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

Marguerite Burns, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, MadisonFollow
Lu Tang, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
Chung-Chou H. Chang, Department of Medicine, School of Medicine, University of Pittsburgh,
Joo Yeon Kim, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh
Katherine A. Aherns MPH, PhD, Muskie School of Public Service, University of Southern Maine
Lindsay Allen, Health Policy, Management and Leadership Department, School of Public Health, West Virginia University, Morgantown
Peter Cunningham, Health Behavior and Policy Department, School of Medicine, Virginia Commonwealth University, Richmond
Adam J. Gordon, Department of Medicine and Department of Psychiatry, School of Medicine, University of Utah, Salt Lake City
Marian P. Jarlenski, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
Paul Lanier, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
Rachel Mauk, School of Social Work, University of North Carolina at Chapel Hill
Mary Joan McDuffie, Government Resource Center, Ohio Colleges of Medicine, The Ohio State University, Columbus,
Jeffery Talbert, Hilltop Institute, University of Maryland Baltimore County, Baltimore
Kara Zivin, Division of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington
Julie Donohue, Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh

Document Type

Article

Publication Date

12-2022

Publication Title

Addiction, Volume117, Issue12 December 2022 Pages 3079-3088

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.

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