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Research Letter |

Use of Opioid Agonist Therapy for Medicare Patients in 2013

Anna Lembke, MD1; Jonathan H. Chen, MD, PhD2
[+] Author Affiliations
1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
2Department of Medicine, Stanford University School of Medicine, Stanford, California
JAMA Psychiatry. 2016;73(9):990-992. doi:10.1001/jamapsychiatry.2016.1390.
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This pharmacoepidemiology study uses Medicare Part D data to describe the use of buprenorphine-naloxone in the United States in 2013.

Despite public policy efforts to prevent opioid overdose and addiction, opioid overdose rates reached record high numbers in 2014.1 The population that uses Medicare, the federal insurance program for Americans who have certain disabilities or are 65 years or older, has among the highest and most rapidly growing prevalence of opioid use disorder, with more than 6 of every 1000 patients (more than 300 000 of 55 million) diagnosed2 and with hospitalizations increasing 10% per year.3 Data on patients with commercial insurance plans (the other likely source for national population data) show just more than 1 of every 1000 patients diagnosed.2 Prevention initiatives are essential for reducing the number of new patients with opioid use disorder, but treatment will be required for those already addicted to opioids. Opioid agonist therapy (OAT), including buprenorphine-naloxone (Suboxone) and methadone, is the most effective pharmacotherapy for opioid addiction.4

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Figure 1.
Average Prescription Claims per Prescriber by Specialty

Values depicted on a logarithmic scale. Average claims per prescriber for buprenorphine-naloxone by specialty include addiction medicine, 98.8; family medicine, 7.4; psychiatry, 4.9; interventional pain management, 4.7; anesthesiology, 3.1; pain management, 3.0; physical medicine and rehabilitation, 2.1; and general practice, 2.0. The most prolific prescribers of Schedule II opioids by average claims per prescriber include interventional pain management, 1124.9; pain management, 921.1; anesthesiology, 484.2; physical medicine and rehabilitation, 348.2; family practice, 161.1; addiction medicine, 131.5; and internal medicine, 122.0.

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Figure 2.
Ratio of Buprenorphine-Naloxone Claims vs All Drug Claims by State
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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