Portland, Ore. – January 26, 2017 – HealthInsight Oregon is collaborating with Oregon State University and other research partners to investigate the relationships among prescription opioid pain reliever (OPR) use, policies for improving OPR prescribing, and heroin initiation and overdoses. This study is one of three projects funded by the Centers for Disease Control and Prevention (CDC) in an effort to curb opioid misuse, abuse and overdose.
Every day, according to CDC, more than 1,000 people are treated in emergency rooms for misusing prescription opioids. Opioids were involved in more than 28,000 deaths in 2014, and opioid-related mortality continues to rise because of increasing rates of heroin use and poisoning. Mortality from heroin has quadrupled over the past 5 years, with 40% to 70% of heroin users reporting nonmedical use of prescription opioids before starting heroin.
The precise relationship between prescription opioids and the initiation and use of heroin is not fully understood, though most observers agree on the need to develop programs to identify and intervene with people at high risk for transition to heroin. The Oregon study will evaluate policy factors associated with changes in opioid prescribing and heroin-related outcomes in the Medicaid population. The long-term goal is to identify practices that reduce high-risk prescription opioid use, heroin initiation and opioid overdose.
“Very little is known about the precise conditions or predictors of transition from the misuse of prescription opioids to heroin,” said Daniel Hartung, PharmD, MPH, principal investigator. “The findings from this study will increase our understanding of individual risk factors for transition to and overdose with heroin.”
The Oregon Health Authority (OHA) is conducting a statewide performance improvement project (PIP) to reduce the proportion of high-dose opioid prescriptions among Medicaid enrollees. Medicaid services in Oregon are delivered through 16 regional coordinated care organizations (CCOs). OHA has set opioid dosage reduction targets and allowed each CCO to determine its own strategy to meet those targets. The CCOs must show measurable reductions in high-dosage prescribing over time. As the CCOs deploy an array of interventions, the PIP constitutes a natural experiment to study how changes in opioid prescription patterns may affect both prescription opioid and heroin use.
To analyze these relationships, the research team will leverage and link existing data from several sources including Oregon Medicaid and vital statistics data. The researchers will analyze CCO reports and will interview key informants to characterize CCO policies, practices, implementation details and other factors in order to estimate the PIP’s effects on prescription opioid use and heroin-related outcomes.
Dr. Hartung, the principal investigator, is associate professor of pharmacy practice with the Oregon State University (OSU) College of Pharmacy and an investigator in the Pacific Northwest Evidencebased Practice Center at Oregon Health & Science University (OHSU). He has more than 10 years of experience in prescription policy and pharmaceutical health service research. Gillian Leichtling, senior research associate with HealthInsight Oregon, will serve as senior researcher and project manager for this grant. HealthInsight Oregon has conducted federally funded research on prescription drug-related topics since 2012 in partnership with OSU and OHSU investigators.
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