Project Lifeline-II: Feasibility of Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Allegheny County, Pennsylvania.

Objectives: US community pharmacies are a unique and underused health service setting for identifying and potentially intervening with patients at risk of opioid overdose or opioid use disorder with evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT). The aim of our study was to assess the feasibility of implementing SBIRT in community pharmacies in an urban county in terms of engagement, reach, and equity across the cascade of pharmacy screening and care.

Methods: Patients aged 18 years or older receiving a schedule II or III opioid prescription at 1 of 17 participating community pharmacies in Allegheny County, Pennsylvania, were invited to engage in SBIRT as part of Project Lifeline-II from June 2020 through January 2023.

Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association.

Background: Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment.

Methods: We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions.

Simulated impact of medicaid expansion on the economic burden of opioid use disorder in North Carolina.

Background: Opioid use disorder (OUD) imposes significant costs on state and local governments. Medicaid expansion may lead to a reduction in the cost burden of OUD to the state.

Methods: We estimated the health care, criminal justice and child welfare costs, and tax revenue losses, attributable to OUD and borne by the state of North Carolina in 2022, and then estimated changes in the same domains following Medicaid expansion in North Carolina (adopted in December 2023).

Modeling the impact of a long-term horizon and multiple treatment episodes on estimates of the cost-effectiveness of alcohol treatment in the United States.

Background: Most clinical studies of alcohol use disorder (AUD) treatment have short follow-up periods, underestimating the full benefits of alcohol treatment. Furthermore, clinical studies only consider one treatment cycle and do not account for the need for multiple episodes to treat a chronic recurrent condition.

Methods: A validated microsimulation model of the long-term drinking patterns of people with AUD in the United States simulated 10,000 individuals resembling those from a large clinical trial.

The effect of untargeted naloxone distribution on opioid overdose outcomes.

Opioid overdose has claimed the lives of over 340,000 Americans in the last decade. Over that same period, policymakers have taken steps to increase the availability of naloxone-an opioid antagonist used to rescue overdose victims-to people in the community. Previous studies, most of which have examined the effects of state laws designed to facilitate access to naloxone, have reached mixed conclusions about the effects of naloxone access on fatal and non-fatal overdoses.

Modeling the impact of COVID-19 pandemic-driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States.

Background And Aims: Alcohol consumption increased in the early phases of the COVID-19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID-19 pandemic.

Alcohol Consumption During the First Year of the COVID-19 Pandemic in the United States: Results From a Nationally Representative Longitudinal Survey.

Introduction: Alcohol consumption and risky drinking behavior increased in the early phases of the COVID-19 pandemic in the United States, but it is not known if and for whom those changes were sustained over the longer term. This study analyzes longitudinal data on drinking patterns during the first year of the COVID-19 pandemic in the United States.

Methods: A nationally representative longitudinal survey was used to assess alcohol consumption patterns among respondents 21 years and older who reported drinking between February and November 2020 (N = 557) overall and by subgroups.

Development and validation of a claim-based provider-level measurement of use of medications to treat opioid use disorder.

Objective: Medication for opioid use disorder (MOUD) is effective but underused. Measuring the percentage of a provider's patients with an opioid use disorder (OUD) who receive MOUD may drive quality improvement and stimulate greater use of medications. This study introduces and tests a provider-level measure of MOUD receipt.

Changes in Buprenorphine Prescribing to Medicaid Beneficiaries During the First Year of the COVID-19 Pandemic.

This cross-sectional study compares trends in prescribing buprenorphine to all Medicaid beneficiaries before and after the start of the COVID-19 pandemic.

Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study.

Background And Aims: Alcohol consumption increased during the COVID-19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol-associated liver disease (ALD) and mortality.

Approach And Results: We extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the United States born between 1920 and 2012.

The Relationship Between Reductions in WHO Risk Drinking Levels During Treatment and Subsequent Healthcare Costs for the ACTIVE Workgroup.

Background: Abstinence has historically been considered the target outcome for alcohol use disorder (AUD) treatment, yet recent work has found drinking reductions after AUD treatment, as measured by World Health Organization (WHO) risk drinking levels, are associated with meaningful improvements in functioning, physical health, and quality of life.

Objectives: This study extends previous analyses of AUD treatment outcomes by estimating the association between changes in WHO risk drinking levels (very high, high, medium, and low, based on average daily alcohol consumption) and healthcare costs.

Methods: Secondary data analysis of the COMBINE study, a multisite randomized clinical trial of acamprosate, naltrexone and behavioral interventions for AUD.

Development, Testing, and Dissemination of a Public-Facing Tool to Help Consumers Find Higher-Quality Addiction Treatment.

Objective: The authors aimed to describe the development and testing of quality measures included in a public-facing addiction treatment facility search engine.

Methods: An addiction treatment facility survey was created that queried providers in six U.S.

SF-6D utility scores for alcohol use disorder status and alcohol consumption risk levels in the US population.

Aims: To estimate US population health utilities for subgroups defined by alcohol use disorder (AUD) status and consumption level.

Design: Cross-sectional survey.

Setting: Community settings in the United States (i.

Alcohol Consumption in Response to the COVID-19 Pandemic in the United States.

Objectives: Excessive alcohol use is a serious and growing public health problem. Alcoholic beverage sales in the United States increased greatly immediately after the stay-at-home orders and relaxing of alcohol restrictions associated with the COVID-19 pandemic. However, it is not known to what degree alcohol consumption changed.

Economic Evaluation of Interventions to Address Opioid Misuse: A Systematic Review of Methods Used in Simulation Modeling Studies.

Objectives: Several evidence-based interventions exist for people who misuse opioids, but there is limited guidance on optimal intervention selection. Economic evaluations using simulation modeling can guide the allocation of resources and help tackle the opioid crisis. This study reviews methods employed by economic evaluations using computer simulations to investigate the health and economic effects of interventions meant to address opioid misuse.

The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation.

The introduction of abuse-deterrent OxyContin in 2010 was intended to reduce its misuse by making it more tamper resistant. However, some studies have suggested that this reformulation might have had unintended consequences, such as increases in heroin-related deaths. We used the 2005-2014 cross-sectional U.

Estimating Long-Term Drinking Patterns for People with Lifetime Alcohol Use Disorder.

There is a lack of data on alcohol consumption over time. This study characterizes the long-term drinking patterns of people with lifetime alcohol use disorders who have engaged in treatment or informal care. We developed multinomial logit models using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to estimate short-term transition probabilities (TPs) among the 4 World Health Organization drinking risk levels (low, medium, high, and very high risk) and abstinence by age, sex, and race/ethnicity.

Substance use disorder treatment admissions and state-level prenatal substance use policies: Evidence from a national treatment database.

State policies pertaining to prenatal substance use have important implications for health outcomes of pregnant women and their infants. However, little is known about the impact of the various types of state-level prenatal substance use policies (i.e.

Cost and Return on Investment of a Work-Family Intervention in the Extended Care Industry: Evidence From the Work, Family, and Health Network.

Objective: To estimate the cost and return on investment (ROI) of an intervention targeting work-family conflict (WFC) in the extended care industry.

Methods: Costs to deliver the intervention during a group-randomized controlled trial were estimated, and data on organizational costs-presenteeism, health care costs, voluntary termination, and sick time-were collected from interviews and administrative data. Generalized linear models were used to estimate the intervention's impact on organizational costs.

Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: Evidence from the National Survey of Drug Use and Health.

In the United States, nonmedical prescription opioid use is a major public health concern. Various policy initiatives have been undertaken to tackle this crisis, including state prescription drug monitoring programs (PDMPs). This study uses the 2004-2014 National Survey of Drug Use and Health (NSDUH) and exploits state-level variation in the timing of PDMP implementation and PDMP characteristics to investigate whether PDMPs are associated with a reduction in prescription opioid misuse or whether they have the unintended consequence of increasing heroin use.

Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs.

Aims: To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments.

Design: A mathematical model was used to estimate the number of patients needed for revenues to exceed costs.

Setting: Three medical settings in the United States were examined: in-patient, out-patient and emergency department.

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

Aims: Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics.

The Relationship Between End-of-Treatment Alcohol Use and Subsequent Healthcare Costs: Do Heavy Drinking Days Predict Higher Healthcare Costs?

Background: A challenge for evaluating alcohol treatment efficacy is determining what constitutes a "good" outcome or meaningful improvement. Abstinence at the end of treatment is an unambiguously good outcome; however, a focus on abstinence ignores the potential benefits of patients reducing their drinking to less problematic levels. Patients may be drinking at low-risk levels at the end of treatment but may be high-functioning and impose few social costs.