bradleydstein.bsky.social
Child psychiatrist/ health services/policy researcher at RAND, studying improving access, treatment, and outcomes for individuals with mental health and substance use disorders. Often found at youth soccer games and finding recipes to try in my smoker
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Congratulations! Look forward to 7 more years of tremendous work from your team!
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Or you can read my testimony, "Addressing the Opioid Crisis Among Older Americans: Strategies for Prevention, Treatment, and Supporting Families Affected by Addiction" online now. ⬇️
www.rand.org/pubs/testimo...
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If you couldn't tune in, you can watch the full hearing here. ⬇️
www.aging.senate.gov/hearings/com...
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It was inspiring to hear from @SeminoleSheriff on Florida's efforts, Gregory Duckworth on West Virginia's initiatives, Dr. Malik Burnett on treatment access, and Elizabeth Mateer on caring for her grandson.
I look forward to working together to tackle this crisis.
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good question, and first time I've heard someone raise this issue
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Wonderful seeing this effort going on in our own backyard here in Pittsburgh supported by Allegheny County DHS , and great seeing @wesa.fm reporting on this important story
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Congrats!
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4/ Addressing systemic barriers and stigma and supporting clinicians who prescribe buprenorphine for opioid use disorder is crucial for improving treatment access. Read the full paper here: journals.sagepub.com/doi/abs/10.1...
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3/ Even in counties with high opioid overdose rates, the removal of the X-waiver didn't significantly impact buprenorphine access.
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2/ We explored if removing the X-waiver improved treatment access by examining whether buprenorphine prescriptions increased in counties with higher OD rates and fewer waivered prescribers compared to others. We found no significant effect of the X-waiver elimination on buprenorphine dispensation
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Read the full paper here:
doi.org/10.1111/jgs....
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11/ Addressing the needs of older adults with OUD requires models of care delivery that meet their needs. Future research should explore the impact of state policies and interventions—such as collaborative care—on treatment access.
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10/ Our study is limited by the absence of clinical data, such as whether patients are taking prescribed buprenorphine or receiving it for pain. Understanding how older adults with OUD are treated differently remains crucial. #ResearchLimitations
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9/ The removal of the X-waiver in 2023 may improve access to buprenorphine for older adults, but existing state policies could still influence prescribing patterns.
More research is needed to better understand these dynamics.
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8/ These findings highlight how few clinicians prescribe buprenorphine to older adults: Less than 100 clinicians treated more than a third of all the elderly patients receiving buprenorphine.
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7/ And the southern U.S. had more states where a greater proportion of prescribers to the elderly are high prescribers than other regions.
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6/ Primary care clinicians (42%) and advanced practice nurse practitioners/physician assistants (29%) were clinician groups responsible for most buprenorphine prescribing to older adults.
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5/ Only 1,232 clinicians prescribed *any* buprenorphine to older adults.
Of those, only 5% prescribed to more than 15 older adults, accounting for 36% of older adults receiving buprenorphine.
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4/ This study analyzed recent buprenorphine prescribing patterns among older adults using 2019-2020 IQVIA data. We examined prescriptions by patient demographics, prescriber specialty, and urban/rural location.
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3/ There are 3 medications for OUD: buprenorphine, methadone, and naltrexone.
Buprenorphine is the most widely used, but there are persistent barriers to access—most individuals who could benefit don’t receive it.
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2/ The prevalence of opioid use disorder (OUD) among Medicare beneficiaries aged 65+ has tripled since 2013, reaching 15.7 per 1,000 in 2018.
Despite this, access to treatment remains limited—and the need is expected to grow.
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What a fantastic photo! Thanks for sharing
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Appreciate co-authors @adamjgordon.bsky.social and others for their collaboration and @FOREfdn for supporting this research
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This research highlights the complexity of policies to support telehealth for medication treatment and the need for nuanced, supportive approaches and future research around telehealth to maximize the lifesaving potential of buprenorphine.
Learn more: link.springer.com/article/10.1...
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🔑 takeaway: Policy alone isn't enough.
Telehealth for opioid use disorder has benefits, but realizing the full potential for medication treatment at population-level may require more extensive implementation and infrastructure support.
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Counterintuitively, states implementing telehealth payment parity policies in 2020 saw 7.3% fewer new treatment episodes overall.
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One notable policy impact: states joining the psychologist interstate compact in 2020 after the public health emergency declaration had treatment episodes 7.97 days longer than other states.
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We found little change in the number of new buprenorphine treatment episodes started in 2020 compared to 2019 and an increase in treatment duration for episodes started in March 2020 before the public health emergency declaration compared to the comparable 2019 period.
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We used 2019-2020 national pharmacy data to analyze 4️⃣ key policies:
🔹Telehealth payment parity
🔹Interstate medical licensure compact
🔹Psychologist interstate compact
🔹Medicaid audio-only telehealth reimbursement
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This research highlights the complexity of policies to support telehealth for medication treatment and the need for nuanced, supportive approaches and future research around telehealth to maximize the lifesaving potential of buprenorphine.
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ouch. Nicely done!
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Very goood starter pack for Health Policy nerds