Insurance-Related Barriers to Medications for Opioid Use Disorder in Private and Medicaid Plans

In 2021, a record 80,000 opioid overdose deaths occurred in the U.S, highlighting the importance of identifying and reducing barriers to accessing medications for opioid use disorder (MOUD). This project will provide actionable, policy-relevant information on the effect of cost-sharing for MOUD in privately insured patients and on the effect of removing prior authorization requirements for MOUD in Medicaid patients. Findings will demonstrate whether mitigating cost-sharing and prior authorization requirements for MOUD could slow the record rise in opioid overdose deaths or whether policy efforts to achieve this goal should focus elsewhere.

Evaluating Policy Interventions to Decrease Excessive and Risky Perioperative Opioid Prescribing

At least 15.4 million opioid prescriptions in the United States are provided each year during surgical care, and many of these prescriptions are excessive or are written in a manner that increases the risk of opioid-related adverse events, such as overdose. To reduce these harms, policymakers and payers in most states have enacted policies that restrict opioid prescribing for acute pain or mandate clinicians to review prescription drug monitoring program databases before prescribing opioids, but it is not clear if these policies have reduced excessive and risky perioperative opioid prescribing, or if they have had unintended effects, such as worsened pain control.

This project will provide critical information for efforts to mitigate the contribution of perioperative opioid prescribing to the U.S. opioid epidemic. Innovations include use of national claims data with a combined sample size of 76 million adults, maximizing the breadth of analyses, coupled with use of data on patient-reported outcomes at the state level, maximizing the depth of analyses. Ultimately, findings will contribute to the development of well-designed policies that balance the need for safe opioid prescribing with the need for effective postoperative pain management.

U.S. Dental Opioid Prescribing: Epidemiology and Policy Interventions

Dental opioid prescriptions are an important driver of the U.S. opioid epidemic. In 2016, U.S. dentists prescribed opioids more than 50 times more frequently as United Kingdom dentists, in part because the former routinely prescribe opioids after minor procedures such as wisdom tooth extraction. Although the harms associated with dental opioid prescribing affect all age groups, they disproportionately affect adolescents and young adults, for whom dentists are among the most common sources of opioids. In a study of adolescents and young adults who filled an opioid prescription within three days of wisdom tooth extraction, 1.3% continued to fill opioid prescriptions up to a year later (“persistent opioid use”).

This project will provide critical information that will motivate interventions to reduce unnecessary dental opioid prescribing while informing how these interventions should be designed.