Projects

Project Date 
August 1, 2025- May 31, 2030 

Funding
National Institute on Drug Abuse 

Researchers

  • Thuy Nguyen, Ph.D. (Contact Principal Investigator)
  • Basia Andraka-Christou, J.D., Ph.D. (Primary Site Investigator)
  • W. David Bradford, Ph.D. (Co-Investigator)
  • Kao-Ping Chua (Co-Investigator)
  • Keith Kocher (Co-Investigator)
  • Pooja Lagisetty (Co-Investigator)
  • Kosali Simon (Co-Investigator)

Project Summary 
Opioid use disorder (OUD) is a life-threatening health condition affecting 7.6 million people in the U.S. Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, decrease mortality among patients with OUD by 50%. Emergency department (ED) visits for opioid overdose are an important opportunity to initiate MOUD, but buprenorphine is only prescribed to 1 in 12 patients visiting the ED for opioid overdose. Since 2015, at least 5 states have implemented laws requiring EDs treating patients for opioid overdose to offer MOUD induction or prescriptions, provide patients with information about MOUD, and/or provide “warm hand-offs”. State ED MOUD laws could increase MOUD treatment and prevent morbidity and mortality among patients with OUD. This project will be the first to create a database of states’ ED MOUD laws, describe MOUD initiation and retention following ED visits using multiple national claims data, and examine ED MOUD law effects on patient outcomes. Knowledge from this proposal will be critical to inform development and refinement of ED MOUD laws to increase treatment initiation and retention in lifesaving OUD treatment. In Aim 1, we will create a longitudinal, publicly available database of state ED MOUD laws. Through an expert guided search of NexisUni legal software, we will identify state statutes, regulations, and executive orders effective between 2014 and 2024 that appear designed to facilitate MOUD use after ED visits for overdose. In Aim 2, we will examine MOUD initiation and retention following ED visits for opioid overdose and describe key patient, provider, and geographic factors associated with MOUD treatment after ED visits. Using 2014-2024 national Medicaid, Medicare, and commercial insurance claims data, we will describe national and state-level trends in the rates of MOUD initiation and retention after ED visits for opioid overdose. We hypothesize that rates of MOUD initiation and retention after ED visits will increase over time and across payer types, and there will be significant heterogeneity in MOUD treatment across groups based on key patient, provider, and geographic attributes. In Aim 3, we will evaluate ED MOUD laws’ effects on MOUD initiation, MOUD retention, and opioid overdose. Using difference-in-differences analyses, we will examine whether state ED MOUD laws are associated with changes in the rate of MOUD initiation, rate of retention of MOUD for at least 180 days, and opioid overdose within 30 days of ED visits. We will also assess whether the effects of state ED MOUD laws vary by specific features of the laws and by patient race/ethnicity.

Project Date
30 Sep 2023 - 30 Jun 2028

Funding
National Institute on Drug Abuse R01 grant - R01DA057943

Researchers

  • Thuy Nguyen (Contact Principal Investigator)
  • Mark Bicket (Multiple Princial Investigator)

Project Summary
Medications for opioid use disorder (MOUD)–buprenorphine, methadone, and naltrexone–decrease illicit opioid use, increase retention in treatment, and save lives. However, for patients taking MOUD, and buprenorphine in particular, the treatment of acute pain after surgery is challenging. Buprenorphine is a partial opioid agonist that acts as a competitive antagonist for traditional opioids. Due to this fact, perioperative guidelines have historically advocated that patients temporarily discontinue buprenorphine before surgery. However, the national conversation has recently shifted with guidelines recommending that buprenorphine, and to a lesser extent methadone, be continued in the perioperative setting. The evidence supporting this change has relied on small samples, non-surgical cohorts, and studies failing to examine relevant outcomes for pain and opioid use disorder. In this proposal, we will use several state-of-the-art national databases to achieve a better understanding of perioperative management of MOUD and the consequences of therapy retention on opioid overdose risk. 

Publications

  • Bicket MC, Qi X, Buchwalder K, et al. Trends in Use of Medications for Opioid Use Disorder among Commercially Insured U.S. Surgical Patients. Anesthesiology. Published online September 25, 2025. doi:10.1097/ALN.0000000000005771
    https://pubmed.ncbi.nlm.nih.gov/40997040/
  • Bicket MC, Nguyen T. Building a Better Base for Keeping Buprenorphine on Board for Surgery. Anesthesiology. 2025;142(2):266-267. doi:10.1097/ALN.0000000000005282
    https://pubmed.ncbi.nlm.nih.gov/39807913/ 
  • Bicket MC, Chua KP, Lagisetty P, Li Y, Waljee J, Brummett C, Nguyen TD. Prevalence of Surgery Among Individuals in the United States. Annals of Surgery 5(2):p e421, June 2024.DOI: 10.1097/AS9.0000000000000421.
    https://journals.lww.com/aosopen/pages/default.aspx
  • Chua KP, Bicket MC, Bohnert ASB, Conti RM, Lagisetty P, Nguyen TD. Buprenorphine Dispensing after Elimination of the Waiver Requirement. N Engl J Med. 2024;390(16):1530-1532. doi:10.1056/NEJMc2312906.
    https://www.nejm.org/doi/full/10.1056/NEJMc2312906 

In the News

Project Date
01 Sep 2023 - Present

Researchers

  • Thuy Nguyen 
  • Kao-Ping Chua 
  • Pooja Lagisetty
  • Amy Bohnert

Project Summary
Despite a substantial rise in U.S. opioid overdose deaths in recent years, buprenorphine, a medication for opioid use disorder (OUD) that substantially decreases fatal overdose risk, remains widely underused, even after emergency department visits for opioid overdose. Moreover, little is known about buprenorphine treatment among the 38% of low-income adults with OUD covered by Medicaid, a disproportionate share of whom are people of color. To address this knowledge gap, the team will analyze racial and ethnic disparities in the receipt of buprenorphine among Medicaid enrollees to inform targeted interventions focused on improving equity of buprenorphine treatment.

Policy Briefs

In the News

Project Date
30 Sep 2022 - 31 Jul 2026

Funding
National Institute on Drug Abuse R01 grant - R01DA056438

Researchers

  • Kao-Ping Chua (Contact Principal Investigator)
  • Thuy Nguyen (Multiple Princial Investigator)

Project Summary
In 2020, a record 71,000 opioid overdose deaths occurred in the U.S, highlighting the importance of mitigating insurance-related barriers to accessing medications for opioid use disorder (MOUD). In this proposal, we 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. Results will inform and spur efforts to optimize insurance benefit design for MOUD in private and Medicaid plans, potentially leading to the removal of insurance-related barriers that may be contributing to rising opioid-related morbidity and mortality.

Publications

  • Chua KP, Conti RM, Lagisetty P, Bohnert A, Nuliyalu U, Nguyen TD. Association Between Cost-Sharing and Buprenorphine Prescription Abandonment. J Gen Intern Med. 2024; https://doi.org/10.1007/s11606-024-08819-2. 
    https://link.springer.com/article/10.1007/s11606-024-08819-2#citeas
  • Chua KP, Bicket MC, Bohnert ASB, Conti RM, Lagisetty P, Nguyen TD. Buprenorphine Dispensing after Elimination of the Waiver Requirement. N Engl J Med. 2024;390(16):1530-1532. doi:10.1056/NEJMc2312906. 
    https://www.nejm.org/doi/full/10.1056/NEJMc2312906   
  • Chua KP, Nguyen TD, Zhang J, Conti RM, Lagisetty P, Bohnert AS. Trends in Buprenorphine Initiation and Retention in the United States, 2016-2022. JAMA. 2023;329(16):1402-1404. doi:10.1001/jama.2023.1207
    https://pubmed.ncbi.nlm.nih.gov/37097363/
  • Chua KP, Nguyen TD, Waljee JF, Nalliah RP, Brummett CM. Association Between State Opioid Prescribing Limits and Duration of Opioid Prescriptions From Dentists. JAMA Netw Open. 2023;6(1):e2250409. Published 2023 Jan 3. doi:10.1001/jamanetworkopen.2022.50409
    https://pubmed.ncbi.nlm.nih.gov/36630136/
  • Andraka-Christou B, Simon KI, Bradford WD, Nguyen T. Buprenorphine Treatment For Opioid Use Disorder: Comparison Of Insurance Restrictions, 2017-21. Health Aff (Millwood). 2023;42(5):658-664. doi:10.1377/hlthaff.2022.01513
    https://pubmed.ncbi.nlm.nih.gov/37126752/ 

Visual Abstracts

  • Association Between Cost-Sharing and Naloxone Prescription Dispensing

Association_between_cost_sharing_and_naloxone_prescription_dispensing

  • Association Between Cost-Sharing and Buprenorphine Prescription Abandonment

Association Between Cost Sharing and Buprenophine Prescription Abandonment

  • Buprenorphine Dispensing after Elimination of the Waiver Requirement

Buprenorphine Dispensing After Elimination of the Waiver Requirement

In the News

Project Date
01 Jan 2021 - Present

Researchers

  • Thuy Nguyen
  • Christopher Whaley
  • Kosali Simon
  • Jonathan Cantor


Project Summary
The COVID-19 pandemic has caused a variety of disruptions to the health care workforce. Although publications on select workforce sectors chronicle patterns in employment through the early pandemic, there is a lack of national studies on the broad health care workforce using more recent data in this period of rapid change. This limits the ability of health care organizations and policy makers to ensure that patient needs are met. This project aims to address this knowledge gap, providing data driven insights into health care employment using large national databases.

Publications

In the News

Project Date
1 Sep 2019 - present

Researchers

  • Thuy Nguyen
  • Kosali Simon
  • David Bradford
  • Basia Andraka-Christou

Project Summary
Physician prescribing behavior may be influenced by a number of factors including prescriber incentives and pharmaceutical policy. As we search for solutions to address the ongoing opioid epidemic, it is important that we understand both the intended and unintended consequences of such opioid related policies. For example, previous studies by the team have demonstrated an association between less restrictive scope-of-practice regulations and greater buprenorphine prescribing by nurse practitioners. Future work will continue to explore the link between opioid related policy and clinician behavior. 

Publications

  • Bradford AC, Nguyen T, Schulson L, et al. High-Dose Opioid Prescribing in Individuals with Acute Pain: Assessing the Effects of US State Opioid Policies. J Gen Intern Med. 2024;39(14):2689-2697. doi:10.1007/s11606-024-08947-9
    https://link.springer.com/article/10.1007/s11606-024-08947-9 
  • Nguyen TD, Bradford WD, Simon KI. Pharmaceutical payments to physicians may increase prescribing for opioids. Addiction. 2019;114(6):1051-1059. doi:10.1111/add.14509
    https://pubmed.ncbi.nlm.nih.gov/30667135/
  • Nguyen T, Andraka-Christou B, Simon K, Bradford WD. Comparison of Rural vs Urban Direct-to-Physician Commercial Promotion of Medications for Treating Opioid Use Disorder. JAMA Netw Open. 2019;2(12):e1916520. Published 2019 Dec 2. doi:10.1001/jamanetworkopen.2019.16520
    https://pubmed.ncbi.nlm.nih.gov/31790568/
  • Nguyen T, Andraka-Christou B, Simon K, Bradford WD. Provider-directed marketing may increase prescribing of medications for opioid use disorder. J Subst Abuse Treat. 2019;104:104-115. doi:10.1016/j.jsat.2019.06.014
    https://pubmed.ncbi.nlm.nih.gov/31370974/
  • Scrivner O, Nguyen T, Simon K, Middaugh E, Taska B, Börner K. Job postings in the substance use disorder treatment related sector during the first five years of Medicaid expansion. PLoS One. 2020;15(1):e0228394. Published 2020 Jan 30. doi:10.1371/journal.pone.0228394
    https://pubmed.ncbi.nlm.nih.gov/31999764/
  • Andraka-Christou B, Nguyen T, Bradford DW, Simon K. Assessing the impact of drug courts on provider-directed marketing efforts by manufactures of medications for the treatment of opioid use disorder. J Subst Abuse Treat. 2020;110:49-58. doi:10.1016/j.jsat.2019.12.004
    https://pubmed.ncbi.nlm.nih.gov/31952628/
  • Nguyen TD, Gupta S, Ziedan E, et al. Assessment of Filled Buprenorphine Prescriptions for Opioid Use Disorder During the Coronavirus Disease 2019 Pandemic. JAMA Intern Med. 2021;181(4):562-565. doi:10.1001/jamainternmed.2020.7497
    https://pubmed.ncbi.nlm.nih.gov/33346795/
  • Sacks DW, Hollingsworth A, Nguyen T, Simon K. Can policy affect initiation of addictive substance use? Evidence from opioid prescribing. J Health Econ. 2021;76:102397. doi:10.1016/j.jhealeco.2020.102397
    https://pubmed.ncbi.nlm.nih.gov/33383263/
  • Nguyen T, Muench U, Andraka-Christou B, Simon K, Bradford WD, Spetz J. The Association Between Scope of Practice Regulations and Nurse Practitioner Prescribing of Buprenorphine After the 2016 Opioid Bill. Med Care Res Rev. 2022;79(2):290-298. doi:10.1177/10775587211004311
    https://pubmed.ncbi.nlm.nih.gov/33792414/
  • Nguyen T, Cantor J, Andraka-Christou B, Bradford WD, Simon K. Where did the specialty behavioral health workforce grow between 2011 and 2019? Evidence from census data. J Subst Abuse Treat. 2021;130:108482. doi:10.1016/j.jsat.2021.108482
    https://pubmed.ncbi.nlm.nih.gov/34118714/
  • Nguyen T, Andraka-Christou B, Bradford WD, Simon K. Opting into the Public List of DATA-Waivered Practitioners: Variations by Specialty, Treatment Capacity, and Practitioner Characteristics. J Addict Med. 2022;16(3):e197-e202. doi:10.1097/ADM.0000000000000911
    https://pubmed.ncbi.nlm.nih.gov/34669615/ 

In the News