Rita Vandivort-Warren

Alcohol and opioid dependence medications: Prescription trends, overall and by physician specialty

Over the past decade, advances in addiction neurobiology have led to the approval of new medications to treat alcohol and opioid dependence. This study examined data from the IMS National Prescription Audit (NPA) Plus database of retail pharmacy transactions to evaluate trends in U.S. retail sales and prescriptions of FDA-approved medications to treat substance use disorders. Data reveal that prescriptions for alcoholism medications grew from 393,000 in 2003 (

Changes In US Spending On Mental Health And Substance Abuse Treatment, 1986–2005, And Implications For Policy

30 million in sales) to an estimated 720,000 (

Type of health insurance and the substance abuse treatment gap

78 million in sales) in 2007. The growth was largely driven by the introduction of acamprosate in 2005, which soon became the market leader (

An Analysis of the Slowdown in Growth of Spending for Psychiatric Drugs, 1986-2008

35 million in sales). Prescriptions for the two buprenorphine formulations increased from 48,000 prescriptions (

Mental Health and Substance Abuse Spending by Age, 2003

5 million in sales) in the year of their introduction (2003) to 1.9 million prescriptions (

Spending trends on substance abuse treatment under private employer-sponsored insurance, 2001-2009.

327 million in sales) in 2007. While acamprosate and buprenorphine grew rapidly after market entry, overall substance abuse retail medication sales remain small relative to the size of the population that could benefit from treatment and relative to sales for other medications, such as antidepressants. The extent to which substance dependence medications will be adopted by physicians and patients, and marketed by industry, remains uncertain.

Evidence for Substance Abuse Services and Policy Research A Systematic Review of National Databases

The United States invests a sizable amount of money on treatments for mental health and substance abuse:

Factors affecting detoxification readmission: Analysis of public sector data from three states

135 billion in 2005, or 1.07 percent of the gross domestic product. We provide treatment spending estimates from the period 1986-2005 to build understanding of past trends and consider future possibilities. We find that the growth rate in spending on mental health medications-a major driver of mental health expenditures in prior years-declined dramatically. As a result, mental health and substance abuse spending grew at a slightly slower rate than gross domestic product in 2004 and 2005, and it continued to shrink as a share of all health spending. Of note, we also find that Medicaids share of total spending on mental health grew from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. The recent recession, the full implementation of federal parity law, and such health reform-related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and substance abuse treatment and to alter spending patterns further. Our spending estimates provide an important context for evaluating the effect of those policies.

U.S. spending for mental health and substance abuse treatment, 1991-2001.

OBJECTIVE Most individuals reporting symptoms consistent with substance use disorders do not receive care. This study examines the correlation between type of insurance coverage and receipt of substance abuse treatment, controlling for other observable factors that may influence treatment receipt. METHOD Descriptive and multivariate analyses are conducted using pooled observations from the 2002-2007 editions of the National Survey on Drug Use and Health. The likelihood of treatment entry is estimated by type of insurance coverage controlling for personal characteristics and characteristics of the individuals substance use disorder. RESULTS Multivariate analyses that control for type of substance and severity of disorder (dependence vs. abuse) find that those with Civilian Health and Medical Program of the Uniformed Services/Veterans Affairs, Medicaid only, Medicare only, and Medicare and Medicaid (dual eligibles) have 50% to almost 90% greater odds of receiving treatment relative to those with private insurance. CONCLUSIONS The privately insured population has substantially lower treatment entry rates than those with publicly provided insurance. Additional research is warranted to understand the source of the differences across insurance types so that improvements can be achieved.

Trends In Spending For Substance Abuse Treatment, 1986–2003

OBJECTIVE This study analyzed recent trends in spending on psychiatric prescription drugs and underlying factors that served as drivers of these changes. METHODS Data were collected from the MarketScan Commercial Claims and Encounters Database (1997-2008), Substance Abuse and Mental Health Services Administration spending estimates (1986-2005), and the Medical Expenditure Panel Survey (1997-2007). The trends in medication spending derived from the data were decomposed into three categories: percentage of enrollees who used psychiatric medications, days supplied per user, and cost per day supplied. RESULTS The average annual rate of growth in expenditures per enrollee slowed from 18.5% in 1997-2001 to 6.3% in 2001-2008. A decline in the growth rate of cost per day supplied, from 8% to 2%, accounted for 49% of the overall decline in spending growth, and a decline in the growth of the percentage of enrollees who used medication, from 7% to 2%, contributed 41% to the overall decline. There was a smaller change in days supplied per user, from 3% to 2%, that contributed 10% to the overall decline. The increased entry of generic medications, which constituted 70% of all psychiatric prescriptions by 2008, particularly generic antidepressants, was a key contributor to the slower growth in costs. CONCLUSIONS Past high growth in psychiatric drug spending arising from growth in utilization of branded medications has declined significantly, which may have implications for access and new product investment.