Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018

Julie M. Donohue; Marian P. Jarlenski; Joo Yeon Kim; Lu Tang; Katherine Ahrens; Lindsay Allen; Anna Austin; Andrew J. Barnes; Marguerite Burns; Chung Chou H. Chang; Sarah Clark; Evan Cole; Dushka Crane; Peter Cunningham; David Idala; Stefanie Junker; Paul Lanier; Rachel Mauk; Mary Joan McDuffie; Shamis Mohamoud; Nathan Pauly; Logan Sheets; Jeffery Talbert; Kara Zivin; Adam J. Gordon; Susan Kennedy

doi:10.1001/jama.2021.7374

Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018

Julie M. Donohue^*, Marian P. Jarlenski, Joo Yeon Kim, Lu Tang, Katherine Ahrens, Lindsay Allen, Anna Austin, Andrew J. Barnes, Marguerite Burns, Chung Chou H. Chang, Sarah Clark, Evan Cole, Dushka Crane, Peter Cunningham, David Idala, Stefanie Junker, Paul Lanier, Rachel Mauk, Mary Joan McDuffie, Shamis MohamoudNathan Pauly, Logan Sheets, Jeffery Talbert, Kara Zivin, Adam J. Gordon, Susan Kennedy

^*Corresponding author for this work

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. Design, Setting, and Participants: Exploratory serial cross-sectional study of 1024301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. Exposures: Calendar year, demographic characteristics, eligibility groups, and comorbidities. Main Outcomes and Measures: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). Results: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290628 of 8737082) in 2014 to 5.0% (527983 of 10585790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P <.001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P <.001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P <.001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. Conclusions and Relevance: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research..

Original language	English (US)
Pages (from-to)	154-164
Number of pages	11
Journal	JAMA - Journal of the American Medical Association
Volume	326
Issue number	2
DOIs	https://doi.org/10.1001/jama.2021.7374
State	Published - Jul 13 2021

Funding

reported receiving support from the Maine Department of Health cooperative agreement. Dr Chang reported receiving grants from National Institutes of Health (NIH). Dr Cunningham reported receiving support from the Virginia Department of Medical Assistance contract to evaluate Addiction and Recovery Treatment Services program. Dr Mauk reported receiving grants from the NIH and support from the Ohio Department of Medicaid. Ms McDuffie reported receiving grants from the Delaware Division of Medicaid and Medical Assistance. Dr Gordon reported receiving institutional support from grants CIN 13-414 from the Department of Veterans Affairs' Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, and 1UG1DA049444-01 from the National Institute on Drug Abuse; serving on the board of directors (not compensated) for the American Society of Addiction Medicine (ASAM), the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA), and the International Society of Addiction Journal Editors (ISAJE); and receiving royalties from the medical online reference, UpToDate. No other disclosures were reported. Funding/Support: This study was supported by

ASJC Scopus subject areas

General Medicine

Access to Document

10.1001/jama.2021.7374

Cite this

Donohue, J. M., Jarlenski, M. P., Kim, J. Y., Tang, L., Ahrens, K., Allen, L., Austin, A., Barnes, A. J., Burns, M., Chang, C. C. H., Clark, S., Cole, E., Crane, D., Cunningham, P., Idala, D., Junker, S., Lanier, P., Mauk, R., McDuffie, M. J., ... Kennedy, S. (2021). Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018. JAMA - Journal of the American Medical Association, 326(2), 154-164. https://doi.org/10.1001/jama.2021.7374

@article{506868e7108d4e0886e00e015bf7d61a,

title = "Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018",

abstract = "Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. Design, Setting, and Participants: Exploratory serial cross-sectional study of 1024301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. Exposures: Calendar year, demographic characteristics, eligibility groups, and comorbidities. Main Outcomes and Measures: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). Results: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290628 of 8737082) in 2014 to 5.0% (527983 of 10585790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P <.001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P <.001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P <.001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. Conclusions and Relevance: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research..",

author = "Donohue, {Julie M.} and Jarlenski, {Marian P.} and Kim, {Joo Yeon} and Lu Tang and Katherine Ahrens and Lindsay Allen and Anna Austin and Barnes, {Andrew J.} and Marguerite Burns and Chang, {Chung Chou H.} and Sarah Clark and Evan Cole and Dushka Crane and Peter Cunningham and David Idala and Stefanie Junker and Paul Lanier and Rachel Mauk and McDuffie, {Mary Joan} and Shamis Mohamoud and Nathan Pauly and Logan Sheets and Jeffery Talbert and Kara Zivin and Gordon, {Adam J.} and Susan Kennedy",

note = "Funding Information: reported receiving support from the Maine Department of Health cooperative agreement. Dr Chang reported receiving grants from National Institutes of Health (NIH). Dr Cunningham reported receiving support from the Virginia Department of Medical Assistance contract to evaluate Addiction and Recovery Treatment Services program. Dr Mauk reported receiving grants from the NIH and support from the Ohio Department of Medicaid. Ms McDuffie reported receiving grants from the Delaware Division of Medicaid and Medical Assistance. Dr Gordon reported receiving institutional support from grants CIN 13-414 from the Department of Veterans Affairs' Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, and 1UG1DA049444-01 from the National Institute on Drug Abuse; serving on the board of directors (not compensated) for the American Society of Addiction Medicine (ASAM), the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA), and the International Society of Addiction Journal Editors (ISAJE); and receiving royalties from the medical online reference, UpToDate. No other disclosures were reported. Funding Information: Funding/Support: This study was supported by Publisher Copyright: {\textcopyright} 2021 American Medical Association. All rights reserved.",

year = "2021",

month = jul,

day = "13",

doi = "10.1001/jama.2021.7374",

language = "English (US)",

volume = "326",

pages = "154--164",

journal = "JAMA - Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "2",

}

Donohue, JM, Jarlenski, MP, Kim, JY, Tang, L, Ahrens, K, Allen, L, Austin, A, Barnes, AJ, Burns, M, Chang, CCH, Clark, S, Cole, E, Crane, D, Cunningham, P, Idala, D, Junker, S, Lanier, P, Mauk, R, McDuffie, MJ, Mohamoud, S, Pauly, N, Sheets, L, Talbert, J, Zivin, K, Gordon, AJ & Kennedy, S 2021, 'Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018', JAMA - Journal of the American Medical Association, vol. 326, no. 2, pp. 154-164. https://doi.org/10.1001/jama.2021.7374

TY - JOUR

T1 - Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018

AU - Donohue, Julie M.

AU - Jarlenski, Marian P.

AU - Kim, Joo Yeon

AU - Tang, Lu

AU - Ahrens, Katherine

AU - Allen, Lindsay

AU - Austin, Anna

AU - Barnes, Andrew J.

AU - Burns, Marguerite

AU - Chang, Chung Chou H.

AU - Clark, Sarah

AU - Cole, Evan

AU - Crane, Dushka

AU - Cunningham, Peter

AU - Idala, David

AU - Junker, Stefanie

AU - Lanier, Paul

AU - Mauk, Rachel

AU - McDuffie, Mary Joan

AU - Mohamoud, Shamis

AU - Pauly, Nathan

AU - Sheets, Logan

AU - Talbert, Jeffery

AU - Zivin, Kara

AU - Gordon, Adam J.

AU - Kennedy, Susan

N1 - Funding Information: reported receiving support from the Maine Department of Health cooperative agreement. Dr Chang reported receiving grants from National Institutes of Health (NIH). Dr Cunningham reported receiving support from the Virginia Department of Medical Assistance contract to evaluate Addiction and Recovery Treatment Services program. Dr Mauk reported receiving grants from the NIH and support from the Ohio Department of Medicaid. Ms McDuffie reported receiving grants from the Delaware Division of Medicaid and Medical Assistance. Dr Gordon reported receiving institutional support from grants CIN 13-414 from the Department of Veterans Affairs' Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, and 1UG1DA049444-01 from the National Institute on Drug Abuse; serving on the board of directors (not compensated) for the American Society of Addiction Medicine (ASAM), the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA), and the International Society of Addiction Journal Editors (ISAJE); and receiving royalties from the medical online reference, UpToDate. No other disclosures were reported. Funding Information: Funding/Support: This study was supported by Publisher Copyright: © 2021 American Medical Association. All rights reserved.

PY - 2021/7/13

Y1 - 2021/7/13

N2 - Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. Design, Setting, and Participants: Exploratory serial cross-sectional study of 1024301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. Exposures: Calendar year, demographic characteristics, eligibility groups, and comorbidities. Main Outcomes and Measures: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). Results: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290628 of 8737082) in 2014 to 5.0% (527983 of 10585790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P <.001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P <.001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P <.001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. Conclusions and Relevance: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research..

AB - Importance: There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. Objective: To examine the use of medications for OUD and potential indicators of quality of care in multiple states. Design, Setting, and Participants: Exploratory serial cross-sectional study of 1024301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. Exposures: Calendar year, demographic characteristics, eligibility groups, and comorbidities. Main Outcomes and Measures: Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). Results: In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290628 of 8737082) in 2014 to 5.0% (527983 of 10585790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P <.001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P <.001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P <.001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. Conclusions and Relevance: Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research..

UR - http://www.scopus.com/inward/record.url?scp=85110574458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85110574458&partnerID=8YFLogxK

U2 - 10.1001/jama.2021.7374

DO - 10.1001/jama.2021.7374

M3 - Article

C2 - 34255008

AN - SCOPUS:85110574458

SN - 0098-7484

VL - 326

SP - 154

EP - 164

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

IS - 2

ER -

Use of Medications for Treatment of Opioid Use Disorder among US Medicaid Enrollees in 11 States, 2014-2018

Abstract

Funding

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this