Treatment of Opioid Use Disorder Increased from 2014 - 2018 Among Medicaid Enrollees

Julie M. Donohue, PhD

While Medicaid is the largest financing source in the United States for opioid use disorder (OUD) treatment, covering 38% of patients, there is a lack of data on Medicaid regarding the differences in use of medication for OUD.

Investigators, led by Julie M. Donohue, PhD, Health Policy and Management, University of Pittsburgh Graduate School of Public Health, found among US Medicaid enrollees in 11 states examined, the treatment of OUD increased from 2014 - 2018.

Study

Investigators performed an exploratory serial cross-sectional study including 1,024,301 Medicaid enrollees in 11 states, aged 12 - 64 years old.

Eligible patients were classified with International Classification of Diseases codes for OUD from January 2014 - December 2018.

The data was obtained from Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, and Wisconsin, accounting for 16.3 million Medicaid enrollees.

Investigators noted the states include 6 of 10 states ranking highest in overdose deaths.

The team created an indicator of any medications for OUD during the same year as OUD diagnosis, regardless of timing of treatment in respect to diagnosis.

In addition, they measured use of buprenorphine, buprenorphine-naloxone, and naltrexone through prescription fills from retail pharmacy claims or procedure codes for administration of medication in an office setting or a licensed opioid treatment facility.

Investigators indicated demographic characteristics of enrollees diagnosed with OUD including age, sex, and race/ethnicity.

In addition, the team created 5 standardized, exclusive eligibility groups as person-year, including pregnant women, youth, adults with disability-related Medicaid eligibility, adults newly eligible under the ACA Medicaid expansion, and traditionally eligible non-disabled adults.

Each state in the study used generalized estimated equations in determining association between characteristics and outcome measure prevalence.

Further, it was pooled to create global estimates using random effects meta-analyses.

Investigators restricted measures to beneficiaries enrolled in Medicaid for 180 or more days after OUD medication claim. They further created indicators for patients who had ≥1 claim for urine drug test or ≥1 behavioral health counseling.

Lastly, investigators indicated use of other controlled substances associated with increased risk of overdose, including medications for OUD filled prescriptions of opioid analgesics not used for treatment of OUD or benzodiazepines.

Results

Of the study population, 41.7% of Medicaid enrollees with OUD were 21 - 34 years, with 51.2% female and 76.1% non-Hispanic White.

Data also show 50.7% of enrollees were eligible through Medicaid expansion and 50.6% had other substance use disorders.

Investigators found the prevalence of OUD diagnosis increased in the 11 states from 3.3% (290,628 or 8,737,082) in 2014 to 5.0% (527,983 of 10,585,790) in 2018.

Further, the number of Medicaid enrollees in the 11 states receiving medication treatment increased from 47.8% to 57.1% with some variation across states.

In addition, the team observed the overall prevalence of enrollees receiving 180 days of continuous medication for OUD did not significantly change from the 2014 - 2015 period, compared to the 2017 - 2018 (−0.01 prevalence difference, 95% CI, −0.03 to 0.02).

They noted a variability in trend by state (90% prediction interval, -0.08 - 0.06).

Moreover, a receipt of ≥1 urine drug test among enrollees using medications for OUD increased (prevalence difference, 0.02; 95% CI, 0.00 to 0.04; 90% prediction interval, −0.04 - 0.08)

The team observed variability across states in the level and trend in use of behavioral health counseling for patients receiving medication for OUD.

Furthermore, non-hispanic black enrollees had lower OUD medication compared to White enrollees (prevalence ratio (PR), 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 - 1.00).

Comparatively, pregnant women had higher use of OUD medication (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38), as well as medication continuity (PR, 1.14; 95% CI, 1.10 - 1.17, P < .001; 90% prediction interval, 1.06 - 1.22) than other eligibility groups.

Conclusion

Investigators concluded that among US Medicaid enrollees in the 11 states noted, the prevalence of medication use for OUD increased from 2014 - 2018.

However, they observed gaps in treatment with substantial variability across states, as well as noting the pattern in other states required further research.

“Increased rates of treatment may reflect states’ use of federal funds to enhance treatment capacity,” investigators wrote. “Reduced stigma may have contributed to increased treatment. Improved understanding of factors driving increased use of medications for OUD is crucial to closing remaining treatment gaps.”

The study, “​​Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018,” was published online in JAMA.