Initiation and retention of opioid use disorder treatment medication after emergency department discharge among South Carolina Medicaid enrollees.

Racial inequity in medication treatment for opioid use disorder: Exploring potential facilitators and barriers to use

Objective:We examined patterns of use of perioperative medication for opioid use disorder (MOUD) in patients undergoing surgical procedures and assessed the association between MOUD use and perioperative opioid use and postsurgical adverse events.Background:Optimal management of patients with opioid use disorder (OUD) undergoing surgery is unknown.Methods:We identified patients who underwent major and minor surgery from 2016 to 2021 in the MarketScan Database. Patients were classified into OUD and non-OUD groups (opioid-naïve, intermittent use, and chronic use). Among patients with OUD, preoperative MOUD (buprenorphine, methadone) use was noted. Outcomes were compared between patients with and without OUD and among OUD patients who used or did not use MOUD.Results:Of 917,754 surgical patients, 1.6% had OUD, 63.7% were opioid-naïve, 27.8% were intermittent opioid users, and 6.8% were chronic opioid users. Among OUD patients, 27.6% were current MOUD users before surgery. Compared to opioid-naïve patients, patients with OUD had higher rates of persistent perioperative opioid use (42.2% vs. 8.2%), higher rates of emergency department (ED) visits (21.7% vs. 6.9%), and higher rates of readmissions (6.6% vs. 2.2%) within 30 days following surgery (all P < 0.05). Among patients with OUD, current MOUD use was associated with lower perioperative opioid use compared with no MOUD (53.7% vs. 82.9%), lower persistent postoperative opioid use (13.8% vs. 56.7%), lower rates of ED visits (18.3% vs. 22.3%), and lower readmission rates (4.8% vs. 7.2%) (all P < 0.05), compared to untreated OUD patients.Conclusions:Among patients with OUD undergoing surgery, preoperative current MOUD is associated with reduced postoperative opioid use, and fewer ED visits and readmissions compared to patients who had a diagnosis of OUD but were untreated.

Opioid use disorder (OUD) is a major cause of death and disability among Medicaid beneficiaries. Understanding progress on engaging Medicaid beneficiaries in effective treatment is vital for reducing burden. To examine changes over time and state variation in rates of OUD diagnosis, receipt of medications for OUD (MOUD), MOUD continuity, and OUD-related hospitalization or emergency department (ED) visits among Medicaid beneficiaries. This repeated cross-sectional study used 2018-2023 Medicaid claims data for measurement years 2019 to 2023. The study included non-dual eligible Medicaid beneficiaries aged 18 to 64 years residing in 47 states and the District of Columbia. The data analyses were performed between July 1 and December 11, 2025. Medicaid coverage. The main outcome was the percentage of Medicaid beneficiaries with (1) an OUD diagnosis, (2) MOUD, (3) MOUD continuity for at least 180 days, and (4) OUD-related hospitalization or emergency department visit. Among 126 430 422 Medicaid beneficiary-year observations (aged 35-64 years range, 47.7%-52.3%; female range, 59.5%-61.2%), the percentage diagnosed with OUD declined from 4.2% in measurement year 2019 to 3.6% in measurement year 2023 and declined in 34 states. The percentage of all Medicaid beneficiaries with OUD who received MOUD increased from 60.0% to 69.1% and increased in 45 states. The percentage of Medicaid beneficiaries who continued MOUD for at least 180 days decreased from 62.6% to 57.6% and decreased in 29 states. The percentage of beneficiaries with OUD who had an OUD-related hospitalization or ED visit decreased from 10.9% to 10.6% but increased in 31 states. This cross-sectional study found a substantial increase in the percentage of individuals with OUD who received MOUD among almost all states. The increase in MOUD use may have contributed to reductions in overdose deaths, but more research is needed.

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. 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. 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. MOUD formulations included methadone, buprenorphine and naltrexone. We measured medically treated opioid-related overdose within claims within 12 months of the index MOUD claim. 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). 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.

Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention.

BackgroundHospitalizations involving opioid use disorder (OUD) are increasing. Addiction consultation services (ACS) initiate medications for opioid use disorder (MOUD) in hospital settings and arrange post-hospital follow-up for ongoing MOUD care. Engagement in MOUD following hospital discharge is hampered by challenges in timely access to MOUD. This protocol describes an open-label randomized comparative effectiveness trial comparing ACS treatment as usual (TAU) to a single injection of a 28-day formulation extended-release buprenorphine (XR-BUP) on MOUD engagement 34-days following hospital discharge.MethodsSix U.S. hospitals with ACS capable of prescribing all MOUD (i.e., methadone, buprenorphine, and extended-release naltrexone) recruit and randomize hospitalized patients with OUD who have not been on MOUD in the fourteen days prior to hospitalization. TAU may consist of any MOUD other than XR-BUP. Participants randomized to XR-BUP may receive any MOUD throughout their hospital stay and receive a 28-day XR-BUP injection within 72-hours of anticipated hospital discharge. There is no intervention beyond hospital stay. Participants are followed 34-, 90-, and 180-days following hospital discharge. The primary outcome is engagement in any MOUD 34-days following hospital discharge, which we hypothesize will be greater in the XR-BUP group. Randomizing 342 participants (171 per arm) provides 90% power to detect difference in the primary outcome between groups with an odds ratio of 2.1. Safety, secondary, and exploratory outcomes include: adverse events, MOUD engagement on days 90 and 180, opioid positive urine drug tests, self-reported drug use, hospital readmissions and emergency department visits, use of non-opioid drugs, fatal and non-fatal opioid overdose, all-cause mortality, quality of life, and cost-effectiveness. Data are analyzed by intention-to-treat, with pre-planned per-protocol and other secondary analyses that examine gender as an effect modifier, differences between groups, and impact of missingness.DiscussionEngagement in MOUD care following hospitalization in individuals with OUD is low. This randomized comparative effectiveness trial can inform hospital ACS in medication selection to improve MOUD engagement 34-days following hospital discharge.Trial registrationNCT04345718.

Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD). We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions. Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states. Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.

Thousands of pregnant people with opioid use disorder (OUD) enter US jails annually, yet their access to medications for OUD (MOUD) that meet the standard of care (methadone and/or buprenorphine) is unknown. To assess the availability of MOUD for the treatment of pregnant individuals with OUD in US jails. In this cross-sectional study, electronic and paper surveys were sent to all 2885 identifiable US jails verified in the National Jails Compendium between August 19 and November 7, 2019. Respondents were medical and custody leaders within the jails. The primary outcome was the availability of MOUD (methadone and/or buprenorphine) for the treatment of pregnant people with OUD in US jails. Availability of MOUD was assessed based on (1) continuation of MOUD for pregnant incarcerated individuals (if the individual was receiving MOUD before incarceration), with or without initiation of MOUD; (2) both initiation and continuation of MOUD for pregnant individuals; (3) only continuation of MOUD for pregnant individuals; and (4) management of opioid withdrawal for pregnant individuals. Secondary outcomes included MOUD availability during the postpartum period and logistical factors associated with the provision of MOUD. Multivariate logistic regression analysis was used to assess factors associated with MOUD availability during pregnancy. Among 2885 total surveys sent, 1139 (39.5%) were returned; of those, 836 surveys (73.4%; 29.0% of all surveys sent) could be analyzed, with similar proportions from metropolitan (399 jails [47.7%]) and rural (381 jails [45.6%]) settings. Overall, 504 jails (60.3%) reported that MOUD was available for medication continuation, with or without medication initiation, during pregnancy. Of those, 267 jails (53.0%; 31.9% of surveys included in the analysis) both initiated and continued MOUD, and 237 jails (47.0%; 28.3% of surveys included in the analysis) only continued MOUD; 190 of 577 jails (32.9%; 22.7% of surveys included in the analysis) reported opioid withdrawal as the only management for pregnant people with OUD. Among the 504 medication-providing jails, only 120 (23.8%) continued to provide MOUD during the postpartum period. Methadone was more commonly available at jails that only continued MOUD (84 of 123 jails [68.3%]), whereas buprenorphine was more commonly available at jails that both initiated and continued MOUD (73 of 119 jails [61.3%]). In an adjusted model, jails with higher odds of MOUD availability were located in the Northeast (odds ratio [OR], 10.72; 95% CI, 2.43-47.36) or metropolitan areas (OR, 1.92; 95% CI, 1.31-2.83), had private health care contracts (OR, 1.49; 95% CI, 1.03-2.14) and a higher number of women (≥70) reported in the female census (OR, 1.69; 95% CI, 1.02-2.80), and provided pregnancy testing within 2 weeks of arrival at the jail (OR, 2.66; 95% CI, 1.69-4.17). In this cross-sectional study, a substantial proportion of US jails did not provide access to MOUD to pregnant people with OUD. Although most jails reported continuing to provide MOUD to individuals who were receiving medication before incarceration, few jails initiated MOUD, and most medication-providing jails discontinued MOUD during the postpartum period. These results suggest that many pregnant and postpartum people with OUD in US jails do not receive medication that is the standard of care and are required to endure opioid withdrawal, signaling an opportunity for intervention to improve care for pregnant people who are incarcerated.

Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states

Background: Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. Methods: An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman's test for related samples or Cochran's Q was used to make within-group comparisons between policies and MOUDs. Results: We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Conclusion: Because respondents rarely chose “never” or “always” for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.

Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic.

Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment. To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses. This case-control study used Washington State Medicaid data from 2016 to 2019 (for use) and 2017 to 2018 (for continuity). Data were obtained for outpatient, residential, and inpatient settings with Medicaid claims. Participants included Washington State full-benefit Medicaid enrollees aged 18 to 64 years, continuously eligible for 12 months, with OUD during the study years and not enrolled in Medicare. Data analysis was performed from January to September 2022. Disability status, including physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities. The main outcomes were National Quality Forum-endorsed quality measures: (1) use of MOUD (buprenorphine, methadone, or naltrexone) during each study year and (2) 6-month continuity of treatment (for those taking MOUD). A total of 84 728 Washington Medicaid enrollees had claims evidence of OUD, representing 159 591 person-years (84 762 person-years [53.1%] for female participants, 116 145 person-years [72.8%] for non-Hispanic White participants, and 100 970 person-years [63.3%] for participants aged 18-39 years); 15.5% of the population (24 743 person-years) had evidence of a physical, sensory, developmental, or cognitive disability. PWD were 40% less likely than those without a disability to receive any MOUD (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58-0.61; P < .001). This was true for each disability type, with variations. Individuals with a developmental disability were least likely to use MOUD (AOR, 0.50; 95% CI, 0.46-0.55; P < .001). Of those using MOUD, PWD were 13% less likely than people without disability to continue MOUD for 6 months (adjusted OR, 0.87; 95% CI, 0.82-0.93; P < .001). In this case-control study of a Medicaid population, treatment differences were found between PWD and people without these disabilities; these differences cannot be explained clinically and highlight inequities in treatment. Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among PWD. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations to improve OUD treatment for PWD.

To evaluate the association between medication for opioid use disorder (MOUD) and surgical complications and health care utilization among patients with opioid use disorder (OUD) undergoing hysterectomy. Using MarketScan Research Databases (2016-2021), we identified patients with OUD who underwent hysterectomy for benign indications. Use of MOUD (methadone or buprenorphine) was assessed within 1 year preoperatively, distinguishing among prior MOUD use (365 to 31 days preoperatively), current MOUD use (30 to 1 days preoperatively), and nonuse of MOUD. The primary outcomes included perioperative surgical complications. The secondary outcome included perioperative and postoperative opioid prescription, 30-day readmissions, and emergency department (ED) visits within 30 and 90 days. Propensity scores inverse probability of treatment weighting was used to evaluate the association between current MOUD and outcomes. Of 1,715 patients with preoperative OUD who underwent hysterectomy, 491 (28.6%, 95% CI, 26.5-30.8%) reported current MOUD use. Current MOUD use was associated with fewer perioperative complications than nonuse of MOUD (27.7% vs 33.9%, adjusted risk ratio 0.86, 95% CI, 0.76-0.97), including surgical site (12.8% vs 16.9%) and medical (17.5% vs 22.8%) complications. Current MOUD use was also associated with fewer ED visits within 30 days (19.1% vs 27.7%) and 90 days (32.6% vs 42.8%). Buprenorphine and methadone had similar outcomes. Patients on MOUD for more than 90 days had lower risks of complications and health care utilization than those on MOUD for 90 days or less. Among patients with OUD undergoing hysterectomy, MOUD use was associated with reduced perioperative complications and health care utilization. Findings support methadone and buprenorphine use to improve hysterectomy surgical outcomes, particularly with more than 90 days of MOUD.

Acute care encounters for opioid overdose are increasingly recognized as critical opportunities to connect patients to opioid use disorder (OUD) treatment. However, national data on receipt of medication for OUD (MOUD) after overdose events are limited, particularly for new MOUD initiation. To examine MOUD receipt and timing after emergency department or inpatient encounters for opioid overdose, including patient characteristics associated with new MOUD initiation. Retrospective analysis of 2014-2019 national Medicaid claims data. Acute care opioid overdose events among non-dual eligible Medicaid enrollees aged 18-64 with continuous enrollment during the 180-day (6-month) baseline period preceding the overdose. The primary outcome was any MOUD (buprenorphine, methadone, naltrexone) receipt in the 180days after discharge. Baseline MOUD receipt was categorized by the proportion of days covered (PDC): none (reference), very low (> 0 to < 20%), low (20 to < 50%), moderate (50 to < 80%), high (≥ 80%). Of 318,536 opioid overdose events, 22.8% and 26.0% had MOUD in the 6 months before and after the event, respectively. Prior MOUD had the strongest association with follow-up MOUD, with a gradient by baseline exposure levels. In Cox models adjusting for patient sociodemographic and clinical covariates, overdose characteristics, and community-level factors, the likelihood of follow-up MOUD was 3.58 times higher for very low (95% CI = 3.50-3.66), 5.47 times higher for low (95% CI = 5.35-5.60), 7.36 times higher for moderate (95% CI = 7.17-7.56), and 16.35 times higher for high (95% CI = 15.92-16.80) baseline MOUD exposure compared to no prior MOUD. Timely follow-up MOUD within 30days was also higher among those with (76.0%) than without (32.4%) prior MOUD. Substantial gaps in MOUD receipt after opioid overdose indicate an urgent need to expand acute care interventions for treatment initiation, engagement, and referral as well as broader efforts to increase MOUD prescribing and uptake.

Objectives: Although evidence-based recommendations from treatment guidelines support the use of medications for opioid use disorder (MOUD) in addition to psychosocial counseling, about 86.6% of patients diagnosed with opioid use disorder (OUD) do not receive MOUD and several barriers still restrict access to MOUD in the United States. This study assesses the impact of MOUD on healthcare resource utilization (HCRU) and costs for Medicaid beneficiaries. Methods: An exploratory retrospective matched-cohort analysis was performed among Medicaid patients not concurrently enrolled in Medicare using anonymized claims data from South Carolina Medicaid between 7/1/2016 and 12/31/2019. Patients newly diagnosed with OUD who received MOUD were matched based on age, gender, and race to patients who did not receive MOUD to evaluate HCRU and costs in the 6 months prior to and 12 months following initial OUD diagnosis. Results: A total of 397 matched pairs of MOUD and non-MOUD patients were identified for this analysis. A significantly lower percentage of patients had emergency department visits (63.2% vs 74.3%; P=0.0005) and hospitalizations (21.9% vs 37.8%; P&lt;0.0001) in the matched MOUD cohort compared to the non-MOUD cohort. All-cause total direct costs were numerically lower for the matched MOUD cohort ($15,212 vs $17,451; P=0.3388), as numerically higher all-cause pharmacy costs associated with MOUD utilization were offset by significantly lower all-cause medical costs compared to the non-MOUD cohort ($9,265 vs $14,819; P=0.0005). Conclusions: The results of this analysis suggest that MOUD utilization has a positive association with reducing HCRU and all-cause medical costs for Medicaid patients with OUD.