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Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies - United States, 2007-2014.

Abstract Drug overdose is a leading cause of injury death in the United States; 47,055 fatal drug overdoses were reported in 2014, a 6.5% increase from the previous year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed for pain management and is also provided through opioid treatment programs to treat opioid use disorders. Because methadone might remain in a person's system long after the pain-relieving benefits have been exhausted, it can cause slow or shallow breathing and dangerous changes in heartbeat that might not be perceived by the patient (4,5). In December 2006, the Food and Drug Administration issued a Public Health Advisory that alerted health care professionals to reports of death and life-threatening adverse events, such as respiratory depression and cardiac arrhythmias, in patients receiving methadone (4); in January 2008, a voluntary manufacturer restriction limited distribution of the 40 mg formulation of methadone.* CDC analyzed state mortality and health care data and preferred drug list (PDL) policies to 1) compare the percentage of deaths involving methadone with the rate of prescribing methadone for pain, 2) characterize variation in methadone prescribing among payers and states, and 3) assess whether an association existed between state Medicaid reimbursement PDL policies and methadone overdose rates. The analyses found that, from 2007 to 2014, large declines in methadone-related overdose deaths occurred. Prescriptions for methadone accounted for 0.85% of all opioid prescriptions for pain in the commercially insured population and 1.1% in the Medicaid population. In addition, an association was observed between Medicaid PDLs requiring prior authorization for methadone and lower rates of methadone overdose among Medicaid enrollees. PDL policies requiring prior authorization might help to reduce the number of methadone overdoses.
PMID
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Authors

Mayor MeshTerms

Medicaid

Keywords
Journal Title mmwr. morbidity and mortality weekly report
Publication Year Start




PMID- 28358791
OWN - NLM
STAT- MEDLINE
DA  - 20170330
DCOM- 20170403
LR  - 20170403
IS  - 1545-861X (Electronic)
IS  - 0149-2195 (Linking)
VI  - 66
IP  - 12
DP  - 2017 Mar 31
TI  - Methadone Prescribing and Overdose and the Association with Medicaid Preferred
      Drug List Policies - United States, 2007-2014.
PG  - 320-323
LID - 10.15585/mmwr.mm6612a2 [doi]
AB  - Drug overdose is a leading cause of injury death in the United States; 47,055
      fatal drug overdoses were reported in 2014, a 6.5% increase from the previous
      year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed 
      for pain management and is also provided through opioid treatment programs to
      treat opioid use disorders. Because methadone might remain in a person's system
      long after the pain-relieving benefits have been exhausted, it can cause slow or 
      shallow breathing and dangerous changes in heartbeat that might not be perceived 
      by the patient (4,5). In December 2006, the Food and Drug Administration issued a
      Public Health Advisory that alerted health care professionals to reports of death
      and life-threatening adverse events, such as respiratory depression and cardiac
      arrhythmias, in patients receiving methadone (4); in January 2008, a voluntary
      manufacturer restriction limited distribution of the 40 mg formulation of
      methadone.* CDC analyzed state mortality and health care data and preferred drug 
      list (PDL) policies to 1) compare the percentage of deaths involving methadone
      with the rate of prescribing methadone for pain, 2) characterize variation in
      methadone prescribing among payers and states, and 3) assess whether an
      association existed between state Medicaid reimbursement PDL policies and
      methadone overdose rates. The analyses found that, from 2007 to 2014, large
      declines in methadone-related overdose deaths occurred. Prescriptions for
      methadone accounted for 0.85% of all opioid prescriptions for pain in the
      commercially insured population and 1.1% in the Medicaid population. In addition,
      an association was observed between Medicaid PDLs requiring prior authorization
      for methadone and lower rates of methadone overdose among Medicaid enrollees. PDL
      policies requiring prior authorization might help to reduce the number of
      methadone overdoses.
FAU - Faul, Mark
AU  - Faul M
FAU - Bohm, Michele
AU  - Bohm M
FAU - Alexander, Caleb
AU  - Alexander C
LA  - eng
PT  - Journal Article
DEP - 20170331
PL  - United States
TA  - MMWR Morb Mortal Wkly Rep
JT  - MMWR. Morbidity and mortality weekly report
JID - 7802429
RN  - UC6VBE7V1Z (Methadone)
SB  - IM
MH  - Databases, Factual
MH  - Drug Overdose/*epidemiology/mortality
MH  - Drug Prescriptions/economics/*statistics & numerical data
MH  - Health Policy
MH  - Humans
MH  - *Medicaid/economics
MH  - Methadone/*poisoning/*therapeutic use
MH  - Pain/*drug therapy
MH  - Reimbursement Mechanisms
MH  - United States/epidemiology
EDAT- 2017/03/31 06:00
MHDA- 2017/04/04 06:00
CRDT- 2017/03/31 06:00
AID - 10.15585/mmwr.mm6612a2 [doi]
PST - epublish
SO  - MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):320-323. doi:
      10.15585/mmwr.mm6612a2.

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