TY - JOUR
AU - A. E. Austin
AU - L. Tang
AU - J . Y. Kim
AU - L. Allen
AU - A. J. Barnes
AU - C. H. Chang
AU - S. Clark
AU - E. S. Cole
AU - C. P. Durrance
AU - J. M. Donohue
AU - A. J. Gordon
AU - H. A. Huskamp
AU - M. J. McDuffie
AU - A. Mehrotra
AU - S. Mohamoud
AU - J. Talbert
AU - K. A. Ahrens
AU - M. Applegate
AU - L. R. Hammerslag
AU - P. Lanier
AU - K. Tossone
AU - K. Zivin
AU - M. E. Burns
A1 - 
AB - IMPORTANCE: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. OBJECTIVES: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. EXPOSURES: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). MAIN OUTCOMES AND MEASURES: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. RESULTS: Among a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth.
AD - Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill.;Injury Prevention Research Center, The University of North Carolina at Chapel Hill.;Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.;Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.;Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.;Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond.;Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor.;La Follette School of Public Affairs, University of Wisconsin-Madison.;Department of Internal Medicine, University of Utah, Salt Lake City.;Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.;Center for Community Research and Service, Joseph R. Biden, Jr. School of Public Policy and Administration, University of Delaware, Newark.;The Hilltop Institute, University of Maryland, Baltimore County, Baltimore.;Institute for Biomedical Informatics, University of Kentucky, Lexington.;Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland.;Ohio Department of Medicaid, Columbus.;School of Social Work, The University of North Carolina at Chapel Hill.;The Ohio Colleges of Medicine, Government Resource Center, College of Medicine, The Ohio State University, Columbus.;Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor.;Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison.
AN - 37327009
BT - JAMA Health Forum
C5 - Opioids & Substance Use; Financing & Sustainability
CP - 6
DA - Jun 2
DO - 10.1001/jamahealthforum.2023.1422
DP - NLM
ET - 20230602
IS - 6
JF - JAMA Health Forum
LA - eng
N2 - IMPORTANCE: Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. OBJECTIVES: To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. EXPOSURES: Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). MAIN OUTCOMES AND MEASURES: Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. RESULTS: Among a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth.
PY - 2023
SN - 2689-0186
SP - e231422
ST - Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs
T1 - Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs
T2 - JAMA Health Forum
TI - Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs
U1 - Opioids & Substance Use; Financing & Sustainability
U3 - 10.1001/jamahealthforum.2023.1422
VL - 4
VO - 2689-0186
Y1 - 2023
ER -