The majority are well-intentioned prescribers caught in a web of entangling interests spun over the past two decades. When the powerful narcotic OxyContin was first made available in the mids, all that doctors heard from sweeping educational campaigns many driven by pharmaceutical industry marketing was that they were undertreating pain. Several reports around the time suggested that opioids could be useful without causing addiction.
Lakdawalla, Darius Abstract Despite growing attention to the problem of prescription opioid use, misuse, and abuse in the United States, there are many unanswered questions. Further, many policies aimed at curbing opioid use have been enacted ahead of reliable evidence on the likely efficacy of such interventions.
The goal of my dissertation is to fill in these major gaps in our understanding. Each paper adds critical knowledge that deepens our understanding of the scope and trajectory of opioid utilization in the United States, the effect of existing policies on both appropriate and inappropriate opioid utilization, and the role of physicians in prescribing these drugs.
The majority of research on opioid utilization and abuse has focused on the under population. The few studies that tackle the question of opioid use in Medicare provide single-year snapshots or report on a limited number of outcomes.
My results fill that gap by chronicling multiple measures of opioid utilization in a 20 percent sample of Medicare beneficiaries from to I estimate multivariate regression models to show patterns of use, misuse, and prescribing that control for demographics, patient health, socio-economic status, and eligibility status.
Results indicate that in contrast to the general population, opioid utilization in Medicare—while high—is fairly stable. Despite stable use, opioid abuse in the Medicare population is on the rise; and, medical diagnoses of abuse fail to capture substantial numbers of patients with utilization patterns indicative of opioid misuse.
The study also provides useful insights for future research and policy—for example that claims-based estimates of misuse are important indicators and that policies related to opioid use and abuse should explicitly consider the Medicare population as they are large consumers of opioids.
Previous analyses of the impact of state policies on opioid use have looked at relatively rare outcomes like overdose, relied largely on survey data, and only explored the role of one type of policy on these outcomes.
I improve on that literature by considering the impact of three separate types of laws, controlling for the existence of other opioid-related regulations, employing a large and representative sample, exploring nine distinct outcomes, and estimating these effects in administrative claims rather than survey data.
In addition, I employ a difference-in-differences framework to make my findings more robust than a simple comparison of states with and without these laws.
I find that controlling for individual characteristics, state and time fixed effects, and pre-treatment trends by state, two of these three laws reduce measures of opioid utilization, opioid abuse or misuse, or physician prescribing of opioids. Moreover, the impacts are felt broadly across categories of patients—both proper and improper opioid users.
Thus my findings represent important evidence to be considered in structuring more effective, targeted prescription drug regulations. To fill this gap in the literature, we use multivariate regression analysis to estimate the relative contribution of the ED to opioid prescribing from to using data from the Medical Expenditure Panel Survey MEPS.
A unique contribution of this study is to look not only at increased counts of opioid prescriptions, but also at a decomposition of those prescriptions into: We find that the vast majority of the increase in prescribing observed in the MEPS data is due to prescriptions originating in office-based rather than ED settings and to opioids that are refills of previous prescriptions rather than incident prescriptions.
Our findings indicate that the move to restrict opioid prescriptions in the ED setting is unlikely to have a large impact on opioid prescribing.An arresting photo essay shows the human costs of a disaster that deserves better.
Their fantasy of benign long-term opioid use is the root of the epidemic. The problem with hospitalizing. The opioid epidemic problem Essay Sample.
The opioid epidemic began over the course of more than a decade. During the early s, it has grew into a problem destroying many lives across the nation, regardless of age, race, wealth, or location.
Opioid addiction is a serious chronic relapsing but treatable disorder. Treatments approaches must be tailored to address each client’s drug abuse patterns, psychiatric and social problems, the primary care provider will choose along with client the best treatment.
There is no right or wrong medications, only the right and wrong ways to use them. Aug 03, · Now there’s evidence that the opioid epidemic is dividing into two waves, with a new group of younger drug users growing addicted to, and dying from, heroin or fentanyl rather than prescription.
In a new series for TIME, ‘The Opioid Diaries,’ photographer James Nachtwey documents the worst opioid addiction crisis in U.S. history. The opioid epidemic has been called the worst drug crisis in American history. Death rates now rival those of AIDS during the s, and with overdoses from heroin and other opioids now killing.