Association of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder

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dc.contributor.authorSmart, Rosanna
dc.contributor.authorKim, Joo Yeon
dc.contributor.authorKennedy, Susan
dc.contributor.authorTang, Lu
dc.contributor.authorAllen, Lindsay
dc.contributor.authorCrane, Dushka
dc.contributor.authorMack, Aimee
dc.contributor.authorMohamoud, Shamis
dc.contributor.authorPauly, Nathan
dc.contributor.authorPerez, Rosa
dc.contributor.authorDonohue, Julie
dc.date.accessioned2024-01-03T21:02:27Z
dc.date.available2024-01-03T21:02:27Z
dc.date.issued2022-10-31
dc.description.abstractIntroduction: The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention. Methods: Using Medicaid data for 2017–2018 from four states participating in a distributed research network, this retrospective cohort study documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and assesses the extent to which different SUD presentations are associated with differential patterns of MOUD and psychosocial treatments. Results: We find that more than half of enrollees with OUD had a co-occurring SUD, and the most prevalent co-occurring SUD was for “other psychoactive substances”, indicated among about one-quarter of enrollees with OUD in each state. We also find some substantial gaps in MOUD treatment receipt and engagement for individuals with OUD and a co-occurring SUD, a group representing more than half of individuals with OUD. In most states, enrollees with OUD and alcohol, cannabis, or amphetamine use disorder are significantly less likely to receive MOUD compared to enrollees with OUD only. In contrast, enrollees with OUD and other psychoactive SUD were significantly more likely to receive MOUD treatment. Conditional on MOUD receipt, enrollees with co-occurring SUDs had 10 % to 50 % lower odds of having a 180-day period of continuous MOUD treatment, an important predictor of better patient outcomes. Associations with concurrent receipt of MOUD and behavioral counseling were mixed across states and varied depending on co-occurring SUD type. Conclusions: Overall, ongoing progress toward increasing access to and quality of evidence-based treatment for OUD requires further efforts to ensure that individuals with co-occurring SUDs are engaged and retained in effective treatment. As the opioid crisis evolves, continued changes in drug use patterns and populations experiencing harms may necessitate new policy approaches that more fully address the complex needs of a growing population of individuals with OUD and other types of SUD.
dc.description.sponsorshipThis work was supported by the National Institute on Drug Abuse (R01DA048029) and a contract from the Medicaid and CHIP Payment and Advisory Commission (MACPAC).
dc.description.urihttps://www.sciencedirect.com/science/article/abs/pii/S0740547222002033?via%3Dihub
dc.format.extent24 pages
dc.genrejournal articles
dc.genrepostprints
dc.identifier.citationSmart, Rosanna, Joo Yeon Kim, Susan Kennedy, Lu Tang, Lindsay Allen, Dushka Crane, Aimee Mack, et al. “Association of Polysubstance Use Disorder with Treatment Quality among Medicaid Beneficiaries with Opioid Use Disorder.” Journal of Substance Abuse Treatment 144 (January 1, 2023): 108921. https://doi.org/10.1016/j.jsat.2022.108921.
dc.identifier.urihttps://doi.org/10.1016/j.jsat.2022.108921
dc.identifier.urihttp://hdl.handle.net/11603/31169
dc.language.isoen_US
dc.publisherElsevier
dc.relation.isAvailableAtThe University of Maryland, Baltimore County (UMBC)
dc.relation.ispartofA. All Hilltop Institute (UMBC) Works
dc.relation.ispartofUMBC Staff Collection
dc.relation.ispartofE. Behavioral Health (The Hilltop Institute, UMBC)
dc.rightsThis item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
dc.rightsCC BY-NC-ND 4.0 DEED Attribution-NonCommercial-NoDerivs 4.0 International en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.titleAssociation of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder
dc.typeText

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