Substantially more people in the U.S. with opioid use disorder are receiving evidence-based treatment for the disease, but there are still considerable gaps in care along racial lines, according to the largest analysis to date of opioid use disorder among Medicaid recipients.
The results, published in JAMA, provide insights that policymakers and medical providers can act on to improve access to quality care for opioid use disorder, one of the leading causes of death in the U.S. The analysis was possible because of a unique network that partnered academic institutes with state Medicaid programs to overcome barriers to data sharing between states.
Julie Donohue said, “Medicaid plays an incredibly important role in our health system, and the population it serves overlaps with those most likely to have opioid use disorder. But Medicaid is 50-plus separate programs that can’t easily share data,” said co-author Julie Donohue, PhD, chair and professor of the University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management. “For the first time, we’ve pooled a large part of that data, enabling us to draw powerful conclusions that could better enable our country to address the opioid epidemic, which has only grown more intense during the COVID-19 pandemic.”
The Medicaid Outcomes Distributed Research Network (MODRN), which Donohue leads, obtained de-identified, standardized data from 11 states, including Pennsylvania and five other states that rank among the highest for opioid overdose deaths, accounting for 16.3 million people aged 12 through 64, or 22% of Medicaid’s enrollees.
The prevalence of opioid use disorder increased from 3.3% of enrollees in 2014 to 5% in 2018. Notably, the share of enrollees with opioid use disorder enrolled in Medicaid due to the ACA expansion grew from 27.3% to 50.7% in the same time period.
There are several medications—buprenorphine, methadone and naltrexone—to treat opioid use disorder. These medications work best when taken continuously, so the MODRN team looked at several indicators of quality of care, including at least one period of 180 days of continuous medication, at least one order for a urine drug test and at least one claim for behavioral health counseling. They also looked into whether people with opioid use disorder were being prescribed other controlled substances associated with increased risk of overdose, such as benzodiazepines, which would indicate a clinician hadn’t adequately reviewed their medical history.
States that legalize recreational marijuana experience a short-term decline in opioid-related emergency department visits, particularly among 25- to 44-year-olds and men, according to an analysis led by the University of Pittsburgh Graduate School of Public Health.
Published in the journal Health Economics, the study shows that even after the temporary decline wears off, recreational cannabis laws are not associated with increases in opioid-related emergency department visits.
Drake and his colleagues analyzed data on emergency department visits involving opioids from 29 states between 2011 and 2017. The study included four states that legalized recreational marijuana during that time frame: California, Maine, Massachusetts and Nevada. The remaining 25 states acted as controls.