Below is a nursing research article critique on opioid treatment.
Research Article: Ronquest, N. A., Wilson, T. M., Montejano, L. B., Nadipelli, V. R., & Wollschlaeger, B. A. (2018). Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder. Substance Abuse & Rehabilitation, 9, 59-78. doi: 10.2147/SAR.S150253.
Review: Other Nursing Research Article Critiques
Nursing Research Article Critique: Opioid Treatment
I. Introduction
The shift towards opioids for pain management led to a dramatic increase in prescription opioid production and consequently an increase in misuse, addiction, and overdose. Opioid abuse has become a public health crisis. According to the National Institute on Drug Abuse (2019), about 21 to 29 percent of patients prescribed opioids for chronic pain misuse them and 4 to 6 percent of those misusers later transition to heroin. The Center for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (Florence, Zhou, Luo & Xu 2016).
II. Problem Statement and Significance
Treatment of opioid use disorder (OUD) poses many challenges including relapse, psychiatric and medical comorbidities, increased risk of infection with blood-borne pathogens such as Hepatitis C and HIV, and the disproportionate impact on those in socioeconomically disadvantaged areas. Medication-assisted treatment (MAT) using drugs such as methadone or buprenorphine in combination with various therapies have been shown to improve outcomes. According to Connery (2015), “it significantly augments treatment retention, reduces illicit opioid use, reduces the burden of opioid craving, and, in the case of agonist therapies, provides effective relief of the opioid withdrawal syndrome” (p. 69). These treatments, however are not without their side effects. In addition, buprenorphine and methadone are known to be diverted by patients and to be commonly used illicitly, resulting in further opioid misuse and overdoses, in accidental pediatric exposures, and in adolescent exposures (Connery, 2015).
III. Objectives
- The objective is to examine the benefits and risks of medication assisted treatment (MAT) in the opioid addicted adult population and determine whether adherence to drugs such as buprenorphine reduces relapse, healthcare costs, and other negative consequences.
- It is also important to examine the side effects of MAT and effect on overall quality of life.
IV. Search for Relevant Evidence
To start the process of searching for evidence, we looked for peer-reviewed articles on medication-assisted treatment for opioid using Wagner library. The databases used for this search included EBSCO, CINAHL and Google scholar. We were able to browse through articles that were relevant to our topic using the search tips. First, we narrowed down the search by only choosing peer-reviewed articles. We typed ‘medication-assisted treatment’, and this search returned about 3418 peer-reviewed articles. While changing the keyword to ‘opioid use’, the search results were around 43,026. This further increased the number of results. Then we used the keyword ‘medication-assisted treatment for opioid,’ which narrowed the scope to 1377 articles. Furthermore, we searched ‘the effects of medication-assisted treatment,’ and the results decreased to 969 articles. Search criteria to language and articles within five years was applied. It was difficult to find a quantitative study based in the United States, so the search was further narrowed by country of origin. We selected the option full-text to avoid the frustration of locating the full-text article. Keywords such as ‘medication-assisted treatment’, ‘opioid’, ‘methadone’, ‘buprenorphine’, and ‘naltrexone’ were used to find results.
V. Critique of the Study’s Research Question
In regard to the research question, the article does not explicitly state one. Similarly, the authors do not expressly mention the hypothesis of the study. Nonetheless, the article implicitly infers that a relation exists between health care costs and buprenorphine adherence and relapse among patients taking this medicine. Furthermore, the research design is in congruence with the hypothesis since they are aligned with the primary objective of the study. Consequently, such research studies should consider including a clearly defined research question and hypothesis.
VI. Literature Review: Critical Appraisal and Analysis
In the article, “Relationship between Buprenorphine Adherence and Relapse, Health Care Utilization and Costs in Privately and Publicly Insured Patients with Opioid Use Disorder,” Ronquest, Wilson, Montejano, Nadipelli, and Wollschlaeger contend that treating opioid use disorder is highly important due to the negative consequences that certain addictive drugs may cause to the patient’s overall quality of life (2018, p. 60). However, the authors posit that adherence to opioid treatment is a challenge. In this regard, the study investigated the relationship between buprenorphine medical-assisted treatment (MAT) adherence and relapse, as well as the associated health care costs. The findings of the research established that adherence to the buprenorphine MAT was linked with the decreased unadjusted health care costs and reduced relapse probability.
VII. Critique of the Study’s Research Design
The authors used a quantitative approach to conduct the research. The data used in the study was majorly drawn from employers and health insurance plans covering the employees. More specifically, the data was obtained from the Medicaid database, commercial claims, and encounters database. As a result, Ronquest et al. obtained information on cost, utilization, and health care outcomes for services provided to inpatient and outpatient clients (2018, p. 61). Notably, outpatient pharmacies that handle retail and mail orders were included in the data. The sampling criteria corresponded to the research design since the study featured patients with at least one buprenorphine prescription claim between 2008 and 2014. Ronquest et al. state that the sample eligibility criteria required patients to have been diagnosed with opioid use disorder through receiving either inpatient or outpatient care (2018, p. 60).
VIII. Critique of the Study’s Findings
The findings of the study were analyzed using statistical methods. The research employed various statistical tests, including t-tests and Chi-squared tests. To eliminate selection bias, the study used a random sample of patients aged over 12 years that are or were subjected to opioid treatment. According to Melnyk and Fineout-Overholt, a researcher ought to use credible scientific methods when generating results of the study to prevent any bias in the findings (2018, p. 132). The participants were grouped into privately and publically insured patients and further organized as addicted and non-addicted in accordance with the number of days during which the person was taking the drug. Subsequently, the non-adherence and adherence results of both the commercial sample and Medicaid sample were cross-analyzed with the relapse prevalence and health care utilization and costs. The findings established that the buprenorphine adherence rate was low, accounting for 41 percent of privately insured patients and 37 percent of the second group, with a PDC rate of ≥0.80 as the statistical reference category for comparison (Ronquest et al. (2018, p. 63). On the contrary, adherence was linked with a decrease in health care costs and relapse prevalence for both Medicaid and commercial patients. The reliability of the study results is based on the statistical tests use to determine the numerical significance in the PDC rates.
References
Appendix: Evidence Summary Table
| Article | Author & Date | Evidence Type | Study findings that help answer the EBP question | Limitations |
| #1. | HS Connery, 2015 | Quantitative | This article explains the medication-assisted treatment of opioid use disorder together with psychological dependence. In addition, it uses the current evidence reviews of medication-assisted treatment of opioid disorders while presenting the clinical practice imperatives which are applied in preventing an overdose of opioid and prevention of transmission of infectious diseases. Moreover, the article supports the application of agonist therapies in order to reduce opioid use since it also helps in retaining patients in treatment with the methadone which in turn ensures the gold standard of care. Consequently, the article explained the individualized treatment and population management which is used in the selection of available Food and Drug Administration and the approved maintenance therapies used in handling the opioid disorder. | The article, however, fails to explain that the use of methadone and buprenorphine maintenance will reduce the use of illicit opioids as well as increase the risks of HIV transmission through the use of injections drugs though the impacts of the methadone and buprenorphine have fewer impacts on their sexual behaviors. In addition, there is variability regarding the treatment outcomes that are measured in the studies which denote a challenge in the synthesis of the contents. The article also has paucity in the outcome of patients as reported in clinical trials which test the effectiveness of treatment of the opioid disorder. |
| #2. | C Florence, F Luo, L Xu, C Zhou, 2016 | Quantitative | This article describes the various adverse health impacts emanating from the misuse of opioids prescriptions. Fatal prescriptions drugs overdose is denoted as an epidemic in the Centers for Disease Control and Prevention in the United States. In this regards, the decision-makers at Federal and State levels have come up with strategies to reduce the burden of the epidemic. Further, the article shows that the decision-makers, together with the healthcare sector, face financial constraints which need cost-efficient strategies. It is explained that an essential component in identification and prevention strategies is the cost since it helps in prioritizing the crucial health needs. The article also examined specific components from other studies pertaining to the overall use and misuse of opioids. These include poisoning and non-medical use. It also involves the abuse of opioids. | The article did not differentiate between prescription opioids and heroin since it is crucial to understand the differences in healthcare spending. This will help in understanding those with abuse and those with dependence as well as those without. The article thus biases the results in case the prescription opioid abuse or dependence in heroine has impacts on healthcare spending. The implication therefore is that the conclusion of the article is also biased and thus not suitable for use in making decisions regarding the treatment of opioids. |
| #3. | Maglione, M. A., Raaen, L., Chen, C., Azhar, G., Shahidinia, N., Shen, M., … Hempel, S. 2018 | Quantitative | This article reviews the synthesized article pertaining to the effects of Medication-Assisted Treatment for the use of opioids on the functional outcomes. It is denoted that opioid misuse has tremendously increased since the year 2000. By the year 2014, over 28,000 individuals have died due to overdose of an opioid. The evidence-based treatment for the opioid use disorder entails the medication-assisted treatment together with the use of approved medication with counseling combined. In addition, it is described that the medications approved in the united states for the Medication-Assisted Treatment include methadone; buprenorphine combines with the naloxone and naltrexone. | This article has numerous limitations which include the quality of evidence used for the functional outcome being rates low and very low. This implies that the weakness in the body of the evidence prevented the establishment of a strong conclusion pertaining to the effects of Medication-Assisted Treatment for opioid use disorders on functional outcomes. In this regards, the rigorous studies of the functional effects would help in strengthening the body of the literature. |
| #4. | National Institute on Drug Abuse, 2019 | Quantitative | This journal describes that in the 1990s, the pharmaceutical companies reassured the medical community that the patients would not become addicted to the opioid since the prescriptions are done at high rates. However, the misuses of opioids increased in 2017 with more than 47,000 Americans dying due to such abuse. Additionally, it is described that roughly twenty-seven per cent of the patients who are prescribed opioids misuse them. Further, it is described that approximately ten percent of the patients develop opioids disorders which imply that they misuse them until it affects them adversely. The Midwestern region is shown to have seen an increase in overdose by seventy percent as recorded in July 2016 through September 2017. | This journal, however, is weak since most of its findings is an approximation. The impacts of opioids and the abuse are approximated which shows that no thorough research was carried out. In this regards, the conclusion will not be factual since the required research was not done and this impacting the authenticity of the conclusion. |
| #5. | Ronquest, N. A., Wilson, T. M., Montejano, L. B., Nadipelli, V. R., & Wollschlaeger, 2018 | Quantitative | This book explains that the misuse of opioids is a growing public health concern. It is estimated that about two million individuals who are aged twelve years or older met the criteria for an opioid user disorder which involves the prescriptions as pain relievers. The book further explains that treatment for an opioid is crucial since there are adverse consequences linked to the use of illicit opioids. Treating opioid, however, is depicted to be challenging since it is chronic and mostly characterized by the episodes of relapse as well as remission. In essence, the most used effective treatment for an opioid is the Medication-Assisted Treatment and Buprenorphine. This treatment, however, is limited in some states and waivered to the physicians under the scope of practice laws. | The study conflicts with the Medicaid in the intuitive association between the buprenorphine adherence and most importantly the better outcomes which can lead to reduced health costs. It is in conflicts since when compared with the total costs distribution among the Medicare patients, it is denoted that the cost variation within the group is inconsiderably higher. This, therefore, implies that Medicaid patients are more heterogeneous group and involve the patients having multiple preexisting morbidities. |