Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs

Anna E. Austin; Lu Tang; Joo Yeon Kim; Lindsay Allen; Andrew J. Barnes; Chung Chou H. Chang; Sarah Clark; Evan S. Cole; Christine Piette Durrance; Julie M. Donohue; Adam J. Gordon; Haiden A. Huskamp; Mary Joan McDuffie; Ateev Mehrotra; Shamis Mohamoud; Jeffery Talbert; Katherine A. Ahrens; Mary Applegate; Lindsey R. Hammerslag; Paul Lanier; Krystel Tossone; Kara Zivin; Marguerite E. Burns

doi:10.1001/jamahealthforum.2023.1422

Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs

Anna E. Austin, Lu Tang, Joo Yeon Kim, Lindsay Allen, Andrew J. Barnes, Chung Chou H. Chang, Sarah Clark, Evan S. Cole, Christine Piette Durrance, Julie M. Donohue, Adam J. Gordon, Haiden A. Huskamp, Mary Joan McDuffie, Ateev Mehrotra, Shamis Mohamoud, Jeffery Talbert, Katherine A. Ahrens, Mary Applegate, Lindsey R. Hammerslag, Paul LanierKrystel Tossone, Kara Zivin, Marguerite E. Burns

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Importance: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results: Among a total of 8167497 Medicaid enrollees before the PHE and 8181144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100000 enrollees in March 2020 to 171.8 per 100000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100000 enrollees in March 2020 to 21.1 per 100000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth..

Original language	English
Pages (from-to)	E231422
Journal	JAMA Health Forum
Volume	4
Issue number	6
DOIs	https://doi.org/10.1001/jamahealthforum.2023.1422
State	Published - Jun 16 2023

Bibliographical note

Funding Information:
Funding/Support: This study was supported by grants R01 DA048533 (Drs Huskamp and Mehrotra) and 1 R01 DA048029-01 (Dr Donohue) from the NIDA. Dr Ahrens was supported for this work by a cooperative agreement between the University of Southern Maine and the Maine DHHS.

Funding Information:
Conflict of Interest Disclosures: Ms Kim reported receiving funding from the Pennsylvania Department of Human Services. Dr Chang reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving funding from the Pennsylvania Department of Human Services. Dr Cole reported having a contract with the Pennsylvania Department of Human Services and receiving consulting fees from AcademyHealth during the conduct of the study. Dr Donohue reported having an intergovernmental agreement with the Pennsylvania Department of Human Services outside the submitted work. Dr Gordon reported receiving grants from the NIH, the Department of Veterans Affairs, and the US Department of Health and Human Services (DHHS) during the conduct of the study; receiving honorarium from UpToDate submitted work; and being an unpaid member of the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction Journal Editors. Ms McDuffie reported receiving funding from the Delaware Division of Medicaid and Medical Assistance during the conduct of the study. Dr Mehrotra reported receiving grants from the NIH during the conduct of the study and receiving grants from The Commonwealth Fund and personal fees from the NORC, the Commonwealth of Massachusetts, Sanofi Pasteur, The Pew Charitable Trusts, and Black Opal Ventures outside the submitted work. No other disclosures were reported.

Publisher Copyright:
© 2023 American Medical Association. All rights reserved.

ASJC Scopus subject areas

Health Policy
Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1001/jamahealthforum.2023.1422

Cite this

Austin, A. E., Tang, L., Kim, J. Y., Allen, L., Barnes, A. J., Chang, C. C. H., Clark, S., Cole, E. S., Durrance, C. P., Donohue, J. M., Gordon, A. J., Huskamp, H. A., McDuffie, M. J., Mehrotra, A., Mohamoud, S., Talbert, J., Ahrens, K. A., Applegate, M., Hammerslag, L. R., ... Burns, M. E. (2023). Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs. JAMA Health Forum, 4(6), E231422. https://doi.org/10.1001/jamahealthforum.2023.1422

@article{45ad1d6ee01f49fca812da6b8e8838f8,

title = "Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs",

abstract = "Importance: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results: Among a total of 8167497 Medicaid enrollees before the PHE and 8181144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100000 enrollees in March 2020 to 171.8 per 100000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100000 enrollees in March 2020 to 21.1 per 100000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth..",

author = "Austin, {Anna E.} and Lu Tang and Kim, {Joo Yeon} and Lindsay Allen and Barnes, {Andrew J.} and Chang, {Chung Chou H.} and Sarah Clark and Cole, {Evan S.} and Durrance, {Christine Piette} and Donohue, {Julie M.} and Gordon, {Adam J.} and Huskamp, {Haiden A.} and McDuffie, {Mary Joan} and Ateev Mehrotra and Shamis Mohamoud and Jeffery Talbert and Ahrens, {Katherine A.} and Mary Applegate and Hammerslag, {Lindsey R.} and Paul Lanier and Krystel Tossone and Kara Zivin and Burns, {Marguerite E.}",

note = "Funding Information: Funding/Support: This study was supported by grants R01 DA048533 (Drs Huskamp and Mehrotra) and 1 R01 DA048029-01 (Dr Donohue) from the NIDA. Dr Ahrens was supported for this work by a cooperative agreement between the University of Southern Maine and the Maine DHHS. Funding Information: Conflict of Interest Disclosures: Ms Kim reported receiving funding from the Pennsylvania Department of Human Services. Dr Chang reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving funding from the Pennsylvania Department of Human Services. Dr Cole reported having a contract with the Pennsylvania Department of Human Services and receiving consulting fees from AcademyHealth during the conduct of the study. Dr Donohue reported having an intergovernmental agreement with the Pennsylvania Department of Human Services outside the submitted work. Dr Gordon reported receiving grants from the NIH, the Department of Veterans Affairs, and the US Department of Health and Human Services (DHHS) during the conduct of the study; receiving honorarium from UpToDate submitted work; and being an unpaid member of the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction Journal Editors. Ms McDuffie reported receiving funding from the Delaware Division of Medicaid and Medical Assistance during the conduct of the study. Dr Mehrotra reported receiving grants from the NIH during the conduct of the study and receiving grants from The Commonwealth Fund and personal fees from the NORC, the Commonwealth of Massachusetts, Sanofi Pasteur, The Pew Charitable Trusts, and Black Opal Ventures outside the submitted work. No other disclosures were reported. Publisher Copyright: {\textcopyright} 2023 American Medical Association. All rights reserved.",

year = "2023",

month = jun,

day = "16",

doi = "10.1001/jamahealthforum.2023.1422",

language = "English",

volume = "4",

pages = "E231422",

number = "6",

}

Austin, AE, Tang, L, Kim, JY, Allen, L, Barnes, AJ, Chang, CCH, Clark, S, Cole, ES, Durrance, CP, Donohue, JM, Gordon, AJ, Huskamp, HA, McDuffie, MJ, Mehrotra, A, Mohamoud, S, Talbert, J, Ahrens, KA, Applegate, M, Hammerslag, LR, Lanier, P, Tossone, K, Zivin, K & Burns, ME 2023, 'Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs', JAMA Health Forum, vol. 4, no. 6, pp. E231422. https://doi.org/10.1001/jamahealthforum.2023.1422

TY - JOUR

T1 - Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs

AU - Austin, Anna E.

AU - Tang, Lu

AU - Kim, Joo Yeon

AU - Allen, Lindsay

AU - Barnes, Andrew J.

AU - Chang, Chung Chou H.

AU - Clark, Sarah

AU - Cole, Evan S.

AU - Durrance, Christine Piette

AU - Donohue, Julie M.

AU - Gordon, Adam J.

AU - Huskamp, Haiden A.

AU - McDuffie, Mary Joan

AU - Mehrotra, Ateev

AU - Mohamoud, Shamis

AU - Talbert, Jeffery

AU - Ahrens, Katherine A.

AU - Applegate, Mary

AU - Hammerslag, Lindsey R.

AU - Lanier, Paul

AU - Tossone, Krystel

AU - Zivin, Kara

AU - Burns, Marguerite E.

N1 - Funding Information: Funding/Support: This study was supported by grants R01 DA048533 (Drs Huskamp and Mehrotra) and 1 R01 DA048029-01 (Dr Donohue) from the NIDA. Dr Ahrens was supported for this work by a cooperative agreement between the University of Southern Maine and the Maine DHHS. Funding Information: Conflict of Interest Disclosures: Ms Kim reported receiving funding from the Pennsylvania Department of Human Services. Dr Chang reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and receiving funding from the Pennsylvania Department of Human Services. Dr Cole reported having a contract with the Pennsylvania Department of Human Services and receiving consulting fees from AcademyHealth during the conduct of the study. Dr Donohue reported having an intergovernmental agreement with the Pennsylvania Department of Human Services outside the submitted work. Dr Gordon reported receiving grants from the NIH, the Department of Veterans Affairs, and the US Department of Health and Human Services (DHHS) during the conduct of the study; receiving honorarium from UpToDate submitted work; and being an unpaid member of the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction Journal Editors. Ms McDuffie reported receiving funding from the Delaware Division of Medicaid and Medical Assistance during the conduct of the study. Dr Mehrotra reported receiving grants from the NIH during the conduct of the study and receiving grants from The Commonwealth Fund and personal fees from the NORC, the Commonwealth of Massachusetts, Sanofi Pasteur, The Pew Charitable Trusts, and Black Opal Ventures outside the submitted work. No other disclosures were reported. Publisher Copyright: © 2023 American Medical Association. All rights reserved.

PY - 2023/6/16

Y1 - 2023/6/16

N2 - Importance: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results: Among a total of 8167497 Medicaid enrollees before the PHE and 8181144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100000 enrollees in March 2020 to 171.8 per 100000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100000 enrollees in March 2020 to 21.1 per 100000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth..

AB - Importance: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results: Among a total of 8167497 Medicaid enrollees before the PHE and 8181144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100000 enrollees in March 2020 to 171.8 per 100000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100000 enrollees in March 2020 to 21.1 per 100000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth..

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Trends in Use of Medication to Treat Opioid Use Disorder during the COVID-19 Pandemic in 10 State Medicaid Programs

Abstract

Bibliographical note

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