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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dc.contributor.authorBurns, Marguerite
dc.contributor.authorTang, Lu
dc.contributor.authorChang, Chung-Chou H.
dc.contributor.authorKim, Joo Yeon
dc.contributor.authorAhrens, Katherine
dc.contributor.authorAllen, Lindsay
dc.contributor.authorCunningham, Peter
dc.contributor.authorGordon, Adam J.
dc.contributor.authorJarlenski, Marian P.
dc.contributor.authorLanier, Paul
dc.contributor.authorMauk, Rachel
dc.contributor.authorMcDuffie, Mary Joan
dc.contributor.authorMohamoud, Shamis
dc.contributor.authorTalbert, Jeffery
dc.contributor.authorZivin, Kara
dc.contributor.authorDonohue, Julie
dc.date.accessioned2024-01-03T21:04:09Z
dc.date.available2024-01-03T21:04:09Z
dc.date.issued2022-06-02
dc.description.abstractBackground 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.
dc.description.sponsorshipNational Institute on Drug Abuse, R01 DA048029 (PI: Donohue)
dc.description.urihttps://onlinelibrary.wiley.com/doi/10.1111/add.15959
dc.format.extent20 pages
dc.genrejournal articles
dc.genrepostprints
dc.identifier.citationBurns, 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.
dc.identifier.urihttps://doi.org/10.1111/add.15959
dc.identifier.urihttp://hdl.handle.net/11603/31176
dc.language.isoen_US
dc.publisherWiley
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 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.
dc.titleDuration of Medication Treatment for Opioid-Use Disorder and Risk of Overdose among Medicaid Enrollees in Eleven States: A Retrospective Cohort Study
dc.typeText

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