In 2016, over 11 million people misused prescription opioids and the economic costs were estimated to be over $500 billion. In the same year, opioids killed 42,000 people, which was more than any year on record. These data highlight the need to reduce the harm caused to individuals, families, communities, and the nation. One element of a more comprehensive national strategy is increasing awareness among citizens, physicians and policy makers. Given its widespread reach YouTube can be very helpful. There is a large literature on the opiate epidemic, but no published studies describing the sources or content of YouTube videos on the opiate epidemic were identified. This study was, therefore, intended to help fill this gap in current knowledge. YouTube was searched using two key terms, “opiate addiction” and “opioids.” The results were sorted by number of views, and the URL, title, and number of views were saved for videos with a minimum of 1,500 views. Videos were then screened for the inclusion and exclusion criteria. The remaining sample comprised 309 videos. Collectively, these 309 videos were viewed 44,693,887 times. The results revealed the sources that were most viewed and the nature of content that was and was not likely to be covered. The two main sources of videos were Internet Based and Television news/Entertainment. Compared with videos with health professions as the main speaker, those featuring consumers garnered almost 10 times as many cumulative views (30.35%versus 3.24%). Government organizations uploaded 11 videos (< 4%), collectively garnering 343,983 views (less than 1% of cumulative views). YouTube represents an important opportunity for health promotion and disease prevention regarding the opiate epidemic. However, improved understanding about ways to communicate accurate and useful information in ways that attract viewers is needed. Recommendations for research, policy and practice are presented relevant to how YouTube can help mitigate the harm caused by the opiate epidemic.

Opioid morbidity and mortality and suicide are two current and central public health problems in the U.S. Both have continuously increased in the last two decades, and disproportionately affected some groups more than others, leading to the suggestion that these epidemics are connected. However, there is little evidence on the potential role that the opioid epidemic had on the rise of suicides. The overarching goal of this dissertation was to advance our understanding of the effects of the opioid epidemic on the rise in suicide rates in the U.S. First, a systematic review of the literature was conducted to critically evaluate the evidence on the effects of different opioid exposures on suicidal outcomes (e.g., suicidal ideation, attempts and suicides). There was ample evidence of individual-level associations between opioid use and related abuse/ dependence on suicidal outcomes. In contrast, the gap in the literature on group-level effects was clear, with only two studies examining these effects and showing that opioid availability was associated with suicide behavior in different populations. Several limitations were also identified in the reviewed studies that could partially explain the observed associations, indicating the need for further research. Second, the individual-level effects of prescription opioids nonmedical use and related abuse/ dependence on persistence and onset of suicidal ideation and attempts were examined. Longitudinal data from a national representative sample of the adult U.S. population was used to examine these associations. Results showed that heavy/ frequent use of prescription opioids and related abuse/ dependence had an effect on persistence and onset of suicidal ideation and persistence of attempts. However, none of these exposures were associated with onset of suicide attempt. Overall, these findings suggest that by increasing the number of those using prescription opioids and with opioid abuse/ dependence, and in turn the number of those with suicidal ideation/ behavior, the prescription opioid epidemic could have led to increases in suicide rates in the population. Finally, the group-level (i.e., state level) effects of three state level exposures, i.e., increasing trends in the per capita volume of prescription opioids, in the nonmedical use of these drugs, and in unintentional fatal opioid overdoses, on the increase in suicide rates were examined. For this, pooled cross sectional time series data from the 50 states (1999-2016) were used in linear regression models with state and year fixed effects. Although the volume of prescription opioids and the rate of fatal opioid overdoses increased over the study period, the prevalence of nonmedical use of prescription opioids decreased in most states. Results showed that the rate of unintentional fatal prescription opioid overdoses was associated with an increase in the rate of suicides. The range of effects sizes compatible with the data also suggested that the increase in the per capita volume of prescription opioids was linked to increases in suicide rates. Overall, this dissertation increased our understanding of the possible role that the opioid epidemic played on the increase in suicide rates in the U.S. As public efforts continue to fight the opioid epidemic, these findings can help inform future research that will guide the development of suicide prevention strategies and approaches to reduce the burden that the opioid epidemic poses on communities.

Opioid dependence and opioid related deaths are a public health problem which the United States Centers of Disease Control have declared an epidemic. While opioid agonist therapy for opioid addiction has been accepted as the most effective treatment for opioid dependence among academics, and office based buprenorphine treatment has been available in the Unites States for over 10 years, OB buprenorphine faces many barriers to widespread adoption. Empirical data on the geographic distribution of physicians able to prescribe buprenorphine and the prescribing patterns of those physicians show considerable unevenness in access and utilization of treatment services. Federal-level policies have recently been implemented to expand access to opioid agonist therapy, but the medium and long term impacts of these policy changes on individual outcomes, public health, and geographic access equity are not yet clear. This dissertation compares two recent federal level policies on expanding access to buprenorphine treatment: raising the regulatory limit on the number of patients a provider can treat (implemented July, 2016), and extending prescribing privileges to nurse practitioners and physician assistants (implemented February, 2017), using an empirically supported Agent Based Simulation model. Policies are assessed by a novel, at-a-glance, quantitative access equity metric: the Spatial Potential Access Gini Index, in addition to year-end treatment utilization, opioid overdose deaths, and the amount of illicit medication diversion. In the simulation, expanding access by increasing the patient limit did not result in more equitable spatial access, while extending prescribing to NPs and PAs increased both utilization and spatial access equity. This is likely due to empirically supported model assumptions that NPs and PAs providing primary care often serve in medically underserved areas including rural and remote regions. Extending prescribing to these practitioners opens up new treatment locations changing the spatial distribution of treatment opportunities. Changing patient limits does not change the overall spatial distribution of services, so spatial access equity does not change even if overall treatment supply gets better or worse. The primary contribution of this work is the Spatial Potential Access Lorenz Curve and the Spatial Potential Access Gini Index, measures that aggregate individual-level Spatial Potential Access Scores commonly used in health care geography to map and identify areas of access disparity within a region. The equitability of Spatial Potential Access is calculated by using the Lorenz Curve, which is commonly used to characterize the distribution of wealth or income in a society, from which a Gini Index is calculated. The Spatial Potential Access Gini Index allows for direct comparison of complex quantitative information about the geographic distribution of supply and demand in a region with other regions, or in response to policies that impact supply or demand within the region. The measure has potential applications in simulation studies on the spatial allocation of services, allowing equity assessment of policy alternatives, as well as in empirical work, allowing equity comparisons of different regions, or in hybrid studies in which policy experiments are conducted on data-rich maps.

Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients. The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.

Thesis (Ed.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 96-107).

No description available.

The Argus Commission identified three major federal priorities related to health care, including the precision medicine initiative, the Cancer Moonshot and the opioid abuse epidemic. Current activities at the federal level were summarized and an analysis of activities within the profession, and academic pharmacy specifically, was prepared. The implications for pharmacy education, research and practice are compelling in all three areas. Recommendations, suggestions and two policy statements aim to optimize the attention to these priorities by the academy. Further, aligning the AACP Strategic Engagement agenda with the opportunities and threats acknowledged in the analysis is essential.

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals. Opioid use disorder (OUD)-related hospitalizations are increasing, and incurring significant costs; care delivered in this setting is likely sub-optimal. This study examined hospital-based services for OUD using a conceptual framework based on an interdisciplinary review of policy, organizational behavior, systems science, economics, and health services delivery scholarship. The study's primary research question was: How do supply-side attributes influence hospital OAT delivery, health outcomes, and health services utilization for persons hospitalized with OUD? Supply-side attributes refer to the contextual elements inside and outside of a hospital that may be associated with hospital OAT delivery performance, such as social structures (e.g., hospital standards of care, societal values) and resources and technologies (e.g., hospital staffing, federal treatment policies). A mixed methods study described, explored, and identified how patients with OUD are cared for in the hospital and the barriers and facilitators to delivering OAT during hospitalization. The sequential mixed methods approach (i.e., qualitative followed by quantitative analyses) included analysis of 17 key informant interviews with addiction medicine physicians from 16 non-federal U.S. hospitals, 25 hospital guidance documents from 10 non-federal U.S. hospitals, and administrative data from 12,407 OUD-related hospital admissions from the Veterans Health Administration (VHA) health system. The findings from the study's three aims and 16 research sub-questions were integrated to reach seven conclusions: 1) OAT is underused in the hospital; 2) OAT delivery varies within and across hospitals; 3) OAT is used ineffectively; 4) non-OAT modalities are inappropriately used during and after hospitalization; 5) supply-side attributes inside and outside the hospital facilitate and impede hospital OAT delivery; 6) demand-side attributes facilitate and impede hospital OAT delivery; and 7) the hospital is an important service delivery mechanism in the OUD care continuum. The study's findings could be extrapolated to improve policy and practice by implementing education and health service delivery interventions through regulatory and allocative policy mechanisms focused on physicians, medical trainees, and hospital and health system administrators. Understanding how OAT delivery may be improved within the acute care delivery system is an important element to support efforts to curb the ongoing drug poisoning crisis.

According to the Centers for Disease Control and Prevention, prescribers should evaluate risk factors related to opioid use prior to initiation of opioid medication. The practice problem in this DNP project was that providers failed to consistently assess patients with complaints of pain for risk of opioid misuse and/or abuse prior to initiating opioid medication. An opioid risk-assessment screening tool (ORAST) has the potential to identify patients at high risk for opioid misuse and/or abuse. The purpose of this Doctor of Nursing Practice project was to identify and introduce an ORAST and then develop a policy to guide providers in its use in an ambulatory care clinic. Rosswurm and Larrabee's model for evidence-based practice served as the framework that helped guide project development. Evidence in the literature review supported The Opioid Risk Tool (ORT) as the most appropriate tool for the clinic. An 11-member project team voted unanimously for the ORT and to develop a policy to guide the use of the tool in the clinic. The ORT and its policy were evaluated by the team using the AGREE II Instrument. The team agreed that the ORT and its policy should be implemented into their practice setting (64% strongly agreed and 36% moderately agreed). A summative evaluation supported the Doctor of Nursing Practice student leadership of the project. Use of an ORAST has the potential to create positive social change by reducing the number of prescribed opioid by assisting providers in determining a patient's plan of care based on the patient's level of risk for prescription opioid misuse and/or abuse. Patient outcomes may be improved through reduction in opioid misuse and/or abuse.

The use of naloxone (NAL) for opioid overdose treatment is limited mostly to parenteral (intravenous, intramuscular, and subcutaneous) or intranasal route due to significant first-pass metabolism associated with oral delivery. Injectables are painful and frequent administrations by the existing routes for patient stabilization due to the short half-life of NAL are needed. Alternative delivery systems would be beneficial if they provide a balance between sustained release properties and a comparable rapid release as is achievable with the available parenteral forms. Thus, the goal of our study is to design a clinically viable polymeric microneedle (MN) patch for NAL. MNs of varying geometric dimensions were fabricated. In vitro skin permeation data for the best-performing patch was mathematically modeled and predictions on geometric parameters for a MN patch of comparable pharmacokinetic properties to parenteral and intranasal NAL as seen in the market were determined. From these evaluations, the need to devise ways to improve flux and amount of drug released from a patch per time was identified. We explored the influence of iontophoretically driving ionized drug content in MN patches on cumulative permeation of NAL from the best-performing MN patch. To optimize the iontophoresis parameters, the influence of citrate phosphate buffer strength on drug release profile was evaluated. Also, the impact of combining iontophoresis and higher drug loading was evaluated. A reduced lag time of about 5-15 min was observed with fabricated polymeric MN patches. From the polymeric MN patch P1 loaded with 50 mg/mL of NAL, a significant drug flux of 15.09 ± 7.68 ��g/cm2/h was observed in the first 1 h (p.Increasing MN length and density (P2 and P3) made a significant difference in the amount permeated and flux (pin-vitrorelease from the best-performing patch (P3) revealed the significance of needle base diameter and needle count in improving systemic pharmacokinetics of NAL from the MN patches. With this approach, an optimized design of the patch that can reproduce the clinical pharmacokinetics of NAL obtained with commercial devices was predicted. Investigation on the influence of iontophoresis in improving flux from the P3 patch shows about a 2-fold (p