Duration of medication treatment for opioid‐use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study.
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 conti...
| Publicado en: | Addiction Vol. 117; no. 12; pp. 3079 - 3089 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Dec2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=160000918&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 160000918 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Dec2022 vid: 117 iid: 12 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 160000918 157401457 160000918 160000918 10.1111/add.15959 160000918 ppf: 3079 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Duration of medication treatment for opioid‐use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study. aug: au: Burns, Marguerite Tang, Lu Chang, Chung‐Chou H. Kim, Joo Yeon Ahrens, Katherine Allen, Lindsay Cunningham, Peter Gordon, Adam J. Jarlenski, Marian P. Lanier, Paul Mauk, Rachel McDuffie, Mary Joan Mohamoud, Shamis Talbert, Jeffery Zivin, Kara Donohue, Julie affil: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison WI,, USA sug: subj: Analgesics, Opioid Adverse Effects Substance Use Disorders Drug Therapy Treatment Duration Overdose Risk Factors Risk Assessment Medicaid Human Retrospective Design Prospective Studies Survival Analysis Adolescence Adult Middle Age Aged Aged, 80 and Over Methadone Therapeutic Use Buprenorphine Therapeutic Use Naltrexone Therapeutic Use Billing and Claims Comparative Studies Confidence Intervals Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over ab: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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