TY - JOUR
KW - Adolescent
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Child
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Male
KW - Medicaid
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Naltrexone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Opiate Substitution Treatment/trends
KW - Opioid-Related Disorders/drug therapy
KW - Pregnancy
KW - Pregnancy Complications/drug therapy
KW - United States
KW - Young Adult
AU - Medicaid Outcomes Distributed Research Network
AU - J. M. Donohue
AU - M. P. Jarlenski
AU - J . Y. Kim
AU - L. Tang
AU - K. Ahrens
AU - L. Allen
AU - A. Austin
AU - A. J. Barnes
AU - M. Burns
AU - C. H. Chang
AU - S. Clark
AU - E. Cole
AU - D. Crane
AU - P. Cunningham
AU - D. Idala
AU - S. Junker
AU - P. Lanier
AU - R. Mauk
AU - M. J. McDuffie
AU - S. Mohamoud
AU - N. Pauly
AU - L. Sheets
AU - J. Talbert
AU - K. Zivin
AU - A. J. Gordon
AU - S. Kennedy
A1 - 
AB - IMPORTANCE: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. OBJECTIVE: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. DESIGN, SETTING, AND PARTICIPANTS: Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. EXPOSURES: Calendar year, demographic characteristics, eligibility groups, and comorbidities. MAIN OUTCOMES AND MEASURES: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). RESULTS: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. CONCLUSIONS AND RELEVANCE: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.
AD - Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland.; Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown.; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.; Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond.; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison.; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Pediatrics, University of Michigan Medical School, Ann Arbor.; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus.; Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond.; The Hilltop Institute, University of Maryland Baltimore County, Baltimore.; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; School of Social Work, University of North Carolina at Chapel Hill.; Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus.; Center for Community Research & Service, Bi(TRUNCATED)
BT - Jama
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 2
DO - 10.1001/jama.2021.7374
IS - 2
JF - Jama
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. OBJECTIVE: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. DESIGN, SETTING, AND PARTICIPANTS: Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. EXPOSURES: Calendar year, demographic characteristics, eligibility groups, and comorbidities. MAIN OUTCOMES AND MEASURES: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). RESULTS: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. CONCLUSIONS AND RELEVANCE: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.
PY - 2021
SN - 1538-3598; 0098-7484; 0098-7484
SP - 154
EP - 164
EP - 
T1 - Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018
T2 - Jama
TI - Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 34255008
U3 - 10.1001/jama.2021.7374
VL - 326
VO - 1538-3598; 0098-7484; 0098-7484
Y1 - 2021
Y2 - Jul 13
ER -