Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic

Alyssa Shell Tilhou,Brendan Saloner,Laura Dague,Daniel Beemon,Marguerite Burns

doi:10.1001/jamahealthforum.2022.0093

Abstract

Disruptions in care during the COVID-19 pandemic may have decreased access to care for patients with opioid use disorder. To examine trends in opioid use disorder treatment including buprenorphine possession, urine drug testing, and opioid treatment program services during the COVID-19 public health emergency. This cohort study included 6453 parent and childless adult Medicaid beneficiaries, aged 18 to 64 years, with opioid use disorder and continuous enrollment from December 1, 2018, to September 30, 2020, in Wisconsin. Logistic regression compared differences in study outcomes before, early, and later in the COVID-19 public health emergency. Analyses were conducted from January 2021 to October 2021. Early (March 16, 2020, to May 15, 2020) and later (May 16, 2020, to September 30, 2020) in the public health emergency. Person-week outcomes included possession of buprenorphine, completion of outpatient urine drug testing, and receipt of opioid treatment program services. The final cohort of 6453 participants included 3986 (61.8%) childless adults; 5741 (89%) were younger than 50 years, 3435 (53.2%) were women, 5036 (78.0%) White, and 22.0% were racial and ethnic minority groups (American Indian, 269 [4.2%]; Asian, 26 [0.4%]; Black, 458 [7.1%]; Hispanic, 292 [4.5%]; Pacific Islander, 1 [.02%]; Multiracial, 238 [3.7%]). Overall, 2858 (44.3%), 5074 (78.6%), and 2928 (45.4%) received buprenorphine, urine drug testing, or opioid treatment program services during the study period, respectively. Probability of buprenorphine possession did not change in the early or later part of the public health emergency. Probability of urine drug testing initially decreased (marginal effect [ME], -0.04; 95% CI, -0.04 to -0.03; P < .001) and then partially recovered in the later public health emergency (ME, -0.02; 95% CI, -0.03 to -0.02; P < .001). Probability of opioid treatment program services followed a similar pattern, with an early decrease (ME, -0.05; 95% CI, -0.05 to -0.04; P < .001) followed by partial recovery (ME, -0.02; 95% CI, -0.03 to -0.02; P < .001). In a sample of continuously enrolled adult Medicaid beneficiaries, the COVID-19 public health emergency was not associated with decreased probability of buprenorphine possession, but was associated with decreased probability of urine drug testing and opioid treatment program services. These findings suggest patients in office-based settings retained access to buprenorphine despite decreased on-site services like urine drug tests, whereas patients at opioid treatment programs experienced greater disruption in care. Given the importance of medications for opioid use disorder in preventing overdose, policy makers should consider permanent policy changes based on lessons learned from the public health emergency to enable ongoing enhanced access to these medications.

Highlights

Opioid use disorder (OUD) is a chronic relapsing disease that continues to take lives at an escalating rate.[1,2] Against the backdrop of the COVID-19 public health emergency (PHE), opioid-involved overdose deaths reached a record high of 69 710 in 2020.3 Opioid agonist therapy with buprenorphine and methadone are central to the treatment of OUD
In a sample of continuously enrolled adult Medicaid beneficiaries, the COVID-19 public health emergency was not associated with decreased probability of buprenorphine possession, but was associated with decreased probability of urine drug testing and opioid treatment program services
Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic of medications for opioid use disorder in preventing overdose, policy makers should consider permanent policy changes based on lessons learned from the public health emergency to enable ongoing enhanced access to these medications

Summary

Introduction

Opioid use disorder (OUD) is a chronic relapsing disease that continues to take lives at an escalating rate.[1,2] Against the backdrop of the COVID-19 public health emergency (PHE), opioid-involved overdose deaths reached a record high of 69 710 in 2020.3 Opioid agonist therapy with buprenorphine and methadone are central to the treatment of OUD. Against the backdrop of the COVID-19 public health emergency (PHE), opioid-involved overdose deaths reached a record high of 69 710 in 2020.3 Opioid agonist therapy with buprenorphine and methadone are central to the treatment of OUD. The COVID-19 pandemic in early 2020 created barriers to in-person care, potentially disrupting access to opioid agonist therapy. Access to these medications occurs through 2 main settings: office-based opioid treatment, where patients can receive buprenorphine prescriptions, and federally regulated opioid treatment programs (OTPs), where patients can receive dispensed methadone or buprenorphine, usually in the form of daily dosing; more rarely in the form of takehome doses—OTP-dispensed doses for future use. Many patients avoided or delayed in-person care.[7,8] In combination, these factors may have reduced access to opioid agonist therapy. Little research has focused on access to treatment among Medicaid patients,[11] a population vulnerable to the challenges posed by the pandemic owing to higher rates of financial, housing, and employment insecurity.[14,15]

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