Medication-assisted Treatment for Opioid Use Disorder in Rhode Island: Who Gets Treatment, and Does Treatment Improve Health Outcomes?

Abstract

Since the early 2000s Rhode Island has been among the states hardest hit by the opioid crisis. In response, the state has made it a priority to expand access to medication-assisted treatment (MAT) for opioid use disorder (OUD), which refers to the use of the FDA-approved medications methadone, buprenorphine, and/or naltrexone in conjunction with behavioral therapy. MAT is strongly supported by scientific evidence and endorsed by US public health officials and yet fails to reach many OUD patients. Using administrative data covering medical treatments and selected health outcomes for more than three-quarters of the Rhode Islanders covered by health insurance from mid-2011 through mid-2019, this report considers MAT’s efficacy in preventing opioid overdoses in Rhode Island and sheds light on the barriers to receiving MAT. The authors find evidence that MAT, as practiced in Rhode Island, appears to reduce the risk of opioid overdose: Among patients who had an initial (nonfatal) overdose, those who had received MAT in the preceding three months were less likely to experience a second overdose. In addition, federal policies that allowed a broader set of health-care providers to prescribe buprenorphine for OUD and enabled each prescriber to treat more patients with that drug are shown to have had some success in expanding the set of patients receiving MAT in Rhode Island.Unfortunately, we observe significant disparities in access to MAT across different groups within Rhode Island. Among individuals diagnosed with opioid dependence, those living in places with elevated poverty rates are less likely to receive buprenorphine, but they are also somewhat more likely to receive methadone. Because a treatment regimen involving methadone is much less convenient for the patient compared with one involving buprenorphine, ideally patients should have similar access to both drugs. Having Medicaid insurance as opposed to some other form of insurance is associated with a much greater chance of receiving methadone treatment, a finding that supports policies that would incentivize the expansion of Medicaid in states that have not yet done so. Women are somewhat less likely than men to receive either methadone or buprenorphine.This research demonstrates that recent federal policies helped to increase the number of Rhode Islanders who were prescribed buprenorphine for OUD. Raising patient-number limits enabled select prescribers to serve more patients and expand the total patient pool; however, more people could be helped if more prescribers took full advantage of their prescribing limits. This research and similar findings from other states reveal that the typical buprenorphine prescriber has a caseload that is well below the maximum number of patients they could treat. A separate policy that enabled mid-level practitioners (such as physician assistants) to train to prescribe buprenorphine was also found to draw in new patients, particularly those in high-poverty Zip codes. The research also underscores the urgency of helping more OUD patients receive methadone and/or buprenorphine treatment quickly following an overdose (in hospitals, for example) and to maintain that treatment over time for a sufficient duration.Some additional policies that could promote greater access to MAT include allowing pharmacists to prescribe buprenorphine, relaxing restrictions on the use of telehealth for obtaining buprenorphine prescriptions, and revisiting the rules about allowing take-home doses of methadone. Additional research is required on these interventions before specific recommendations can be made, but consideration of further policy adjustments is critically important given the ongoing scourge of opioid abuse and the proven ability of MAT to help those suffering from opioid use disorder. In response to the COVID-19 pandemic there has in fact been a temporary loosening of policies related to MAT in order to minimize patients’ exposure to the virus while helping them to get on or stay on medications, thus offering an opportunity to evaluate the efficacy and safety of the revised measures.