Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications.
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ABSTRACT:
SUBMITTER: Grogan CM
PROVIDER: S-EPMC5304419 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
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Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications.
Grogan Colleen M CM Andrews Christina C Abraham Amanda A Humphreys Keith K Pollack Harold A HA Smith Bikki Tran BT Friedmann Peter D PD
Health affairs (Project Hope) 20161201 12
The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treat ...[more]
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Project description:ObjectiveResearch has examined the effect of Medicaid expansion on access to physicians with buprenorphine waivers, but less attention has been paid to Medicaid's impact on opioid use disorder medication availability within the specialty substance use disorder treatment system. To address this gap in the literature, this study examined the impact of Medicaid expansion on availability of opioid medications in specialty programs.MethodsThis study used data from the National Survey of the Substance Abuse Treatment Services (2002-2017), containing all known substance use disorder treatment programs in the United States, to examine the effect of Medicaid expansion on the availability of opioid use disorder medications by treatment program ownership type (publicly owned, private for profit, and private nonprofit) among opioid treatment programs (OTPs) and non-OTPs.ResultsThe effects of Medicaid expansion were limited to nonprofit and for-profit OTPs. Medicaid expansion was associated with 135.1% and 57.5% increases in the number of nonprofit and for-profit OTPs offering injectable naltrexone, respectively, and with a 64.4% increase in the number of nonprofit OTPs offering buprenorphine. Nonprofit and for-profit OTPs compose <10% of the treatment system, indicating that improvements in opioid use disorder treatment associated with Medicaid expansion were limited to a small share of the specialty system.ConclusionsThe limited impact of Medicaid expansion on the specialty treatment system may perpetuate disparities in the accessibility and quality of opioid use disorder treatment for Medicaid enrollees and fail to alleviate high rates of opioid use disorder and opioid overdose deaths in this vulnerable population.
| S-EPMC8262068 | biostudies-literature
Project description:ImportanceThere is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.ObjectiveTo examine the use of medications for OUD and potential indicators of quality of care in multiple states.Design, setting, and participantsExploratory 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.ExposuresCalendar year, demographic characteristics, eligibility groups, and comorbidities.Main outcomes and measuresUse 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).ResultsIn 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 relevanceAmong 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.
| S-EPMC8278273 | biostudies-literature
Project description:ObjectiveTo examine the impact of Section 1115 waivers on Medicaid coverage and opioid agonist therapy (OAT) utilization among substance use treatment admissions.Data sourceTreatment Episode Data Set-Admissions (TEDS-A) (2001-2012).Study designWe examined effects of 1115 waiver implementation on proportions of substance use treatment admissions with Medicaid and receiving OAT, using random intercept linear regression.Principal findings1115 waiver implementation was associated with an average of a 6 percentage point increase in proportion of all admissions with Medicaid, and 4 percentage point increase among opioid outpatient admissions. Implementation was not associated with change in proportion of opioid outpatient admissions receiving OAT.Conclusions1115 waivers influence Medicaid coverage among substance use treatment admissions. The findings improve our understanding of how state policies impact substance use treatment utilization.
| S-EPMC7080398 | biostudies-literature
Project description:ImportanceWhile many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear.ObjectiveTo examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use.Design, setting, and participantsThis cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019.ExposuresAdmissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice.Main outcomes and measuresAvailability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone).ResultsOf 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001).Conclusions and relevanceIn this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.
| S-EPMC8188643 | biostudies-literature
Project description:ObjectiveTo examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD).MethodsWe conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (N = 9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine).ResultsBetween 1992 and 2017, treatment admissions involving opioid/cocaine (-17.2 percentage points [PP]) and opioid/alcohol co-use (-12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4-38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6-35.9), methamphetamine (23.9%; 95% CI 23.7-24.2), alcohol (25.0%; 95% CI 24.8-25.2), or benzodiazepines (34.6%; 95% CI 34.3-34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017.ConclusionsOpioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.
| S-EPMC7969153 | biostudies-literature
Project description:INTRODUCTION:In response to the US opioid crisis, interventions are being implemented to lower opioid prescribing to reduce opioid misuse and overdose. As opioid prescribing falls, opioid misuse may shift from prescriptions to other, possibly illicit, sources. We examined how the percentage of patients with an opioid use disorder (OUD) diagnosis in a given year without a current opioid prescription changed over a decade among commercially insured enrollees and Medicaid beneficiaries. We also examined how the percentages differed by enrollee demographic factors. METHODS:We used commercial and Medicaid claims from the IBM MarketScan® databases from 2005 to 2015 to identify enrollees with and without current opioid prescriptions who have been diagnosed with OUD. We measured the percentage of enrollees with OUD without a current opioid prescription by year and demographic factors. RESULTS:We identified 99,396 enrollee-years with OUD covered by commercial insurance and 60,492 enrollee-years with OUD covered by Medicaid. Among enrollees with OUD, the percentage without a current opioid prescription increased from 37% in 2005 to 49% in 2012 before falling back to 39% in 2015 in the commercial population, and increased from 32% in 2005 to 38% in 2015 in the Medicaid population. Differences in percentages were observed by age, sex, race, and region, particularly among young people where 70 to 89% had OUD without a current prescription. CONCLUSIONS:Most enrollees with OUD in the data had current opioid prescriptions, suggesting that continuing efforts to reduce misuse of prescribed opioids among patients with prescriptions may be effective. However, a substantial percentage of enrollees with OUD may be obtaining opioids via other, likely illegitimate, channels, particularly younger people, which suggests an opportunity for targeted efforts to reduce opioid diversion.
| S-EPMC6597680 | biostudies-literature
Project description:ObjectiveTo examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States.Data sources/study settingData come from the 2012 National Survey of Substance Abuse Treatment Services.Study design/data collectionWe used local measures of spatial autocorrelation (LISA) analysis to identify (1) clusters of counties with higher and lower than average rates of opioid use disorders and (2) clusters of counties with higher and lower than average treatment admissions among OTPs that accept Medicaid, adjusting for county population size.Principal findingsOur results reveal several clusters of counties with higher than average rates of opioid use disorder (OUD) and lower than average treatment admissions among OTPs that accept Medicaid. These clusters are highly concentrated in the Southeast region of the country and include Arkansas, Kentucky, Louisiana, Mississippi, and Tennessee.ConclusionsMedicaid enrollees in areas in the Southeast have the largest gaps between county-level OUD rates and estimated county-level capacity for treatment, as measured by county-level total treatment admissions among OTPs that accept Medicaid. Policy makers should consider strategies to increase the availability of OTPs with the capacity to serve Medicaid enrollees.
| S-EPMC5785305 | biostudies-literature
Project description:Extensive undertreatment of substance use disorders has focused attention on whether the expansion of eligibility for Medicaid under the Affordable Care Act (ACA) has promoted increased coverage and treatment of these disorders. We assessed changes in coverage and substance use disorder treatment among low-income adults with the disorders following the 2014 ACA Medicaid expansion, using data for 2008-15 from the National Survey on Drug Use and Health. The percentage of low-income expansion state residents with substance use disorders who were uninsured decreased from 34.4 percent in 2012-13 to 20.4 percent in 2014-15, while the corresponding decrease among residents of nonexpansion states was from 45.2 percent to 38.6 percent. However, there was no corresponding increase in overall substance use disorder treatment in either expansion or nonexpansion states. The differential increase in insurance coverage suggests that Medicaid expansion contributed to insurance gains, but corresponding treatment gains were not observed. Increasing treatment may require the integration of substance use disorder treatment with other medical services and clinical interventions to motivate people to engage in treatment.
| S-EPMC6190698 | biostudies-literature
Project description:Objectives:Several medications have been shown to be safe and effective for treating alcohol use disorder (AUD); however, these medications are prescribed infrequently. We conducted a survey of the demographics, practice characteristics, and self-perceived knowledge, experience, and opinions of addiction specialists on the use of AUD medications and how to increase their use. Methods:We sent a 19-question survey to members of the American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP). Results:We received a total of 395 responses from ASAM members and 194 responses from AAAP members. One hundred of the respondents were members of both organizations. The large majority of respondents (92.6%) were prescribers, and 81.6% were non-trainee physicians. The two most frequently used medications for treating AUD were oral naltrexone (27%) and long-acting naltrexone (18%). Respondents were significantly more confident in the strength of the research findings and evidence for the efficacy and safety of naltrexone than other AUD medications (p < 0.001 ). Respondents identified additional education to current providers about existing medications as the most important potential intervention to increase the use of AUD medications. Conclusions:Compared with a survey published in 2001, in 2018 the proportion of respondents who reported using naltrexone more than doubled and addiction specialists were more confident in their use of AUD medications, rating their efficacy and safety more highly. Consistent with findings from other recent studies, providing more education to practitioners about existing AUD medications may be the most effective way to increase their use.
| S-EPMC7034336 | biostudies-literature
Project description:Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world, recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we assembled recursive-partitioning frameworks (classification tree analyses) with clinical, demographic, and ADGRL3 genetic information to predict SUD susceptibility. Our results indicate that SUD can be efficiently and robustly predicted in ADHD participants. The genetic models used remained highly efficient in predicting SUD in a large sample of individuals with severe SUD from a psychiatric institution that were not ascertained on the basis of ADHD diagnosis, thus identifying ADGRL3 as a risk gene for SUD. Recursive partitioning analyses revealed that rs4860437 was the predominant predictive variant. This new methodological approach offers novel insights into higher order predictive interactions and offers a unique opportunity for translational application in the clinical assessment of patients at high risk for SUD
2020-04-01 | GSE112652 | GEO