Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Yet few affected people receive treatment for OUD and a minority of those who receive treatment are effectively retained in care. The purpose of this study was to examine duration of buprenorphine treatment for OUD following treatment initiation to identify risk factors for early discontinuation. Methods: We analyzed insurance claims from the 2013–2015 MarketScan multi-state Medicaid database. The sample included adults 18–64 years old with an OUD diagnosis in the 6 months before initiating buprenorphine treatment, defined as 6 months without a buprenorphine claim prior to the index buprenorphine claim (N=17,329 individuals). We used Cox proportional hazards regression to estimate risk of discontinuing treatment (>30 days without buprenorphine supply), and logistic regression to estimate the odds of persistent treatment for a minimum of 180 days. Results: Over one-quarter of the sample discontinued buprenorphine in the first month of treatment (N=4,928; 28.4%) and most discontinued before 180 days (N=11,189; 64.6%). In the proportional hazards model, risk factors for discontinuation included a lower initial buprenorphine dose (≤4mg; Hazard Ratio [HR]=1.72, p<.001), male sex (HR=1.19, p<.001), younger age (HR=1.34, p<.001), minority race/ethnicity (black HR=1.31, p<.001; Hispanic HR=1.24, p=.01; other HR=1.09, p<.001), capitated insurance (HR=1.21, p<.001), comorbid substance use disorders (alcohol HR=1.07, p=.04; non-opioid drugs HR=1.14, p<.001), hepatitis C (HR=1.06, p=.01), opioid overdose history (HR=1.20, p=.001), or any inpatient care (HR=1.22, p<.001) in the 6-month baseline period. In logistic models, these risk factors were similarly associated with significantly lower odds of treatment retention for at least 180 days. Conclusion: For Medicaid beneficiaries with OUD treated with buprenorphine, there is a need to implement treatment models that more effectively address barriers to treatment retention. These barriers are particularly challenging for minorities, younger individuals, and those with additional substance use disorders.

Objective: Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. Adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum. Methods: A retrospective longitudinal cohort analysis was performed using the MarketScan multi-state Medicaid claims database (2013-2017), covering 12 million beneficiaries annually. The sample included adults (18-64 years of age) who received buprenorphine continuously for ≥180 days by cohorts retained for 6-9 months, 9-12 months, 12-15 months, and 15-18 months. For outcome assessment in the postdiscontinuation period, patients had to be continuously enrolled in Medicaid for 6 months after buprenorphine discontinuation. Primary adverse outcomes included all-cause emergency department visits, all-cause in-patient hospitalizations, opioid prescriptions, and drug overdose (opioid or non-opioid). Results: Adverse events were common across all cohorts, and almost half of patients (42.1%-49.9%) were seen in the emergency department at least once. Compared with patients retained on buprenorphine for 6-9 months (N=4,126), those retained for 15-18 months (N=931) had significantly lower odds of emergency department visits (odds ratio=0.75, 95% CI = 0.65-0.86), in-patient hospitalizations (odds ratio=0.79, 95% CI=0.64-0.99), and filling opioid prescriptions

This cross-sectional study of respondents to the National Survey on Drug Use and Health evaluates rates of medication for opioid use disorder receipt among people with need for treatment as well as associated sociodemographic characteristics.

Given the possibility of obscured concussion deficits after injury, implications for premature return to play, and the need to target psychological distress outright, these findings heighten the clinical importance of screening for psychological distress during baseline and post-injury concussion evaluations.