance use: Past 30-day prevalence, correlates and co-occurring behavioral indicators in the 2016 National Survey on Drug Use and Health.

Prescription opioid misuse has not been well examined in the context of comorbid substance use in representative samples of substance users. Past 30-day comorbid prescription opioid misuse and recreational substance use (eg, alcohol, marijuana, cocaine, etc.) was studied in a representative sample of substance users in the United States using the 2016 National Survey on Drug Use and Health (NSDUH). Prevalence of prescription opioid misuse with and without comorbid substance use was estimated with the 2016 NSDUH. Generalized linear modeling was used to describe demographic correlates of opioid and comorbid substance use and explore the relation of opioid and comorbid substance use with social and behavioral health indicators. The majority of past month prescription opioid misusers reported use of other substances including cigarettes, alcohol, marijuana, or hard drugs (cocaine, methamphetamine, etc.). Males and younger respondents had a significantly higher risk of reporting past month prescription opioid misuse with illicit drug or polydrug use (p's < .01). Prescription opioid and polydrug users had the greatest odds of stealing property, selling drugs, having suicidal ideations, major depressive episode, and perceived treatment need in the past year compared to all other categories of prescription opioid misuse categories. Prescription opioid misuse is likely a part of a larger set of psychological, behavioral, and mental health problems. More attention should be given to the profiles of recreational (non-medical) substance use involving prescription opioids to curtail the current opioid crisis and prevent other similar epidemics in the future. (Am J Addict 2019;XX:1-8).

Reduced Opioid Prescription Practices and Duration of Stay after TAP Block for Laparoscopic Appendectomy

BackgroundWe evaluated whether TAP blocks performed at the time of appendectomy resulted in reduced total oral morphine equivalent (OME) prescribed and fewer 30-day opioid prescription (OP) refills. Study DesignSingle institution review of historical data (2010–2016) was performed. Adults (≥ 18 years) that underwent appendectomy for appendicitis with uniform disease severity (AAST EGS grades I, II) were included. Opioid tolerance was defined as any preoperative OP ordered 1–3 months prior to appendectomy or < 1 month unrelated to appendicitis; opioid naïve patients were without OP. Intraoperative TAP blocks (admixture of liposomal/regular bupivacaine) were performed at surgeon discretion. Risk factors for discharge prescription > 200 OME were assessed using logistic regression and quantified using odds ratios (OR) and 95% confidence intervals (CI). ResultThere were 960 patients with uniform appendicitis severity. During appendectomy, 145 (15%) patients received TAP blocks. There were 46 patients that were opioid tolerant (5%) and the majority of the cohort received discharge OP (n = 914, 95%) with a median prescription OME volume of 225 [150–300]. Only 76 patients required 30-day opioid prescription refill. On regression, factors associated with a discharge prescription > 200 OME included ≥ 65 years of age (OR 0.64 (95%CI 0.41–0.98)) and no TAP block (OR 1.7 (95%CI 1.2–2.5)) but not preoperative opioid utilization. ConclusionsTAP blocks in low-grade appendicitis were associated with reduced OME prescribed, hospital duration of stay, and fewer refills without impacting operative time or total hospital costs.

Effect of narcotic prescription limiting legislation on opioid utilization following lumbar spine surgery

Prescription opioid abuse is a public health emergency. Opioid prescriptions for spine patients account for a large proportion of use. Some states have implemented statutory limits on prescribers, however it remains unclear whether such laws are effective. This investigation compares opioid prescription patterns for patients undergoing lumbar spine surgery before and after the passage of statewide narcotic-limiting legislation in Rhode Island. Retrospective review of prospectively-collected medical and pharmacologic data. Two patient cohorts (pre-law January 1, 2016-June 31, 2016 and post-law June 1, 2017-December 31, 2017) that included all patients undergoing selected lumbar spine surgeries (lumbar discectomy, lumbar decompression without fusion, and posterior lumbar fusion). Demographic and surgical variables were collected from the patient's medical charts, and information on controlled substances was collected from the state prescription drug monitoring program database. Variables collected included the number of pills and total morphine milligram equivalents (MMEs) of the first prescription, number of prescriptions filled within 30 days of surgery, total MMEs filled in the 30-day postoperative period, and total MMEs filled from 30 to 90 days after surgery. For comparison of continuous variables, t test or Mann-Whitney U test were used as appropriate. Chi-squared analysis was utilized for comparison of categorical variables. Independent risk factors for prolonged postoperative opioid use were evaluated using logistic regression. There were no significant differences between pre-law (n = 241) and post-law (n = 311) cohorts in terms of age, sex, preoperative opioid use, or preoperative anxiolytic use (p > .05). A greater than 50% decline was observed among all patients from the pre-law to the post-law period in terms of the number of pills (51.61 vs 23.60 pills, p < .001) and MMEs (525.56 vs 218.77 MMEs, p < .001) provided in the first postoperative opioid prescription. The mean total MMEs provided in the first 30 days decreased significantly (891.26 vs 628.63 MMEs, p < .001) despite an increase in the average number of opioid prescriptions filled (1.75 vs 2.04 prescriptions, p = .002) during this time. There was no significant difference in mean MMEs filled from 30 to 90 days. Upon subgroup analysis, there was a statistically significant decline in both the mean first prescription and total 30-day MMEs regardless of preoperative opioid status (all p < .05) or specific procedure performed (all p < .05). Preoperative opioid use was strongly associated with prolonged postoperative opioid requirements throughout the study period (OR 4.71, 95% CI 3.11-7.13, p < .001). There were no significant differences between cohorts in terms of emergency department (ED) visits or unplanned hospital readmissions at 30 and 90 days following surgery (all p > .05). The institution of mandatory statewide opioid prescription limits has resulted in a significant reduction in initial and 30-day opioid prescriptions following lumbar spine surgery. Decreased opioid utilization was observed in all patients, regardless of preoperative opioid tolerance or procedure performed. No significant change in postoperative ED visits or unplanned hospital readmissions was seen following implementation of the legislation. This investigation provides preliminary evidence that narcotic limiting legislation may be effective in decreasing opioid prescriptions after lumbar spine surgery for both opioid-naïve and opioid-tolerant patients.

Duration of Insulin Supply in Type 1 Diabetes—Is 90 Days Better or Worse than 30 Days?

We evaluated whether the duration of insulin supply was associated with hemoglobin A1c. Data were obtained through the Clinformatics® Data Mart Database, from 2001-2015. Patients were grouped according to the duration of insulin supply: 30 days, 90 days, and a combination of both 30 day and 90 day prescriptions. Generalized estimating equations which account for repeated measures within patients were used, with robust estimates of variance. Prescription duration was regressed on HbA1c (dependent variable) with alpha=0.(2-tailed). There were 16,725 eligible patients (9362 with 30-day, 1280 with 90-day, and 6083 with both 30- and 90-day prescriptions). The mean number of HbA1c tests/patient was 3.1. Patients who used 30-day prescriptions had HbA1c values that were 0.65 greater than those with 90-day prescriptions (p&amp;lt;0.001). Patients who used a combination of 30-day and 90-day prescriptions had HbA1c values that were 0.37 greater compared to 90-day prescriptions (p&amp;lt;0.001). The predicted HbA1c values were 8.33% (95% CI: 8.31%, 8.36%) for 30-day, 8.05% (95% CI: 8.03%, 8.08%) for the combination, and 7.69% (95% CI: 7.64%, 7.73%) for 90-day prescriptions. Results were similar when stratified by age. For those &amp;lt;20 years of age, the predicted HbA1c values were 8.95% for 30-day, 8.71% for the combination, and 8.33% for 90-day prescriptions. For those ≥20 years of age, the results were 8.26%, 7.96% and 7.64%, respectively. Patterns were similar when stratified by sex. Mailed prescriptions were also associated with lower HbA1c (p&amp;lt;0.001). Predicted HbA1c was 7.58% (95% CI: 7.53%, 7.63%) when all prescriptions were mailed and 8.21% (95% CI: 8.19%, 8.23%) when not. After simultaneous adjustment for age, sex, duration of supply, and mailed status, both 90-day prescriptions and mailed prescriptions were associated with lower HbA1c values (p&amp;lt;0.001 for both). In patients with type 1 diabetes, 90-day insulin prescriptions and mailed prescriptions were both independently associated with lower HbA1c values. Disclosure M.A.M. Rogers: None. C. Kim: None. R. Tipirneni: None. T. Banerjee: None. J. Lee: Consultant; Self; Unitio.

Buprenorphine Use and Spending for Opioid Use Disorder Treatment: Trends From 2003 to 2015.

This study examined buprenorphine prescription uptake and expenditure trends among privately insured adults from 2003 to 2015 to inform efforts to expand opioid use disorder treatment. A study with a repeated cross-sectional design using MarketScan prescription claims data was conducted to describe trends in total and new buprenorphine use and median total, plan, and out-of-pocket expenditures for a 30-day buprenorphine prescription among privately insured adults from 2003 to 2015. New and total buprenorphine users increased dramatically from 2003 to 2013 and plateaued. Total buprenorphine spending was stable from 2003 to 2008, increased from 2009 to 2013, and declined from 2013 to 2015. Out-of-pocket expenditures steadily decreased from $67 in 2003 to $32 in 2015 for a 30-day prescription. Buprenorphine treatment costs were stable for health plans and declined for privately insured adults since 2003. Identifying remaining barriers to addressing the opioid addiction treatment gap is a priority.

Prevalence of nonmedical use and routes of administration for prescription stimulant medications among adults in a substance abuse treatment population

The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV®) as part of the clinical intake process between January 2013 and March 2016. A cross-sectional observational study examined prevalence and prescription-adjusted prevalence of past 30-day NMU of prescription stimulants and compound-specific use by ROA (oral, snort, smoke, inject, other oral, and alternate ROA). Compounds of interest were amphetamine extended-release (ER), amphetamine immediate-release (IR), amphetamine mixed salts, methylphenidate ER, and methylphenidate IR. Of 198,411 respondents, 4,185 reported prescription stimulant NMU, prevalence ranged from 0.33% for methylphenidate IR to 1.61% for amphetamine mixed salts. Prescription-adjusted prevalence of NMU was highest for methylphenidate IR (0.51%) and lowest for amphetamine ER (0.28%). The most common ROA was oral, swallowed whole followed by snorting. There was a greater probability of nonmedical prescription stimulant use among respondents with higher drug severity ratings. Results suggest that one should not overlook the impact of prescription stimulant NMU in adults in treatment for substance use problems. NMU of prescription stimulants was associated with riskier routes of administration than reported for college student samples. A pattern of high-risk alternate ROA and increasing drug problem severity has important implications of substance use evaluation.

MP76-19 EXTREME PRICE VARIATION IN GENERIC BENIGN PROSTATIC HYPERPLASIA AND OVERACTIVE BLADDER DRUGS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-19 EXTREME PRICE VARIATION IN GENERIC BENIGN PROSTATIC HYPERPLASIA AND OVERACTIVE BLADDER DRUGS Katherine Theisen, Seo Young Park, Kwonho Jeong, Jathin Bandari, Anobel Odisho, Bruce Jacobs, and Benjamin Davies Katherine TheisenKatherine Theisen More articles by this author , Seo Young ParkSeo Young Park More articles by this author , Kwonho JeongKwonho Jeong More articles by this author , Jathin BandariJathin Bandari More articles by this author , Anobel OdishoAnobel Odisho More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2587AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Benign prostatic hyperplasia (BPH) is the 4th leading chronic disease in men. The importance of medical management results in lifelong medication costs. We sought to measure the price-variation for several generic BPH and anti-cholinergic medications across geographically proximate pharmacies. METHODS All pharmacies and their census tract within a 25-mile radius of our institution, UPMC, were identified. Demographic and socioeconomic data for each census tract were obtained from 2015 American Community Survey. Phone calls to pharmacies assessed the out-of-pocket price (e.g. cash price without insurance) of a 30-day prescription of the following medications: tamsulosin, finasteride, oxybutynin 5mg, and oxybutynin 10mg XL. Median drug prices were compared by pharmacy type (chain, wholesale, or independent). RESULTS Of 255 pharmacies, 165 were chains, 6 were wholesale, and 84 were independent. The pharmacies represented 173 census tracts with a median size of 1.0 square mile. There was significant variation in out-of-pocket drug prices based on pharmacy type for tamsulosin, finasteride, and oxybutynin XL. Specifically, chain pharmacies charged up to 6-fold more than independent pharmacies. For example, median tamsulosin prices were from chain $90.99, wholesale $31.92 and independent $17.15, p=0.0001(Figure 1). When adjusting for pharmacy type (e.g. chain, wholesale, independent), there were no consistent socioeconomic predictors of drug prices. CONCLUSIONS The out-of-pocket price for generic BPH medications varies up to 6-fold between pharmacies in a geographically-confined area. Independent and wholesale pharmacies offer the lowest prices, with chain pharmacies charging over 500% more than independent pharmacies for tamsulosin and finasteride. Socioeconomic factors were not associated with medication cost. Drug-price transparency and pharmacy-shopping could alleviate significant financial burden in long term medical-management of BPH. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1026 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Katherine Theisen More articles by this author Seo Young Park More articles by this author Kwonho Jeong More articles by this author Jathin Bandari More articles by this author Anobel Odisho More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sex and orientation identity matter in the substance use behaviors of sexual minority adolescents in the United States

BackgroundHealth sciences researchers are beginning to understand the differing experiences and health risks among sexual minority subgroups (i.e., those who describe themselves as homosexual/gay/lesbian, bisexual, or unsure/questioning). Such research can promote the allocation of resources to high-risk groups and the development of interventions tailored to their needs. The present study extends this line of research to substance use among adolescents. MethodsThe lifetime and/or past 30-day alcohol, tobacco, cigarette, e-cigarette, marijuana, prescription drug, and illicit drug use of sexual minority and heterosexual adolescents was analyzed using data from the 2015 National Youth Risk Behavior Survey. Controlling for confounders, separate logistic regression models were fit for each substance use outcome. A simulation-based strategy was employed to report adjusted risk ratios for each substance use outcome for each sexual minority subgroup. ResultsSexual minority females, particularly bisexual females, were at an elevated risk for substance use. For example, compared to heterosexual females, sexual minority females were 1.35 (95%CI 1.16–1.56) times more likely to have used a substance in the past 30 days, and bisexual females had an even further elevated risk ratio (RR: 1.48, 95%CI 1.28–1.69). ConclusionsStudying the variance among sexual minority subgroups will help practitioners, advocates, and policymakers identify high risk subgroups. In the case of substance use, this study suggests sexual minority females, particularly bisexual females, should become a target population for prevention and other interventions. The study conducts post-hoc analyses on secondary data, and so these results should be verified in more targeted studies.

DIFFERENCE IN MEDICATION ADHERENCE BETWEEN PATIENTS FILLING 30- VERSUS 90-DAY PRESCRIPTION SUPPLY AFTER ACUTE MYOCARDIAL INFARCTION

We hypothesize that 90-day prescription fills are underutilized in post-myocardial infarction (MI) patients and may lead to higher adherence to evidence-based medications (EBMs) when compared with 30-day fills. We examined MI patients treated with PCI between 2011-2015 in the National

Population-Tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction: A Prospective Quasi-Experimental Trial.

IntroductionAlthough traditional patient-centered medical homes (PCMHs) are effective for patients with complex needs, it is unclear whether homeless-tailored PCMHs work better for homeless veterans. We examined the impact of enrollment in a Veterans Health Administration (VHA) homeless-tailored PCMH on health services use, cost, and satisfaction compared with enrollment in a traditional, nontailored PCMH.MethodsWe conducted a prospective, multicenter, quasi-experimental, single-blinded study at 2 VHA medical centers to assess health services use, cost, and satisfaction during 12 months among 2 groups of homeless veterans: 1) veterans receiving VHA homeless-tailored primary care (Homeless-Patient Aligned Care Team [H-PACT]) and 2) veterans receiving traditional primary care services (PACT). A cohort of 266 homeless veterans enrolled from June 2012 through January 2014.ResultsCompared with PACT patients, H-PACT patients had more social work visits (4.6 vs 2.7 visits) and fewer emergency department (ED) visits for ambulatory care-sensitive conditions (0 vs 0.2 visits); a significantly smaller percentage of veterans in H-PACT were hospitalized (23.1% vs 35.4%) or had mental health–related ED visits (34.1% vs 47.6%). We found significant differences in primary care provider–specific visits (H-PACT, 5.1 vs PACT, 3.6 visits), mental health care visits (H-PACT, 8.8 vs PACT, 13.4 visits), 30-day prescription drug fills (H-PACT, 40.5 vs PACT, 58.8 fills), and use of group therapy (H-PACT, 40.1% vs PACT, 53.7%). Annual costs per patient were significantly higher in the PACT group than the H-PACT group ($37,415 vs $28,036). In logistic regression model of acute care use, assignment to the H-PACT model was protective as was rating health “good” or better.ConclusionHomeless veterans enrolled in the population-tailored primary care approach used less acute care and costs were lower. Tailored-care models have implications for care coordination in the US Department of Veterans Affairs VA and community health systems.

Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure.

The US Food and Drug Administration approved the use of sacubitril/valsartan in patients with heart failure with reduced ejection fraction in July 2015. We aimed to assess the adoption and prescription drug costs of sacubitril/valsartan in its first 18 months after Food and Drug Administration approval. Using a large US insurance database, we identified privately insured and Medicare Advantage beneficiaries who filled a first prescription for sacubitril/valsartan between July 1, 2015, and December 31, 2016. We compared them to patients treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Outcomes included adoption, prescription drug costs, and 180-day adherence, defined as a proportion of days covered ≥80%. A total of 2244 patients initiated sacubitril/valsartan. Although the number of users increased over time, the proportion of heart failure with reduced ejection fraction patients taking sacubitril/valsartan remained low (<3%). Patients prescribed sacubitril/valsartan were younger, more often male, with less comorbidity than those taking an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Although a majority of prescription costs were covered by the health plan (mean, $328.37; median, $362.44 per 30-day prescription), out-of-pocket costs were still high (mean, $71.16; median, $40.27). By comparison, median out-of-pocket costs were $2 to $3 for lisinopril, losartan, carvedilol, and spironolactone. Overall, 59.1% of patients were adherent to sacubitril/valsartan. Refill patterns suggested that nearly half of nonadherent patients discontinued sacubitril/valsartan within 180 days of starting. Adoption of sacubitril/valsartan after Food and Drug Administration approval has been slow and may be associated with the high cost.

Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.

Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p < 0.05 for both). PDMPs may be helpful in identifying patients with certain aberrant drug-related behavior, but are unable to detect many patients with opioid use disorder. The majority of ED patients with opioid use disorder were not captured by the PDMP, highlighting the importance of using additional methods such as screening and clinical history to identify opioid use disorders in ED patients and the limitations of PDMPs to detect opioid use disorders.

Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically

BackgroundBenzodiazepine use dramatically increases the risk of unintentional overdose among people who use opioids non-medically. However, little is known about the patterns of co-occurring benzodiazepine and opioid use among young adults in the United States. MethodsThe Rhode Island Young Adult Prescription Drug Study (RAPiDS) was a cross-sectional study from January 2015—February 2016. RAPiDS recruited 200 young adults aged 18–29 who reported past 30-day non-medical prescription opioid (NMPO) use. Using Wilcoxon rank sum test and Fisher’s exact test, we examined correlates associated with regular prescribed and non-medical use (defined as at least monthly) of benzodiazepines among NMPO users in Rhode Island. ResultsAmong participants, 171 (85.5%) reported lifetime benzodiazepine use and 125 (62.5%) reported regular benzodiazepine use. Nearly all (n=121, 96.8%) reported non-medical use and 43 (34.4%) reported prescribed use. Compared to the 75 participants who did not regularly use benzodiazepines, participants who reported regular use were more likely to be white (66.3% vs. 58.0%, p=0.03), have ever been incarcerated (52.8% vs. 37.3%, p=0.04), and have ever been diagnosed with a psychiatric disorder (bipolar: 29.6% vs. 16.0%, p=0.04; anxiety: 56.8 vs. 36.0%, p=0.01). Although the association was marginally significant, accidental overdose was higher among those who were prescribed the benzodiazepine they used most frequently compared to those who were not (41.9% vs. 24.4%, p=0.06). ConclusionBenzodiazepine use and misuse are highly prevalent among young adult NMPO users. Harm reduction and prevention programs for this population are urgently needed.

School Protective Factors and Substance Use Among Lesbian, Gay, and Bisexual Adolescents in California Public Schools.

The majority of studies examining substance use among lesbian, gay, and bisexual (LGB) youth have focused on a wide array of risk factors (e.g., victimization). Few studies have explored the protective role of schools. This study aims to fill this gap in the literature and inform programs aimed at reducing substance use among LGB youth. More specifically, this study explores the extent to which school connectedness and support from teachers and other adults at school are associated with substance use among LGB youth in school and within the past 30 days. A secondary analysis of the 2013-2015 California Healthy Kids Survey (CHKS) was conducted to examine associations between school protective factors (i.e., school connectedness and adult support) and substance use among LGB youth, above and beyond a key risk factor, school victimization. The study outcomes were past 30-day and in-school use of cigarettes, alcohol, marijuana, inhalants, prescription pain medication, and other illegal drugs. Overall, school connectedness and school adult support were associated with lower odds of substance use. For example, higher levels of school connectedness were associated with 22% decreased odds of past 30-day inhalant use (adjusted odds ratio [AOR] = 0.78; 95% confidence interval [CI] = 0.72-0.86), and 25% decreased odds of past 30-day prescription pain medication use (AOR = 0.75; 95% CI = 0.69-0.82). Higher levels of adult support in school were also associated with 17% decreased odds of marijuana use on school property in the past 30 days (AOR = 0.83; 95% CI = 0.77-0.91). The results indicate a need for substance use prevention programs that integrate school connectedness and adult support in school.