Category Archives: Prescription medications

Making PrEP Accessible to Patients Experiencing Homelessness

By | November 9, 2023

Human Immunodeficiency Virus (HIV) has gone from a deadly infection to a manageable health condition in the last thirty years. Today, we have medications available that can treat those with HIV and prevent HIV in uninfected people. Pre-exposure prophylaxis, also known as PrEP, is a medication given to individuals without HIV to keep them from… Read More »

Healthy Intersections Podcast: August 2023

By | February 17, 2024

Hi everyone! We’re excited to share the August edition of our Healthy Intersections Podcast with you. This month, we hosted Dr. Amanda Onwuka, a social epidemiologist and health services researcher at RTI International, as well as Jeremy Ney, author of American Inequality. We talk about the epidemic of drug overdose deaths in the US, mental… Read More »

Pain: no longer a vital sign?

By | April 7, 2023

Pain was widely under-treated in the 1980s. Two decades ago, pain was recognized as an important problem that needed to be managed by healthcare providers. Today, the opioid crisis has led to under-treatment once again. Professional recognition of pain as a symptom that needs managing was the eventual outcome of several decades of research. Again… Read More »

Early Access vs. Proven Efficacy: FDA’s Accelerated Approval Process

By | October 24, 2022

A recent JAMA article noted that only one-third of new drug approvals through the accelerated approval process by the FDA in the US or the conditional marketing authorization in the EU have shown therapeutic value.  Many of these drugs are high cost, and this begs the question if we are spending our health care dollars appropriately. … Read More »

To Address Synthetic Opioids, These Public Health Strategies Must Play a Vital Role

By | February 14, 2022

The opioid epidemic and substance use disorders have garnered national attention as overdose deaths continue at an alarming rate. Synthetic opioids – chiefly fentanyl – are the culprit in many of those deaths. The Commission’s report Earlier this month, the bipartisan Congressional Commission on Combating Synthetic Opioid Trafficking, with representatives from many Federal agencies and… Read More »

Patient-Centered Transitional Care

By | August 12, 2021

How is research on patient-centered transitional care going? A supplement on this topic funded by the Patient-Centered Outcomes Research Institute (PCORI) was recently published in Medical Care. Care transitions are “ripe with hazard,” as discussed in an editorial from Amy Berman. As pointed out by Berman, figuring out what works and what doesn’t is critical to… Read More »

The Second Decade of Medicare Part D: Time to Modernize?

The Medicare Part D program, which was launched in 2006, is in the middle of its second decade of providing prescription drug coverage to Medicare beneficiaries. The Part D program has improved beneficiaries’ access to prescription drugs but at increasing cost. Federal spending for Part D has more than doubled from $44.3 billion in 2006… Read More »

Part D Senior Savings: Medicare’s New Approach to Paying for Insulin

For older adults in the United States, obtaining and paying for prescriptions can be a challenge. Although most Americans over age 65 are eligible for prescription drug coverage under the Medicare Part D, understanding and navigating the benefit can be difficult. The Center for Medicare and Medicaid Innovation (CMMI) recently launched a new payment model… Read More »

Treating the Opioid Crisis: Current Trends and What’s Next, Part 2

Last week, we discussed three noteworthy trends from the past decade in treating the opioid crisis. The first was recognizing medication for opioid use disorder (MOUD) as the standard of care. The second was formalizing an addiction medicine specialty. And the third was expanding the availability of MOUD. This week, we’ll consider three additional trends in… Read More »

Treating the Opioid Crisis: Current Trends and What’s Next

Throughout the past decade, the U.S. has seen a dramatic shift in addiction medicine research, clinical practice, and related stigma in seeking care. In a pair of blog posts, we will explore the top six trends related to treating the opioid crisis. And we’ll consider what may be next. The Opioid Epidemic Opioid addiction has… Read More »

Moving Upstream to Reduce Harm from Fake Opioids

By | July 16, 2020

When a call came in from the county coroner, it was never good news. Every once in a while, her work included a shock big enough to share with the public health team where I served as Medical Director. This was the case that Monday afternoon. Two teenage deaths, likely from opioid overdoses, likely the… Read More »

Natural Experiments for Diabetes

Over the past two decades, research has helped identify ways to reduce complications among people with diabetes and laid the foundation for primary prevention. However, prevention and treatments are still unequally applied, and social, economic, and age-related disparities persist. The June 2020 supplement issue of Medical Care argues for and presents the results of natural… Read More »

Is hydroxychloroquine ready for prime time for COVID-19? Not just yet.

By | April 17, 2020

In early April, President Trump, in his daily press briefing, told Americans to take the drug hydroxychloroquine, calling it a “game changer” for people with COVID-19: “I really think they should take it. But it’s their choice. And it’s their doctor’s choice or the doctors in the hospital. But hydroxychloroquine. Try it, if you’d like.”… Read More »

What presidential candidates say about healthcare: 2020 edition

By | February 12, 2020

Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition. We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete… Read More »

What contributes to inappropriate antipsychotic medication use?

By | October 18, 2019

Inappropriate antipsychotic medication use among older adults with dementia is associated with increased risk [pdf] of hospitalization and death. In 2017, the rate of potentially inappropriate use was 16%, having fallen from 24% in 2011. While this decline has been substantial, further decreasing the rate is an important goal to protect the health and wellbeing… Read More »

Medication Overload: The drug epidemic that no one is talking about

The opioid crisis has captured America’s attention, becoming an official “national emergency” and prompting swift action from government agencies, patient advocates, and health care providers. This is as it should be. Over the past decade, opioid overdoses have led to millions of hospitalizations, more than 100,000 deaths, and caused great harm in communities all across… Read More »

Veteran Access to Hepatitis C Treatment

By | May 10, 2019

Hepatitis C treatment has gone through a revolution in the last 5 years. Treatment durations have dropped from 48 to 12 weeks, and success rates have improved dramatically. However, treatment costs have sky-rocketed accordingly, and access to care has become a significant issue, particularly for lower socioeconomic individuals and groups. Eligible veterans should have access… Read More »

Employment Reductions and Government Revenue Losses from Opioid Misuse

By | March 21, 2019

The economic burden of the U.S. opioid epidemic likely exceeds $78.5 billion per year when considering its impact on healthcare, substance abuse treatment, the criminal justice system, and productivity costs. Although medication assisted treatment for opioid abuse (covered previously at our blog) may help to reduce these costs [pdf], the epidemic is likely to continue to negatively impact… Read More »

The Link Between Prescription Copayments, Contraceptive Adherence, and Unintended Pregnancy in the United States

By | December 12, 2018

There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the… Read More »

Medication-Assisted Treatment: A Vital Player in the Opioid Epidemic

By | August 15, 2018

For two years in a row, the United States has experienced a decrease in life expectancy, which researchers have largely attributed to the opioid epidemic. Life expectancy for the United States population was 78.6 years in 2016, a decrease of 0.1 year from 2015 [PDF]. Age-specific death rates between 2015 and 2016 increased for younger… Read More »

Do electronic pill bottles improve measurement of medication adherence?

By | August 8, 2018

Medication non-adherence can be a tricky issue for healthcare providers, patients, and pharmacists to solve. In addition to cost, there are many other factors that influence whether someone takes their medication(s) as prescribed. As discussed in the literature, side effects, confusion about medications, and the general human tendency to forget may all play a role.… Read More »

Prescription drug advertising: viewer beware

By | July 9, 2018

Direct-to-consumer advertisements for prescription drugs have been legal in the United States since 1985, but are illegal in almost every other country. The history of consumer-directed ads in this country is that of private companies replacing public agencies as the purveyors of information on prescription drugs to the people. It has left us in a… Read More »

End-of-Life Care and the Opioid Crisis: Potential Implications and Unintended Consequences

Reactions to the opioid crisis are affecting patients in need of hospice and end-of-life care in the United States. Hospice providers have been largely exempt from the increasing regulation of opioid and narcotic prescriptions, as most recent laws and regulations affecting opioid prescribing specifically exempt individuals receiving cancer treatment, palliative care, or those nearing their end-of-life. However,… Read More »

Discussion of antidepressant black-box warnings and youth suicide

By | May 2, 2018

In many situations, randomized controlled trials are infeasible and one must draw conclusions from observational data.  Certain quasi-experimental designs – for example, interrupted time series analyses – strengthen the conclusions that can be drawn from observational data.  However, particularly when the intervention evaluated is important, either clinically or from a health policy perspective, implied or… Read More »

The cost of a box of hope

By | April 2, 2018

There’s a box on my mom’s desk. It’s smaller than a shoe box, and unremarkable unless you know what’s in it, how it got there and why it represents several important things that are wrong with how we treat people with terminal cancer. The box contains 28 doses of two drugs, or one “cycle” of… Read More »

Sometimes the best medicine isn’t a medicine at all

By | March 15, 2018

Ironically, many healthcare providers–doctors, nurses, physician and medical assistants–are not trained in “health” at all but in “medicine” instead. Often, as providers, our instinct is to first reach for a pill bottle or a procedure and forget about lifestyle changes that could be safer and more financially feasible for our patients. As the burden of… Read More »

The Social Determinants of Addiction

By | February 15, 2018

Opioid use is a serious concern that the executive branch of the United States government recently declared a public health emergency. Based on data from the Department of Health and Human Services, in 2016, 2.1 million people misused prescription opioids for the first time, and 42,249 people died from overdosing on opioids. Also in 2016, 170,000… Read More »

In the fight against the opioid epidemic, states should update their needle and syringe access laws

By | February 7, 2018

During my time as a community pharmacist in Maryland, I often encountered individuals who would approach the pharmacy in search of syringes. Although they would try to disguise their intentions by stating that they needed it for someone else or for an animal, it was apparent why they were there; they were going to use… Read More »

Impact of Medication Adherence on Health Services Utilization in Medicaid

By | January 31, 2018

Medication is an essential aspect of tertiary prevention, as it often addresses symptoms, may restore function, and minimizes adverse consequences associated with chronic conditions. Medication adherence is most often studied in the context of Medicare Part D. In a newly published Medical Care article, Drs. Roebuck, Kaestner, and Dougherty, instead measure the associations between medication… Read More »

Abuse-Deterrent Formulations: A Solution to the Problem

By | January 25, 2018

Despite continuous efforts to address the problem, high rates of prescription opioid use and abuse continue to plague our country.  According to the CDC, deaths involving prescription opioids in the United States have quadrupled since 1999, and so have the sales of these prescription drugs.  In 2015, the American Public Health Association published a policy… Read More »

The Effect of Co-Payments on Incarcerated Women

By | January 11, 2018

Prisoners have a fundamental right to receive health care while incarcerated, a right that is mandated by the US Supreme Court. However, negligent care in prisons persists and is often an issue of limited access due to cost mitigating policies. Since the 1990’s, prison systems have integrated managed care strategies, like co-payments, to mitigate increasing… Read More »

Promoting Primary Prevention of Neonatal Abstinence Syndrome

By | March 21, 2021

“Neonatal abstinence syndrome” (NAS) sounds deceptively innocuous, given that it is literally infant drug withdrawal. It is usually caused by prenatal exposure to opioids but can also result from maternal consumption of other substances, like alcohol and antianxiety medications. Common symptoms include excessive high-pitched crying, fever, sweating, irritability, vomiting, diarrhea, rapid breathing, sleep disturbances, and poor… Read More »

What’s the difference between opioid use, misuse, and addiction?

By | September 29, 2017

Opioid addiction seems to be in the news every day. But what’s the difference between an opioid user and an opioid addict? First, let’s define our terms. Opioids are drugs derived from the opium poppy, including heroin and morphine. The class also includes synthetic opium-derived prescription painkillers including oxycontin and fentanyl, as well as drugs… Read More »

Preventing Health Care that Almost Nobody Needs

By | September 28, 2017

Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »

Mobile Apps to Improve Medication Adherence

What do you use your cell phone for on a daily basis? Many people would say using social media, texting, and placing phone calls– but have you ever considered your smartphone as a tool to improve medication adherence?  Our phones are an integral part of our lives, and consequently, researchers, clinicians, and patients have all… Read More »

Patterns of Opioid Use and Risk of Opioid Overdose

By | July 5, 2017

Opiate overdose is now the leading cause of accidental death in the United States, killing more than 50,000 people in 2015. About 20,000 of those deaths were attributed to the use of prescription opiate medications. As a physician, I want to alleviate my patients’ pain, but I have also taken an oath to do my… Read More »

POLICY UPDATE: Contraception Coverage

The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More »

Problems with Epilepsy Drug Treatment for Older Adults

By | June 3, 2017

Expensive brand-name drugs are prescribed over older, less costly generics whose efficacy and risk profiles aren’t much different. Sometimes the financial issues involved are painfully obvious, such as when a drug company introduces a new, “improved” version of a medication that is merely a longer-acting version of the same chemical entity shortly before the patent expires on the original… Read More »

Patterns of Buprenorphine-Naloxone Treatment for Opioid Use Disorder

By | May 4, 2017

Despite a rapid expansion in the use of buprenorphine-naloxone (bup-nx) as a treatment for opioid use disorder, there is little understanding of the patterns of treatment. In a newly published-ahead-of-print Medical Care article, Brendan Saloner and colleagues from Johns Hopkins used an all-payer claims database to investigate what factors predict the duration of treatment, dosage, and continuity of treatment for… Read More »

Avoiding Anticholinergic Drugs May Reduce Alzheimer’s Risk

By | March 27, 2021

I’ll never forget the time Granddaddy tried to eat my hand. At least that’s how it seemed to me at age six. In reality, he’d simply confused my hand with the straw sticking out of the milkshake we’d brought to him at the nursing home. By that point in his early-onset Alzheimer’s disease, the Granddaddy… Read More »

How did Part D affect mortality among women with breast cancer?

By | February 27, 2017

Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More »

Chronic pain, opioids, and medical marijuana

By | February 4, 2017

High-quality evidence supports the use of medical marijuana for chronic pain, neuropathic pain, and other conditions. Yet, patients who live in some states can’t legally use it — and are threatened with loss of access to their prescribed pain medications if they do. I know this because a close family member of mine has chronic pain.… Read More »

Economic Burden of the Opioid Epidemic

By | September 29, 2016

According to the U.S. Department of Health & Human Services, in 2014, more than 240 million prescriptions were written for opioids, which is more than sufficient for each American adult to have one full bottle of opioids. Prescription drugs are second only to marijuana as the most abused category of drug in the United States. A recent article… Read More »

The ACA vs. the doughnut hole: Medicare part D utilization and costs

By | September 8, 2016

President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More »

Seeking Clarity on Opioid Prescribing

By | May 1, 2017

According to the National Institutes of Health (NIH), more than 18,000 people died from overdoses of prescription opioids in 2014. This is more than the number of overdose deaths attributed to heroin (10,854) and cocaine (5,415) combined. Opioids are pain relievers that are chemically similar to morphine. Existing clinical guidelines recommend against exceeding a threshold… Read More »

Measuring Cost-related Medication Burden

By | June 9, 2016

As readers of Medical Care are no doubt aware, prescription drug expenditures for Medicare beneficiaries are high – nearly $90 billion in 2012.  There is some evidence that Medicare Part D has reduced financial burdens, at least among some beneficiaries, but recent surveys suggest that around 4.4% of individuals ages 65 and older (including those not on… Read More »