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Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018.
JAMA. 2021 07 13; 326(2):154-164.JAMA

Abstract

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.

Authors+Show Affiliations

No affiliation info availableDepartment 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, Biden School of Public Policy and Administration, University of Delaware, Newark.The Hilltop Institute, University of Maryland Baltimore County, Baltimore.Health Sciences Center, School of Public Health, Health Affairs Department, School of Public Health, West Virginia University, Morgantown.AcademyHealth, Washington, DC.Division of Biomedical Informatics, College of Medicine, University of Kentucky, Lexington.Department of Psychiatry, University of Michigan Medical School, Ann Arbor.Department of Medicine and Department of Psychiatry, University of Utah School of Medicine, Salt Lake City. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City.AcademyHealth, Washington, DC.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

34255008

Citation

Medicaid Outcomes Distributed Research Network (MODRN), et al. "Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018." JAMA, vol. 326, no. 2, 2021, pp. 154-164.
Medicaid Outcomes Distributed Research Network (MODRN), Donohue JM, Jarlenski MP, et al. Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. JAMA. 2021;326(2):154-164.
Donohue, J. M., Jarlenski, M. P., Kim, J. Y., Tang, L., Ahrens, K., Allen, L., Austin, A., Barnes, A. J., Burns, M., Chang, C. H., Clark, S., Cole, E., Crane, D., Cunningham, P., Idala, D., Junker, S., Lanier, P., Mauk, R., McDuffie, M. J., ... Kennedy, S. (2021). Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. JAMA, 326(2), 154-164. https://doi.org/10.1001/jama.2021.7374
Medicaid Outcomes Distributed Research Network (MODRN), et al. Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. JAMA. 2021 07 13;326(2):154-164. PubMed PMID: 34255008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. AU - ,, AU - Donohue,Julie M, AU - Jarlenski,Marian P, AU - Kim,Joo Yeon, AU - Tang,Lu, AU - Ahrens,Katherine, AU - Allen,Lindsay, AU - Austin,Anna, AU - Barnes,Andrew J, AU - Burns,Marguerite, AU - Chang,Chung-Chou H, AU - Clark,Sarah, AU - Cole,Evan, AU - Crane,Dushka, AU - Cunningham,Peter, AU - Idala,David, AU - Junker,Stefanie, AU - Lanier,Paul, AU - Mauk,Rachel, AU - McDuffie,Mary Joan, AU - Mohamoud,Shamis, AU - Pauly,Nathan, AU - Sheets,Logan, AU - Talbert,Jeffery, AU - Zivin,Kara, AU - Gordon,Adam J, AU - Kennedy,Susan, PY - 2022/01/13/pmc-release PY - 2021/7/13/entrez PY - 2021/7/14/pubmed PY - 2021/7/23/medline SP - 154 EP - 164 JF - JAMA JO - JAMA VL - 326 IS - 2 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/34255008/Use_of_Medications_for_Treatment_of_Opioid_Use_Disorder_Among_US_Medicaid_Enrollees_in_11_States_2014_2018_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2021.7374 DB - PRIME DP - Unbound Medicine ER -