Rebecca Bilden

All Publications

• Private Equity Acquiring Large Shares Of The Opioid Treatment Market Without Changing Market-Level Methadone Supply HEALTH AFFAIRS Singh, Y., Cantor, J., Whaley, C. M., Shuey, B., Bilden, R., Donahoe, J. 2025; 44 (9): 1181-1189

  Abstract

  Private equity (PE) acquisitions of opioid treatment programs (OTPs) are growing, with the potential to expand access to methadone, a critical yet underused medication that can cut the risk for overdose deaths by more than half. At the same time, PE's emphasis on short-term profitability has raised concerns from policy makers that PE acquisitions can consolidate ownership of OTPs among financial firms without expanding access to treatment. Using a difference-in-differences design with novel data on PE acquisitions of OTPs and methadone shipments to all OTPs during the period 2006-19, this study examined the effects of PE acquisitions on methadone supply. PE firms acquired 67 percent of the OTP market in the median county with any acquisition, often through multiple acquisitions within the same county. After acquisition, methadone shipments to PE-acquired OTPs increased by 13 percent relative to matched controls, but this was not statistically significant after adjustment for differential preacquisition trends, indicating that the increase was not driven by the acquisition itself. County-level methadone shipments and opioid mortality remained unchanged. Findings suggest that PE acquisitions of OTPs may consolidate ownership of OTPs among financial investors without changing methadone supply. Given policy makers' widespread call for increased supply, additional scrutiny of the impact of PE investment on patient access to methadone might be warranted.

  View details for DOI 10.1377/hlthaff.2025.00326

  View details for Web of Science ID 001567911000020

  View details for PubMedID 40893070

• Examining the Impact of Eliminating the X Waiver on Buprenorphine Dispensation in 63 Counties in Pennsylvania SUBSTANCE USE & ADDICTION JOURNAL Bilden, R. C., Roberts, M. S., Stein, B. D., Jones, D. B. 2025; 46 (3): 503-509

  Abstract

  Opioid overdose rates continue to rise in the United States while access to treatment options remains limited. The X waiver, which allowed clinicians to prescribe buprenorphine, a medication for opioid use disorder (MOUD), in an outpatient setting, was eliminated in December 2022 with hopes of increasing buprenorphine access. We used a quasi-experimental approach to evaluate how eliminating the X waiver affected buprenorphine prescribing in Pennsylvania.Drawing on Pennsylvania Prescription Drug Monitoring Program data from July 1, 2016, to December 31, 2023, we used a difference-in-differences (DD) approach to assess changes in buprenorphine prescribing between Pennsylvania counties with the proportion of X-waivered providers per county population above the median versus counties with the proportion below the median, before and after the elimination of the X waiver. We also tested whether areas most affected by the opioid epidemic with the highest rates of opioid overdose were more impacted by the X-waiver elimination, using opioid overdose death rates from a pretreatment baseline period (2016-2018) for each county.Thirty-one counties were categorized as above the median and 32 as below the median. We did not observe a significant difference in the effects of eliminating the X waiver on buprenorphine dispensation (DD estimate: -0.6%, 95% CI: -7.5%-6.2%) between above versus below-the-median counties in Pennsylvania. We also did not find a significant effect of the X-waiver elimination on buprenorphine dispensation in counties most affected by the opioid epidemic (difference-in-difference-in-differences estimate 1.6%, 95% CI: -10.2%-13.4%).We found no evidence that eliminating the X waiver had a significant impact on buprenorphine dispensing in Pennsylvania in counties with fewer waivered prescribers or higher fatal overdose rates. Additional efforts to increase buprenorphine use will likely need to address systemic barriers and stigma limiting MOUD access.

  View details for DOI 10.1177/29767342241303583

  View details for Web of Science ID 001379067000001

  View details for PubMedID 39676259

• Global Collaboration Around Digital Mental Health: The LAMP Consortium. Journal of technology in behavioral science Bilden, R., Torous, J. 2022; 7 (2): 227-233

  Abstract

  Despite the great potential, there has been a lack of progress in the development of sharable and scalable tools for digital mental health due to difficulty in reproducibility and clinical application. The LAMP Platform was developed to address this gap by creating a single platform that works for a variety of clinical and research use cases. The study aims to understand how a consortium of clinical and research sites can help onboard, execute, and expand digital health research, software, and use cases. The Division of Digital Psychiatry implemented a formal consortium with goal of expanding the reach of mindLAMP as a digital mental health platform, enabling  diverse studies and expanded use cases, and supportint growth of mindLAMP and consortium members' research. The LAMP Consortium has brought together 54 sites from across the world, encouraging collaboration and idea sharing. These sites' locations range from the USA to the Czech Republic to Australia, and apply the many features of LAMP to research, clinical, research and clinical, and industry use. The most popular features were surveys, sharing/viewing data, and GPS passive data collection. A user support network is necessary to encourage research and clinical use of the LAMP Platform. Resources like documentation, an online forum, and newsletters are essential to promote cooperation between many types of sites that is essential to advancing the field of digital mental health.

  View details for DOI 10.1007/s41347-022-00240-y

  View details for PubMedID 35071742

  View details for PubMedCentralID PMC8764174

• Assessing mental health apps marketplaces with objective metrics from 29,190 data points from 278 apps ACTA PSYCHIATRICA SCANDINAVICA Lagan, S., D'Mello, R., Vaidyam, A., Bilden, R., Torous, J. 2021; 144 (2): 201-210

  Abstract

  Utilizing a standard framework that may help clinicians and patients to identify relevant mental health apps, we sought to gain a comprehensive picture of the space by searching for, downloading, and reviewing 278 mental health apps from both the iOS and Android stores.278 mental health apps from the Apple iOS store and Google Play store were downloaded and reviewed in a standardized manner by trained app raters using a validated framework. Apps were evaluated with this framework comprising 105 questions and covering app origin and accessibility, privacy and security, inputs and outputs, clinical foundation, features and engagement style, and interoperability.Our results confirm that app stars and downloads-even for the most popular apps by these metrics-did not correlate with more clinically relevant metrics related to privacy/security, effectiveness, and engagement. Most mental health apps offer similar functionality, with 16.5% offering both mood tracking and journaling and 7% offering psychoeducation, deep breathing, mindfulness, journaling, and mood tracking. Only 36.4% of apps were updated with a 100-day window, and 7.5% of apps had not been updated in four years.Current app marketplace metrics commonly used to evaluate apps do not offer an accurate representation of individual apps or a comprehensive overview of the entire space. The majority of apps overlap in terms of features offered, with many domains and other features not well represented. Selecting an appropriate app continues to require personal matching given no clear trends or guidance offered by quantitative metrics alone.

  View details for DOI 10.1111/acps.13306

  View details for Web of Science ID 000645469100001

  View details for PubMedID 33835483