A Population-Based Examination of Trends and Disparities in Medication Treatment for Opioid use Disorders among Medicaid Enrollees

Stein, Bradley D.; Dick, Andrew W.; Sorbero, Mark J.; Gordon, Adam J.; Burns, Rachel M.; Leslie, Douglas L.; Pacula, Rosalie Liccardo

doi:10.1080/08897077.2018.1449166

Cited by 97 publications

(77 citation statements)

References 48 publications

(62 reference statements)

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“…Interestingly, downward trends were noted for select subpopulations within the dataset, including non‐Hispanic whites, patients in higher household income brackets, and patients with private insurance. These findings are consistent with reports in existing literature, which have shown that the most significant increases in rate of medication‐based treatment for OUD occurred in counties with lower Hispanic and black populations . Higher and more rapidly increasing prevalence of opioid misuse–related emergency department visits have also been reported among patients 19 to 29 years of age .…”

Section: Discussionsupporting

confidence: 90%

“…These findings are consistent with reports in existing literature, which have shown that the most significant increases in rate of medication-based treatment for OUD occurred in counties with lower Hispanic and black populations. 27 Higher and more rapidly increasing prevalence of opioid misuse-related emergency department visits have also been reported among patients 19 to 29 years of age. 27 Additional reports also cite the highest prevalence among young adults.…”

Section: Discussionmentioning

confidence: 99%

“…27 Higher and more rapidly increasing prevalence of opioid misuse-related emergency department visits have also been reported among patients 19 to 29 years of age. 27 Additional reports also cite the highest prevalence among young adults. 24,28,29 Results also indicate that mean length of stay, provider interventional procedure rates, and discharge pathway remained stable from 2011 to 2015.…”

Section: Discussionmentioning

confidence: 99%

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Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

et al. 2019

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Background Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain. Methods The National Inpatient Sample (NIS) database identified chronic pain admissions with OUD from 2011 to 2015. Patients were identified from the NIS database using International Classification of Diseases (9th and 10th revisions) diagnosis codes for chronic pain and OUD. Annual estimates and trends were determined for OUD, patient characteristics, OUD among subgroups of chronic pain conditions, and discharge diagnosis. Results We identified 10.3 million patients with chronic pain. Of these, 680,631 patients were diagnosed with OUD. The number of patients with OUD increased from 109,222 in 2011 to 172,680 in 2015 (P < 0.001). Similarly, there were upward trends of OUD among females (53.2% to 54.5%; P = 0.09), patients 65 to 84 years of age (11.8% to 17%; P < 0.001), Medicare‐insured patients (39.5% to 46.0%; P < 0.01), patients with low annual household incomes (27.8% to 33.3%; P < 0.001), and patients with cannabinoid use disorder (7.2% to 8.3%; P = 0.01). The prevalence of OUD increased from 2011 to 2015 in patients with chronic regional pain syndrome (5.53% to 7.46%; P = 0.01) and spondylosis (1.32% to 1.81%; P < 0.001). Conclusions These findings suggest that the prevalence of OUD increased substantially from 2011 to 2015. Disparities of OUD with increasing opioid use among vulnerable populations including women, those with Medicare insurance, tobacco use disorder, and low annual income should be explored further.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

et al. 2019

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“…The administration of methadone at alternate locations could improve access in areas outside of the urban African American and Hispanic/Latino communities where these facilities are concentrated. 38 Beginning in 2017, nurse practitioners and physician assistants in the US were able to complete the waiver process to administer buprenorphine under the Comprehensive Addiction and Recovery Act. 39 Similar prescribing regulations in France resulted in increases in use of buprenorphine among people with OUD and large declines in opioid-involved overdose.…”

Section: Discussionmentioning

confidence: 99%

Association of Racial/Ethnic Segregation With Treatment Capacity for Opioid Use Disorder in Counties in the United States

et al. 2020

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IMPORTANCE Treatment with methadone or buprenorphine is the current standard of care for opioid use disorder. Given the paucity of research identifying which patients will respond best to which medication, both medications should be accessible to all patients so that patients can determine which works best for them. However, given differences in the historical contexts of their initial implementation, access to each of these medications may vary along racial/ethnic lines. OBJECTIVE To examine the extent to which capacity to provide methadone and buprenorphine vary with measures of racial/ethnic segregation. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all counties and county-equivalent divisions in the US in 2016. Data on racial/ethnic population distribution were derived from the American Community Survey, and data on locations of facilities providing methadone and buprenorphine were obtained from Substance Abuse and Mental Health Services Administration databases. Data were analyzed from August 22, 2018, to September 11, 2019. EXPOSURES Two county-level measures of racial/ethnic segregation, including dissimilarity (representing the proportion of African American or Hispanic/Latino residents who would need to move census tracts to achieve a uniform spatial distribution of the population by race/ethnicity) and interaction (representing the probability that an African American or Hispanic/Latino resident will interact with a white resident and vice versa, assuming random mixing across census tracts). MAIN OUTCOMES AND MEASURES County-level capacity to provide methadone or buprenorphine, defined as the number of facilities providing a medication per 100 000 population. RESULTS Among 3142 US counties, there were 1698 facilities providing methadone (0.6 facilities per 100 000 population) and 18 868 facilities providing buprenorphine (5.9 facilities per 100 000 population). Each 1% decrease in probability of interaction of an African American resident with a white resident was associated with 0.6 more facilities providing methadone per 100 000 population. Similarly, each 1% decrease in probability of interaction of a Hispanic/Latino resident with a white resident was associated with 0.3 more facilities providing methadone per 100 000 population. Each 1% decrease in the probability of interaction of a white resident with an African American resident was associated with 8.17 more facilities providing buprenorphine per 100 000 population. Similarly, each 1% decrease in the probability of interaction of a white resident with a Hispanic/Latino resident was associated with 1.61 more facilities providing buprenorphine per 100 000 population. CONCLUSIONS AND RELEVANCE These findings suggest that the racial/ethnic composition of a community was associated with which medications residents would likely be able to access when (continued) Key Points Question Does county-level capacity to provide methadone and buprenorphine vary with measures of racial/ethnic segregation? Findings In this cross-sectional s...

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“…While the availability of medication treatment has increased substantially over the past decade, significant and persistent gaps have been well-documented, particularly in the U.S. context (Feder et al, 2017;Hadland et al, 2017;Jones et al, 2015;Morgan et al, 2018;Romo et al, 2018;Saloner and Karthikeyan, 2015). Estimates using 2012 U.S. data place the gap between treatment need and treatment capacity at nearly one million persons out of an estimated 2.3 million individuals with past-year opioid abuse or dependence (Jones et al, 2015), with evidence suggesting more pronounced disparities in rural and socioeconomically disadvantaged counties (Stein et al, 2018). Among individuals with opioid use disorder in the U.S., treatment utilization rates are low, with approximately 23 percent reporting past-year use of any drug use treatment service and less than 20 percent reporting use of opioid-specific treatment (Wu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Evidence on the Effectiveness of Heroin-Assisted Treatment

Smart¹

2018

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A Population-Based Examination of Trends and Disparities in Medication Treatment for Opioid use Disorders among Medicaid Enrollees

Cited by 97 publications

References 48 publications

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain

Association of Racial/Ethnic Segregation With Treatment Capacity for Opioid Use Disorder in Counties in the United States

Evidence on the Effectiveness of Heroin-Assisted Treatment

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