Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic

Tilhou, Alyssa Shell; Dague, Laura; Saloner, Brendan; Beemon, Daniel; Burns, Marguerite

doi:10.1001/jamahealthforum.2022.0093

Cited by 23 publications

(20 citation statements)

References 37 publications

(78 reference statements)

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“…Barriers for access to methadone include the requirement of in-person evaluations for new patients, the requirement to use audiovisual telehealth visits for existing patients, and access to OTPs near patients. 13 , 14 , 15 One study of Medicaid beneficiaries in Wisconsin 33 found that the COVID-19 public health emergency was associated with decreased probability of urine drug testing and OTP services. Another study of commercially insured patients 21 found a similar trend of less urine testing across existing and new patients and fewer individuals initiating MOUD.…”

Section: Discussionmentioning

confidence: 99%

“…Although the literature explaining state disparities in access to methadone is scant, some studies 16 , 26 , 33 , 34 have suggested that the aforementioned barriers could be exacerbated or mitigated by local governments’ responses to the opioid crisis after the COVID-19 outbreak. States with clear guidance and better funding for OTPs could experience less disruption of methadone supply.…”

Section: Discussionmentioning

confidence: 99%

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Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic

2022

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IMPORTANCEThe opioid crisis has been exacerbated by the COVID-19 pandemic in the US, with concerns over major disruptions to medication treatment of opioid use disorder. OBJECTIVE To investigate whether the COVID-19 pandemic was associated with disruption of buprenorphine and methadone supplies in the US. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study used ARCOS (Automated Reports and Consolidated Ordering System) data, which monitor the flow of controlled substances in the US, from January 1, 2012, through June 30, 2021. Manufacturers and point of sale or distribution at the dispensing or retail level, including hospitals, retail pharmacies, clinicians, midlevel clinicians, and teaching institutions, were included in the analysis. EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Quarterly supplies of buprenorphine and methadone per capita in milligrams. RESULTSThe per capita supply of methadone dropped from 13.2 mg in the first quarter of 2020 to 10.5 mg in the second quarter of 2020, whereas the per capita supply of buprenorphine increased from 3.6 mg to 3.7 mg in the same period. The per capita supply of methadone declined 20% (−2.7 mg) in the second quarter of 2020 compared with the first quarter of 2020, and the supply had not returned to 2019 levels as of June 2021, whereas the supply of buprenorphine per person increased consistently during the same period. There were considerable state disparities in the reduction of the methadone supply during the pandemic, with many states experiencing pronounced per capita supply decreases, including reductions as great as 50% in New Hampshire and Florida. These decreases in per capita methadone supply were not compensated by proportional increases in the per capita buprenorphine supply (linear fit, 0.17 [95% CI, −0.43 to 0.76]; P = .47). CONCLUSIONS AND RELEVANCEThis cross-sectional study of buprenorphine and methadone supplies during the COVID-19 pandemic found a pronounced decline in the methadone supply but no disruption to the buprenorphine supply. Future research is needed to explain the pronounced state disparities in the methadone supply.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic

2022

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“…It is not clear whether payment parity will continue after the public health emergency ends, and some have speculated that telehealth visits may be covered at a lower rate than during the COVID-19 pandemic [ 26 ]. Further, early evidence suggests that the pandemic related flexibilities added to federal- and state-level policies may have steadied OUD treatment, particularly for buprenorphine while some decreases were seen in treatment initiation, urine screens and OTP services, at least initially [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

Clemans-Cope

Lynch

Payton

et al. 2022

Subst Abuse Treat Prev Policy

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Background As Medicaid is the largest payer for opioid use disorder (OUD) treatment services in the United States, information about Medicaid provider reimbursement is critical, and Medicaid payment policies influence the structure of OUD treatment services for everyone with OUD treatment needs. Methods We collected Medicaid professional fees for OUD treatment and related services for the District of Columbia and fifty state Medicaid programs and the Medicare program in 2021. We create three fee indexes related to OUD treatment, with an emphasis on services related to first-line medication treatments in outpatient settings. We then create Medicaid fee indexes and Medicaid-to-Medicare fee indexes. Results Weekly Medicaid fee bundles for methadone treatment at OTPs in 2021 varied widely, more than 4-fold across states. The Medicaid-to-Medicare fee index shows that the national average Medicaid fee bundle was 56 percent of Medicare fees for regular methadone treatment at OTPs in 2021. For services related to OUD treatment, Medicaid fees varied up to 5-fold and larger across the components of each of the four services, and Medicaid fees were low relative to Medicare for almost all state services examined. The Medicaid-to-Medicare fee index was 64 percent of Medicare fees in 2021, ranging from 52 percent for evaluation & management to 76 percent for toxicology testing. Conclusions There appears to be little justification for such large variation in Medicaid fees across states. In addition, the generally low fees in Medicaid persist despite recent efforts to increase access to opioid use disorder treatment for Medicaid enrollees, and have important implications for access to life-saving treatment during the current opioid overdose crisis.

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“…Latest drug seizure data reports suggest that the supply of illicit opioids remained stable with some short-term localized disruptions [2], and surveys of people who use opioids have reported that consumption patterns generally have not been affected [3]. Administrative data on opioid use disorder (OUD) treatment showed a decline in service use after the pandemic restrictions, with the rate of new treatment admissions increasing after removal of these measures but below prepandemic levels [4,5]. Nevertheless, there is evidence that people with OUD have had higher rates of COVID-19 infection and worsened health outcomes [6].…”

Section: Opioidsmentioning

confidence: 99%

The impact of the COVID‐19 pandemic on addictive disorders—an update

et al. 2022

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The impact of the COVID-19 pandemic on addictive disorders-an update Overall, the early phases of the pandemic were not associated with more consumption of opioids, alcohol, cannabis and involvement in gambling, but there has been evidence for an increase in addictive behaviours among specific groups. Tobacco use stands somewhat apart with evidence of both increased quitting and more initiation.Natural experiments and other longitudinal research studies are needed to estimate lasting change.

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Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic

Cited by 23 publications

References 37 publications

Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic

Changes in Buprenorphine and Methadone Supplies in the US During the COVID-19 Pandemic

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

The impact of the COVID‐19 pandemic on addictive disorders—an update

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