Todd Shryock

A research simulation examining the opioid crisis predicts that it will get worse before it gets better — and will cost 500,000 lives over the next 10 years. The number of people misusing prescription opioids or heroin is declining, but the risk of overdose has increased dramatically since 2013 due to the spread of fentanyl.

Mohammad Jalali, Ph.D., an investigator at Massachusetts General Hospital and an assistant professor at Harvard Medical School, in collaboration with the FDA has created a data-driven simulation model for the opioid crisis that incorporates feedback such as social influence and risk perceptions. Called SOURCE, the model has projected three key strategies that could save more than 100,000 lives over the next 10 years.

The three strategies must be implemented together and consist of fentanyl harm reduction, naloxone distribution, and recovery support for people in remission from opioid use disorder — the group at highest risk of overdose.

SOURCE found that reducing fentanyl risks from drug-checking services that support people to use drugs safely could dramatically reduce overdose deaths. It also shows that while increased distribution of the overdose reversal drug naloxone has helped mitigate this growing risk, naloxone’s positive effects still lag far behind the growing fentanyl threat. However, naloxone should nonetheless remain a key part of the nation’s overdose deaths prevention strategy, according to the researchers.

 analyzing lifesaving strategies was published in 

Proceedings of the National Academy of Sciences

SOURCE works by replicating 22 years worth of data on prescription opioid use and misuse, heroin use, overdose deaths and other related information. SOURCE can explain historical shifts in opioid use and determine, for example, that opioid risks deter potential users, shifting the biggest risks to those in remission in danger of relapse.

Researchers warn that a significant challenge in addressing the country’s opioid crisis is that policies based on past patterns of behavior may have unintended consequences because those patterns change over time.

This article originally appeared on Medical Economics.

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500,000 lives expected to be lost to opioids over the next 10 years

Before Getting Better, the Opioid Crisis Will Get Worse

While only 5% of older adults lacked prescription drug coverage in 2021 – down from 32% in 1998 – 20% reported financial hardship from prescription drug purchases, according to a study.

Those without prescription drug insurance, requiring multiple daily medications, and reporting a low annual household income struggled the most. Even those with insurance from lower income households still struggled when needing multiple daily medications.

The researchers said that among older adults in the United States, policies that reduce the out-of-pocket expenditures for prescription drugs appeared to reduce the burden of these expenditures, and suggest that managed care policymakers should consider policies that reduce out-of-pocket costs for older adults in an effort to promote medication access. Such policies may enable older adults to reallocate funds for vital expenses like food and shelter, especially for older adults from vulnerable populations.

The report states that the inability to pay for prescription drugs is an important determinant of medication adherence that may lead patients to ration or split doses, delay refills or new prescriptions, and even stop taking medications altogether. Cost-related nonadherence compromises the therapeutic effectiveness in managing most chronic diseases, persists even when patients cut back on basic health-related social needs, and consequently leads to higher preventable health care expenditures.

The data were from four nationally distributed, cross-sectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs.

Olson A, Schommer JC, Mott DA, Adekunle O, Brown LM. Financial hardship from purchasing prescription drugs among older adults in the United States before, during, and after the Medicare Part D “Donut Hole”: Findings from 1998, 2001, 2015, and 2021. 

. 2022 May;28(5):508-517. doi: 10.18553/jmcp.2022.28.5.508. 

Lower household income and requiring multiple medications play large roles

Prescription Drug Insurance Out of Reach for Many Older Adults

One in ten people from ethnic minority groups who refused a vaccine experienced racial discrimination in a medical setting since the start of the pandemic. They also experienced twice as many incidents of racial discrimination compared to those who were vaccinated, according to a study published in the 

The study authors said that this illustrates how the effects of racial discrimination creates low confidence in the health system to handle the pandemic, which led to vaccine refusal.

The study participants included 633 adults belonging to ethnic minority groups who were offered a COVID-19 vaccine between December 2020 and June 2021. 6.69% of participants who had refused the vaccine reported they had experienced poorer service or treatment than other people in a medical setting because of their race or ethnicity.

The researchers said that the findings underscore how government agencies must work to regain trust from ethnic minority groups to increase vaccination rates among these diverse groups. Public health campaigns to increase COVID-19 vaccination rates should not only focus on building trust in the vaccines, but also to prevent racial and ethnic discrimination and support people who have experienced it.

They also pointed out that failure to tackle racial discrimination would lead to a widening of systemic inequalities putting more ethnic minority lives at risk.

Study shows that 10% of minorities refused COVID-19 vaccines because of past racial discrimination experiences

Impact of Racism in Health Care on Vaccine Hesitancy in Minority Groups

The majority of antibiotic prescriptions are written for things like bronchitis, sore throats, common colds, and the flu, even though they are inappropriate for them. This is not only create a public health concern, but a new study shows that it also contributes to physician distress.

The study appeared in the May 2022 issue of 

The Joint Commission Journal on Quality and Patient Safety, 

and looked at the association between clinician distress and the inappropriate prescribing in adult outpatients.

The researchers examined health records and included outpatient visits in family medicine, general internal medicine, and emergency department visits where an acute respiratory tract infection for an otherwise healthy adult was listed as the primary diagnosis. The depression, anxiety, and burnout levels for the physicians were assessed using the National Institute of Health Patient Report Outcomes Measurement Information System and the Stanford Professional Fulfillment Index Burnout Composite scale obtained from clinician wellness survey data.

Overall, approximately 34% and 50% of clinicians in the study reported depression/anxiety and burnout symptoms, respectively. Findings showed each one standard deviation increase in a clinician’s composite depression and anxiety score was associated with a 28% increase in the odds of an inappropriate antibiotic prescription for an acute RTI. Clinician burnout had no significant association with inappropriate antibiotic prescribing.

“Although the current study was conducted in the pre-COVID-19 era, it is plausible that had this work been repeated during the height of the pandemic, the unique stressor imposed by the COVID-19 pandemic would have shown an even greater prevalence of depression and/or anxiety among clinicians,” Sara C. Keller, MD, MSHP and Pranita D. Tamma, MD, MHS, said in a statement. “We applaud … shedding light on an important and unrecognized area in need of intervention—the impact of provider mental health on inappropriate antibiotic prescribing.”

1. Brady KJS, Barlam TF, Trockel MT, et al. 

Clinican distress and inappropriate antibiotic prescribing for acute respiratory tract infections: A retrospective cohort study.

2022;48(5):287-297. doi:10.1016/j.jcjq.2022.01.011

Handing out antibiotics for illnesses they weren’t meant for adds to the distress that health care providers feel.

Evaluating the LInk Between Health Care Provider Stress, Inappropriate Antibiotic Prescribing

A report that tracks the use of medicines in the United States shows that spending on prescriptions rose 12% in 2021 primarily due to COVID-19 vaccines and therapies.

The report, from The IQVIA Institute, found that despite an increase in overall spending, costs per prescription on average were flat or slightly declining.

Prescription drug use reached 194 billion daily doses in 2021, a record compared to the slowdown that occurred in 2020. In addition, health services utilization rates returned to pre-pandemic levels, but have not made up for the backlog of missed patient visits, preventive screenings, and elective procedures.

Physician visits were the least affected during the pandemic and have increased to higher than pre-pandemic levels, but is 3% lower still than projected in prior years. Screening and diagnostic tests have mostly rebounded to pre-pandemic levels as well, but the cumulative deficit is 5% below baseline with a large portion (41%) of that occurring between March and May of 2020.

Despite lags in these visits, the use of medicines has grown 9.6% over the last five years, according to the study. Retail drugs make up 86% of that, with the other 14% of use in non-retail settings, which continues to decline since 2017. Drugs dispensed from retail pharmacies has continued to grow 2.3% annually.

Medicine cost continues to be a significant burden for some patients. Out-of-pocket costs rose $4 billion in 2021 to $79 billion. This growth was driven by retail out-of-pocket costs, which grew 4.8% in 2021 following two years of declines and lower growth. Non-retail out-of-pocket costs have remained relative stable over the last four years, but have grown 16% since 2016.

1. The use of medicines in the U.S. 2022. The IQVIA Institute. April 21, 2022. Accessed April 26, 2022. 

https://www.iqvia.com/insights/the-iqvia-institute/reports/the-use-of-medicines-in-the-us-2022

COVID-19 vaccines and therapies were the main drivers of the increase. 

Increase In Prescription Spending Reported in 2021

HHS announced that is it providing nearly $90 million in American Rescue Plan funding to fund new data-driven efforts for HRSA Health Center Program-supported and HRSA-designated health centers to identify and reduce health disparities.

The data collection and reporting initiative is designed to collect more and better data on social determinants of health, while also streamlining and improving data quality reporting for health centers. This program will enable health centers to tailor their efforts to improve health outcomes and advance health equity, more precisely targeting the needs of specific communities or patients.

“Health centers are vital to increasing equitable access to primary health care,” said HHS Secretary Xavier Becerra, in a statement. He added that the plan will further enable health centers to utilize data to meet the needs of their community and help reduce gaps in care.

“HRSA’s funding has supported our nation’s health centers in becoming leaders in leveraging the latest technology and data to provide high-quality care to individuals and communities who have been historically underserved,” said HRSA Administrator Carole Johnson, in a statement. “Today’s announcement builds on this work and will help health centers modernize their data tools to improve equitable access to care and continue to best meet the needs of the communities and patients they serve.”

The funding can be used for various COVID-19 activities and for modifying, enhancing, and expanding health care services and infrastructure by improving health information technology, enhancing data collection, and supporting related staff training. These efforts will advance broader COVID-19 response, mitigation, and recovery efforts. Additionally, they will help prepare for future public health emergencies.

The enhancements that health centers may make to their infrastructure using the funds will support patient-level reporting and enable them to better identify, measure, and investigate disparities in health care use and health outcomes by race, ethnicity, age, and other important demographic factors, and to more precisely target their resources accordingly. Standardization of patient-level health data will enable the identification of populations most at risk for health disparities and will provide data to inform potential clinical interventions. Furthermore, the ability to collect, house, and report standardized patient-level health data will support health centers’ participation in critical population health surveillance activities during public health emergencies.

HRSA-supported health centers serve medically underserved populations and communities, which are often disproportionately affected by COVID-19. Health centers serve 1 in 5 people living in rural communities, and 1 in 11 people nationwide. More than 90% of HRSA-funded health center patients are individuals or families living at or below 200% of the Federal Poverty Guidelines, and nearly 63% are racial or ethnic minorities.

The funds will help identify and reduce health disparities.