Association between trajectories of buprenorphine treatment and emergency department and in‐patient utilization

Lo-Ciganic, Wei Hsuan; Gellad, Walid F.; Gordon, Adam J.; Cochran, Gerald; Zemaitis, Michael A.; Cathers, Terri; Kelley, David; Donohue, Julie M.

doi:10.1111/add.13270

Cited by 99 publications

(100 citation statements)

References 54 publications

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“…Although a trend, patients with persistent use of buprenorphine were less likely to use the ED, with one interpretation being that they were more stable in terms of their health and in less need of ED services. This is consistent with prior literature, and in addition to improved patient outcomes, would be a benefit to health systems (Schwarz et al 2012; Lo-Ciganic et al 2016; Tkacz et al 2014). Although it is not possible with the present data, it is important to examine the relationship of persistent use of buprenorphine over the longer term to services utilization and other outcomes, since little is known about patients who use buprenorphine over the long term.…”

Section: Discussionsupporting

confidence: 91%

“…However, patients with OUD who are maintained on buprenorphine may have higher functioning and improved health, and potentially more appropriate use of health services. For example, three recent studies indicated that patients with longer retention on buprenorphine had lower likelihood of using expensive services such as the ED and hospitalizations (Schwarz et al 2012; Lo-Ciganic et al 2016; Tkacz et al 2014). Thus, while buprenorphine patients are likely to have multiple health service needs, effective OUD treatment could lead to lower service utilization over time.…”

Section: Introductionmentioning

confidence: 99%

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Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

Campbell

Parthasarathy

Young-Wolff

et al. 2017

Journal of Psychoactive Drugs

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Introduction The Affordable Care Act (ACA) was expected to benefit patients with substance use disorders, including opioid use disorders (OUDs). This study examined buprenorphine use and health services utilization by patients with OUDs pre- and post-ACA in a large health care system. Methods Using electronic health record data, we examined demographic and clinical characteristics (substance use, psychiatric and medical conditions) of two patient cohorts using buprenorphine: those newly enrolled in 2012 (“pre-ACA”, N=204) and in 2014 (“post-ACA”, N=258). Logistic and negative binomial regressions were used to model persistent buprenorphine use, and to examine whether persistent use was related to health services utilization. Results Buprenorphine patients were largely similar pre- and post-ACA, although more post-ACA patients had a marijuana use disorder (p<.01). Post-ACA patients were more likely to have high deductible benefit plans (p<.01). Use of psychiatry services was lower post-ACA (IRR: 0.56, p<.01), and high deductible plans were also related to lower use of psychiatry services (IRR: 0.30, p<.01). Conclusion The relationship between marijuana use disorder and prescription opioid use is complex, and deserves further study, particularly with increasingly widespread marijuana legalization. Access to psychiatry services may be more challenging for buprenorphine patients post-ACA, especially for patients with deductible plans.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

Campbell

Parthasarathy

Young-Wolff

et al. 2017

Journal of Psychoactive Drugs

View full text Add to dashboard Cite

show abstract

“…The median treatment duration (53 days) was lower than expected given clinical recommendations of maintenance treatment for up to 12 months 3 and evidence linking longer treatment to better outcomes. 1,4 The findings are limited in that prescriber waiver status is unknown as is patient clinical status; we cannot exclude the possibility that buprenorphine was prescribed off-label for pain.…”

Section: Discussionmentioning

confidence: 94%

Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment

Stein

Sorbero

Dick

et al. 2016

JAMA

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107

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“…Achieving OBOT veteran status is important as there are significant benefits associated with remaining on buprenorphine for at least one year, including decreased opioid use,(Hser et al, 2016) as well as decreased hospitalizations and emergency department visits. (Lo-Ciganic et al, 2016) Additionally, patients in recovery from heroin use for at least one year report improved quality of life. (Best et al, 2012)…”

Section: 0 Discussionmentioning

confidence: 99%

Long-term retention in Office Based Opioid Treatment with buprenorphine

Weinstein

Kim

Cheng

et al. 2017

Journal of Substance Abuse Treatment

167

138

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Background Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Methods This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations. Results There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1 year retention. Conclusions Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1 year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.

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Association between trajectories of buprenorphine treatment and emergency department and in‐patient utilization

Cited by 99 publications

References 54 publications

Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System

Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment

Long-term retention in Office Based Opioid Treatment with buprenorphine

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