Factors associated with Medicaid patients' access to buprenorphine treatment

Baxter, Jeffrey H.; Clark, Robin E.; Samnaliev, Mihail; Leung, Gary Y.; Hashemi, Lobat

doi:10.1016/j.jsat.2011.02.002

Cited by 27 publications

(19 citation statements)

References 34 publications

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“…Our results are not unusualother studies have observed a similar trend of office-based OAT not necessarily improving the proportion of patients treated with OAT (17,19). Similar to Stein et al (17), we found corresponding increases in the number of patients with opioid use disorders treated with OAT and the number of patients treated with office-based OAT.…”

Section: Discussionsupporting

confidence: 90%

Trends in Opioid Agonist Therapy in the Veterans Health Administration: Is Supply Keeping up with Demand?

Oliva

Trafton

Harris

et al. 2013

The American Journal of Drug and Alcohol Abuse

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Office-based OAT utilization and the number of opioid use disorder veterans treated with OAT are increasing at the same rate over time, suggesting that office-based OAT is being used to meet the growing need for OAT care. Although office-based OAT is increasingly being used within the VHA and may be one way the VHA is keeping up with the demand for OAT, more research is needed to understand how to engage a greater proportion of opioid use disorder patients in treatment.

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Section: Discussionsupporting

confidence: 90%

Trends in Opioid Agonist Therapy in the Veterans Health Administration: Is Supply Keeping up with Demand?

Oliva

Trafton

Harris

et al. 2013

The American Journal of Drug and Alcohol Abuse

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“…In New York City, buprenorphine is most frequently used in neighborhoods with the highest percentage of White and high-income residents (Hansen et al, 2013). This pattern is replicated by other studies finding income and ethnic/racial disparities in buprenorphine treatment (Baxter, Clark, Samnaliev, Leung, & Hashemi, 2011; Knudsen, Ducharme, & Roman, 2006) and that a majority of buprenorphine patients are treated in private physician practices (Stein et al, 2012). Buprenorphine in the US, with some regional exceptions such as Baltimore, where the municipal government promoted its public sector dissemination (Schwartz et al, 2013), has served as a specific intervention for prescription opioid dependent people who are more likely to be affluent, educated, and White than urban heroin users.…”

Section: Introductionsupporting

confidence: 70%

Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America

Mendoza

Rivera-Cabrero

Hansen

2016

Transcult Psychiatry

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Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public’s perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the “War on Drugs” that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.

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“…Additional differences in clinical, psycho-patholological and sociodemographic characteristics, as well co-morbid medical and psychiatric diagnoses, use of concomitant psychotropic medications, and healthcare service use between these two groups have been noted in previous studies (Barnett, 2009; Baxter et al, 2011; Fingerhood et al, 2014; Gerra et al, 2004; Hansen et al, 2013; Maremmani et al, 2011, 2007; Oliva et al, 2012, 2013; Proctor et al, 2014; Stein et al, 2012). However, a detailed national level comparative study of the characteristics of patients who receive each of these treatments has yet to be published despite the dramatic change in the nature of OAT utilization in the United States during the past decade.…”

Section: Introductionsupporting

confidence: 56%

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Manhapra

Quinones

Rosenheck

2016

Drug and Alcohol Dependence

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BACKGROUND The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing the differences between patients who are prescribed these two OAT options. METHODS From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) for characteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups. RESULTS Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups. CONCLUSIONS Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference.

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Factors associated with Medicaid patients' access to buprenorphine treatment

Cited by 27 publications

References 34 publications

Trends in Opioid Agonist Therapy in the Veterans Health Administration: Is Supply Keeping up with Demand?

Trends in Opioid Agonist Therapy in the Veterans Health Administration: Is Supply Keeping up with Demand?

Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

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