Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy.

Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims.

Reducing Opioid Misuse: Evaluation of a Medicaid Controlled Substance Lock-In Program.

Unlabelled: Opioid misuse, abuse, and overdose are a rapidly growing public health epidemic. Medicaid Lock-In Programs (MLIPs) are designed to prevent overutilization of controlled substances by Medicaid patients. However, despite widespread use, there is little information on their effect.

A Randomized Controlled Trial of an Emergency Department Intervention for Patients with Chronic Noncancer Pain.

Background: Emergency Departments (EDs) are beginning to notify their physicians of patients reporting chronic noncancer pain (CNCP) who frequent EDs, and are suggesting that the physicians not prescribe opioids to these patients.

Objectives: We hypothesized that this intervention would reduce both the number of opioids prescribed to these patients by their ED physicians and the number of these patients' return visits to the ED.

Methods: We conducted a randomized controlled trial of this intervention in 13 electronically linked EDs.

The effects of North Carolina's prescription drug monitoring program on the prescribing behaviors of the state's providers.

State-level prescription drug monitoring programs (PDMPs) show promise as a key strategy to respond to the epidemic of the misuse and abuse of controlled substances (CS), particularly opioid analgesics, in the United States. Undocumented concerns have been expressed that these PDMPs may have a "chilling effect" on providers' willingness to prescribe these substances to their patients. Using data from North Carolina's PDMP for the 3-year period from 2009 through 2011, we examined whether rapid increases in (1) the number of providers who queried the system, and (2) the number of days on which they queried it, would be related to their prescribing practices in regards to CS.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

Background: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. 

Objectives: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.

Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain.

Objective: Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic noncancer pain (CNCP) and the role played by physician specialty in these disparities.

Design: A retrospective cohort study.

Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses.

Background: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians' opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown.

Objective: To examine the relationships between physicians' and other providers' primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP).

Methods: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined.

Effects of an online alcohol education course among college freshmen: an investigation of potential mediators.

The authors investigated possible mediating effects of psychosocial variables (perceived drinking norms, positive and negative alcohol expectancies, personal approval of alcohol use, protective behavioral strategies) targeted by an online alcohol education course (AlcoholEdu for College) as part of a 30-campus randomized trial with 2,400 first-year students. Previous multilevel analyses have found significant effects of the AlcoholEdu course on the frequency of past-30-day alcohol use and binge drinking during the fall semester, and the most common types of alcohol-related problems. Exposure to the online AlcoholEdu course was inversely related to perceived drinking norms but was not related to any of the other psychosocial variables.

Statistical methods for designing and assessing the effectiveness of community-based interventions with small numbers.

Community-based interventions are, by their nature, tailored to the particular needs of the members and stakeholders of the community. In the area of safety promotion, the multifaceted aspects of violence and unintentional injuries necessitate complex intertwining of strategies and approaches. The evaluation of the effectiveness of any 'intervention' programme, either as a whole or of its discrete components, is thus challenging.

Predicting high risk adolescents' substance use over time: the role of parental monitoring.

We examined whether parental monitoring at baseline predicted subsequent substance use in a high-risk youth population. Students in 14 alternative high schools in Washington State completed self-report surveys at three time points over the course of 2 years. Primary analyses included 1,423 students aged 14-20 who lived with at least one parent or step-parent at baseline.

Is there an association between adolescent bullying victimization and substance abuse?

Bullying is endemic in the nation's schools and takes a substantial toll on its victims' physical and social-emotional well-being. We assessed the association between specific reasons for which adolescents believe that they are targeted for bullying and their rates of various types of substance use by analyzing the association between self-reported past 30-day substance use and past 30-day bullying victimization among 53,750 middle and high school students in Oregon. Our results confirm previous estimates of prevalence rates for bullying as well as modest (r < 0.

The role of teacher communicator style in the delivery of a middle school substance use prevention program.

We examine whether teachers' communicator style relates to student engagement, teacher-student relationships, student perceptions of teacher immediacy, as well as observer ratings of delivery skills during the implementation of All Stars, a middle school-based substance use prevention program. Data from 48 teachers who taught All Stars up to 3 consecutive years and their respective seventh-grade students (n = 2,240) indicate that having an authoritative communication style is negatively related to student engagement with the curriculum and the quality of the student-teacher relationship, while having an expressive communicator style improves teachers' immediacy to student needs. Adaptations made by a subsample of teachers (n = 27) reveal that those who were more expressive asked students more questions, used more motivational techniques, and introduced more new concepts than authoritarian teachers.

Are substance use prevention programs more effective in schools making adequate yearly progress? A study of Project ALERT.

This exploratory study sought to determine if a popular school-based drug prevention program might be effective in schools that are making adequate yearly progress (AYP). Thirty-four schools with grades 6 through 8 in 11 states were randomly assigned either to receive Project ALERT (n = 17) or to a control group (n = 17); of these, 10 intervention and nine control schools failed to make AYP. Students completed three self-report surveys.

Project success' effects on substance use-related attitudes and behaviors: a randomized controlled trial in alternative high schools.

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets high-risk students. We recruited two groups of alternative high schools in successive academic years, and randomly assigned schools in each group to either receive the intervention (n = 7) or serve as a control (n = 7).

The effects of No Child Left Behind on the prevalence of evidence-based drug prevention curricula in the nation's middle schools.

Background: Concerns have been expressed that No Child Left Behind (NCLB) may be reducing the amount of classroom time devoted to subjects other than those for which students are tested. The purpose of this article is to explore whether NCLB legislation has affected the provision of evidence-based drug prevention curricula (EBC) in the nation's middle schools, a subject area that is not assessed by standardized tests.

Methods: Data were collected in spring 2005 and spring 2008 from a nationally representative sample of middle schools.

Outlet density as a predictor of alcohol use in early adolescence.

Introduction: Recent national youth surveys suggest that alcohol availability plays a role in determining use. One measure of availability receiving recent attention is outlet density; however, few studies have examined the effects of outlet density in younger populations.

Methods: Data were collected from a national sample of the United States (N = 5,903) followed between 6th and 8th grades, as part of a study funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP).

Predicting adolescent substance use: the effects of depressed mood and positive expectancies.

This study examined whether sixth-graders' depressed mood and positive substance use expectancies predicted increases over the next two years in students' lifetime and 30-day cigarette, alcohol, and marijuana use, and whether sixth graders' positive substance use expectancies moderated the relationship between baseline depressed mood and changes over the next two years in the use of these substances. Study data came from a randomized controlled trial of Project ALERT, a school-based substance use prevention program, in which students from 34 schools completed self-report surveys as sixth (n=5782), seventh (n=5065), and eighth graders (n=4940). Primary analyses were performed using Hierarchical Nonlinear Modeling.

The utility of keg registration laws: a cross-sectional study.

Purpose: Many states have implemented keg registration policies to reduce adolescent binge drinking and related consequences. We examined the association between the strength and comprehensiveness of these policies and measures of beer consumption in the general population and adolescent binge drinking, as well as drinking and driving.

Methods: Data concerning the presence and stringency of the states' keg registration laws were secured from the Alcohol Policy Information System.

The use of one- versus two-tailed tests to evaluate prevention programs.

Investigators have used both one- and two-tailed tests to determine the significance of findings yielded by program evaluations. While the literature that addresses the appropriate use of each type of significance test should be used is historically inconsistent, almost all authorities now agree that one-tailed tests are rarely (if ever) appropriate. A review of 85 published evaluations of school-based drug prevention curricula specified on the National Registry of Effective Programs and Practices revealed that 20% employed one-tailed tests and, within this subgroup, an additional 4% also employed two-tailed tests.

The prevalence of evidence-based substance use prevention curricula in the nation's elementary schools.

Current guidelines for school-based substance use prevention suggest that prevention efforts should begin in elementary grades, before students begin using substances. Previous research suggests, however, that the use of evidence-based curricula in these grades may be low. Using a 2005 survey of public school districts in the United States that include elementary grades (n = 1563), we assessed the prevalence of elementary curricula use, particularly those designated as evidence-based.

A short-term, quasi-experimental evaluation of D.A.R.E.'s revised elementary school curriculum.

We present the short-term results of a quasi-experimental evaluation of the revised D.A.R.

The prevalence of evidence-based drug use prevention curricula in U.S. middle schools in 2008.

The No Child Left Behind Act mandates the implementation of evidence-based drug prevention curricula in the nation's schools. The purpose of this paper is to estimate changes in the prevalence of such curricula from 2005 to 2008. We surveyed school staff in a nationally representative sample of schools with middle school grades.

Project ALERT's effects on adolescents' prodrug beliefs: a replication and extension study.

This article represents a replication and extension of previous studies of the effects of Project ALERT, a school-based substance use prevention program, on the prodrug beliefs of adolescents. Specifically, the authors' research examined Project ALERT's effects on adolescents' intentions to use substances in the future, beliefs about substance use consequences, normative beliefs, and resistance self-efficacy. In all, 34 schools with Grades 6 to 8 completed this randomized controlled trial and 71 Project ALERT instructors taught 11 core lessons to 6th graders and 3 booster lessons to 7th graders (one grade level earlier than in previous studies).