Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study

Marguerite Burns, Lu Tang, Chung Chou H. Chang, Joo Yeon Kim, Katherine Ahrens, Lindsay Allen, Peter Cunningham, Adam J. Gordon, Marian P. Jarlenski, Paul Lanier, Rachel Mauk, Mary Joan McDuffie, Shamis Mohamoud, Jeffery Talbert, Kara Zivin, Julie Donohue

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background and aims: Medication for opioid use disorder (MOUD) reduces harms associated with opioid use disorder (OUD), including risk of overdose. Understanding how variation in MOUD duration influences overdose risk is important as health-care payers increasingly remove barriers to treatment continuation (e.g. prior authorization). This study measured the association between MOUD continuation, relative to discontinuation, and opioid-related overdose among Medicaid beneficiaries. Design: Retrospective cohort study using landmark survival analysis. We estimated the association between treatment continuation and overdose risk at 5 points after the index, or first, MOUD claim. Censoring events included death and disenrollment. Setting and participants: Medicaid programs in 11 US states: Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia and Wisconsin. A total of 293 180 Medicaid beneficiaries aged 18–64 years with a diagnosis of OUD and had a first MOUD claim between 2016 and 2017. Measurements: MOUD formulations included methadone, buprenorphine and naltrexone. We measured medically treated opioid-related overdose within claims within 12 months of the index MOUD claim. Findings: Results were consistent across states. In pooled results, 5.1% of beneficiaries had an overdose, and 67% discontinued MOUD before an overdose or censoring event within 12 months. Beneficiaries who continued MOUD beyond 60 days had a lower relative overdose hazard ratio (HR) compared with those who discontinued by day 60 [HR = 0.39; 95% confidence interval (CI) = 0.36–0.42; P < 0.0001]. MOUD continuation was associated with lower overdose risk at 120 days (HR = 0.34; 95% CI = 0.31–0.37; P < 0.0001), 180 days (HR = 0.31; 95% CI = 0.29–0.34; P < 0.0001), 240 days (HR = 0.29; 95% CI = 0.26–0.31; P < 0.0001) and 300 days (HR = 0.28; 95% CI = 0.24–0.32; P < 0.0001). The hazard of overdose was 10% lower with each additional 60 days of MOUD (95% CI = 0.88–0.92; P < 0.0001). Conclusions: Continuation of medication for opioid use disorder (MOUD) in US Medicaid beneficiaries was associated with a substantial reduction in overdose risk up to 12 months after the first claim for MOUD.

Original languageEnglish
Pages (from-to)3079-3088
Number of pages10
JournalAddiction
Volume117
Issue number12
DOIs
StatePublished - Dec 2022

Bibliographical note

Funding Information:
This study was supported by grant R01 DA048029 from the National Institute on Drug Abuse (J. D., L. A., M. B., P. C., R. M., J. T., K. Z., S. M.). L. T. acknowledges support from the University of Pittsburgh Public Health Endowment Fund. K. A. received support from a Maine Department of Health cooperative agreement for this work. We gratefully acknowledge the following colleagues, Catherine McGuire BS at the University of Southern Maine, David Jorgenseon MS from the Maine Department of Health and Human Services, Elizabeth Brown MD, Chief Medical Officer and Dara Hall, Maternal Child Health Clinical Lead from the Division of Medicaid and Medical Assistance, Delaware Department of Health and Social Services. Aimee Mack and Dushka Crane provided assistance with the data production and validation of Ohio data. In Michigan, Sarah Clark and Lisa Cohn conducted analyses. Kristen Voskuil constructed the analytical data set and conducted analyses in Wisconsin.

Funding Information:
This study was supported by grant R01 DA048029 from the National Institute on Drug Abuse (J. D., L. A., M. B., P. C., R. M., J. T., K. Z., S. M.). L. T. acknowledges support from the University of Pittsburgh Public Health Endowment Fund. K. A. received support from a Maine Department of Health cooperative agreement for this work. We gratefully acknowledge the following colleagues, Catherine McGuire BS at the University of Southern Maine, David Jorgenseon MS from the Maine Department of Health and Human Services, Elizabeth Brown MD, Chief Medical Officer and Dara Hall, Maternal Child Health Clinical Lead from the Division of Medicaid and Medical Assistance, Delaware Department of Health and Social Services. Aimee Mack and Dushka Crane provided assistance with the data production and validation of Ohio data. In Michigan, Sarah Clark and Lisa Cohn conducted analyses. Kristen Voskuil constructed the analytical data set and conducted analyses in Wisconsin.

Publisher Copyright:
© 2022 Society for the Study of Addiction.

Keywords

  • Distributed research network
  • Medicaid
  • landmark survival analysis
  • medication
  • opioid use disorder
  • opioid-related overdose

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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