Opioid and Substance Use Disorder and Receipt of Treatment Among Parents Living With Children in the United States, 2015-2017

Clemans-Cope, Lisa; Lynch, Victoria; Epstein, Marni; Kenney, Genevieve M.

doi:10.1370/afm.2389

Cited by 27 publications

(24 citation statements)

References 18 publications

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“…24 There are some indications that treatment with buprenorphine in general medical settings may have also increased in tandem with these funding changes. 51,53…”

Section: Discussionmentioning

confidence: 99%

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

et al. 2019

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Medication treatment (MT) is one of the few evidence-based strategies proposed to combat the current opioid epidemic. We examined national trends and correlates of offering MT in substance use treatment facilities in the United States. According to data from national surveys, the proportion of these facilities that offered any MT increased from 20.0 percent in 2007 to 36.1 percent in 2016—mainly the result of increases in offering buprenorphine and extended-release naltrexone. Only 6.1 percent of facilities offered all three MT medications in 2016. Facilities in states with higher opioid overdose death rates, facilities that accepted health insurance overall (and, more specifically, those that accepted Medicaid in states that opted to expand eligibility for Medicaid), and facilities in states with more comprehensive coverage of MT under their Medicaid plans had higher odds of offering MT. The findings highlight the persistent unmet need for MT nationally and the role of expansion of health insurance in the dissemination of these treatments.

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“…24 There are some indications that treatment with buprenorphine in general medical settings may have also increased in tandem with these funding changes. 51,53…”

Section: Discussionmentioning

confidence: 99%

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

et al. 2019

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“…prior authorization) and coverage for substance use services varies across states, all state Medicaid programs include coverage for buprenorphine (Grogan et al, 2016). Medicaid spending on prescription medications used to treat OUD has increased substantially in recent years, to nearly a billion dollars in 2016 (Clemans-Cope, Epstein, & Kenney, 2017). With growing demand and investment in medications for OUD treatment, understanding factors related to retention within the Medicaid program is critical to develop practices and policies that improve outcomes and maximize resources.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees

Samples

Williams

Olfson

et al. 2018

Journal of Substance Abuse Treatment

162

108

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Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Yet few affected people receive treatment for OUD and a minority of those who receive treatment are effectively retained in care. The purpose of this study was to examine duration of buprenorphine treatment for OUD following treatment initiation to identify risk factors for early discontinuation. Methods: We analyzed insurance claims from the 2013–2015 MarketScan multi-state Medicaid database. The sample included adults 18–64 years old with an OUD diagnosis in the 6 months before initiating buprenorphine treatment, defined as 6 months without a buprenorphine claim prior to the index buprenorphine claim (N=17,329 individuals). We used Cox proportional hazards regression to estimate risk of discontinuing treatment (>30 days without buprenorphine supply), and logistic regression to estimate the odds of persistent treatment for a minimum of 180 days. Results: Over one-quarter of the sample discontinued buprenorphine in the first month of treatment (N=4,928; 28.4%) and most discontinued before 180 days (N=11,189; 64.6%). In the proportional hazards model, risk factors for discontinuation included a lower initial buprenorphine dose (≤4mg; Hazard Ratio [HR]=1.72, p<.001), male sex (HR=1.19, p<.001), younger age (HR=1.34, p<.001), minority race/ethnicity (black HR=1.31, p<.001; Hispanic HR=1.24, p=.01; other HR=1.09, p<.001), capitated insurance (HR=1.21, p<.001), comorbid substance use disorders (alcohol HR=1.07, p=.04; non-opioid drugs HR=1.14, p<.001), hepatitis C (HR=1.06, p=.01), opioid overdose history (HR=1.20, p=.001), or any inpatient care (HR=1.22, p<.001) in the 6-month baseline period. In logistic models, these risk factors were similarly associated with significantly lower odds of treatment retention for at least 180 days. Conclusion: For Medicaid beneficiaries with OUD treated with buprenorphine, there is a need to implement treatment models that more effectively address barriers to treatment retention. These barriers are particularly challenging for minorities, younger individuals, and those with additional substance use disorders.

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“…67 Second, research on Medicaid-covered utilization of buprenorphine has also shown greater increases in the number of prescriptions and the dollars spent in Medicaid expansion states. 68,69 Thus, while physicians in Medicaid expansion states were not more likely to accept this form of payment, the Medicaid expansion remains important for broader questions of buprenorphine treatment supply and access to treatment.…”

Section: Discussionmentioning

confidence: 99%

Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

Knudsen

Studts

2018

J Behav Health Serv Res

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Increasing numbers of individuals with opioid use disorder (OUD) are insured by Medicaid. Little is known about whether providers of buprenorphine, an evidence-based OUD pharmacotherapy, accept this type of payment. Data are scant regarding whether Medicaid acceptance varies by physician and state-level characteristics. To address these gaps, national survey data from 1174 buprenorphine-prescribing physicians (BPPs) and state characteristics were examined in a multi-level model of Medicaid acceptance. Only 52.0% of BPPs accepted Medicaid for buprenorphine-related office visits. Specialists in addiction and psychiatry were significantly less likely to accept Medicaid than other specialties, as were BPPs delivering buprenorphine in individual medical practice. Perceived adequacy of Medicaid reimbursement was positively associated with accepting Medicaid. Medicaid acceptance was not associated with states' implementation of the Medicaid expansion. Individuals who are covered by Medicaid may face barriers to accessing buprenorphine treatment, which has high public health significance given the ongoing opioid epidemic.

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Opioid and Substance Use Disorder and Receipt of Treatment Among Parents Living With Children in the United States, 2015-2017

Cited by 27 publications

References 18 publications

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees

Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

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