Duration of Medication Treatment for Opioid-Use Disorder and Risk of Overdose among Medicaid Enrollees in Eleven States: A Retrospective Cohort Study
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Author/Creator ORCID
Date
2022-06-02
Type of Work
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Citation of Original Publication
Burns, Marguerite, Lu Tang, Chung-Chou H. Chang, Joo Yeon Kim, Katherine Ahrens, Lindsay Allen, Peter Cunningham, et al. “Duration of Medication Treatment for Opioid-Use Disorder and Risk of Overdose among Medicaid Enrollees in 11 States: A Retrospective Cohort Study.” Addiction 117, no. 12 (2022): 3079–88. https://doi.org/10.1111/add.15959.
Rights
This is the peer reviewed version of the following article: Burns, Marguerite, Lu Tang, Chung-Chou H. Chang, Joo Yeon Kim, Katherine Ahrens, Lindsay Allen, Peter Cunningham, et al. “Duration of Medication Treatment for Opioid-Use Disorder and Risk of Overdose among Medicaid Enrollees in 11 States: A Retrospective Cohort Study.” Addiction 117, no. 12 (2022): 3079–88. https://doi.org/10.1111/add.15959., which has been published in final form at https://doi.org/10.1111/add.15959. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Subjects
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.