Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid

Frazier, Winfred; Cochran, Gerald; Lo‐Ciganic, Wei‐Hsuan; Gellad, Walid F.; Gordon, Adam J.; Chang, Chung‐Chou H.; Donohue, Julie M.

doi:10.1001/jama.2017.7818

Cited by 59 publications

(43 citation statements)

References 5 publications

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“…Less than 10% of people every month post-overdose received MOUD or mental health counseling, which is below rates reported in other states. 2,3 In our analysis, MOUD only includes buprenorphine and naltrexone because West Virginia Medicaid did not cover methadone. Despite high rates of mental health comorbidities, people saw little to no change in receipt of counseling or medications for OUD or mental health conditions post-overdose.…”

Section: Discussionmentioning

confidence: 99%

“…1 Post-overdose medications for opioid use disorder (MOUD) are protective against future deaths, 2 yet are infrequently prescribed. [2][3][4] Mental health disorders increase opioid overdose risk. 5 Given the substantial burden of psychiatric comorbidities among people who overdose, it is important to understand how both MOUD and treatment for co-occurring mental health conditions change following overdoses.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Outpatient Services and Medication Use Following a Non-fatal Opioid Overdose in the West Virginia Medicaid Program

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in Outpatient Services and Medication Use Following a Non-fatal Opioid Overdose in the West Virginia Medicaid Program

et al. 2019

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“…The measure assessing initiation of AOD treatment within 14 days of a new OUD diagnosis or those with OUD counseled on available treatments can be applied to patients identified with OUD in primary care settings. Currently, many individuals with OUD who overdose or experience complications (such as Hepatitis C, HIV infection, or abscesses) receive acute services, but are not effectively engaged in care to treat their underlying OUD (Frazier, Cochran, et al, 2017; Larochelle, Liebschutz, Zhang, Ross-Dengan, & Wharam, 2016). …”

Section: Discussionmentioning

confidence: 99%

Developing an opioid use disorder treatment cascade: A review of quality measures

Williams

Nunes

Bisaga

et al. 2018

Journal of Substance Abuse Treatment

125

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Background Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. Methods Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. Results Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. Conclusion Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.

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“…Given that polysubstance use contributes to overdose, assessing, and addressing polysubstance use engagement among survivors of drug overdose may be an effective avenue for intervention; however, research suggests that such opportunistic interventions are underutilized . From both an individual and public health standpoint, state overdose surveillance systems should be improved to provide expedient, comprehensive toxicology testing to identify specific drugs involved …”

Section: Discussionmentioning

confidence: 99%

Expectations about alcohol, cocaine, and benzodiazepine abstinence following inpatient heroin withdrawal management

et al. 2018

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Background and Objectives: Polysubstance use is associated with relapse and poor treatment outcomes among people dependent on heroin. Despite the high prevalence of polysubstance use among patients detoxifying from heroin, little is known about patients' expectations to abstain or use non-opiate substances. The current study examined factors associated with expectations about abstaining from alcohol, cocaine, and benzodiazepines (BZDs) following heroin withdrawal management. Methods: Between May and December of 2015, we surveyed 417 patients (71.9% male, 31.7 [AE8.39] mean years old) initiating shortterm inpatient heroin withdrawal management who reported alcohol, cocaine, or BZD use in the past 30 days. We used logistic regression to evaluate the adjusted associations of background characteristics with expectations about using each substance following discharge.Results: Approximately half of respondents reported past month alcohol (52%), cocaine (47.0%), or BZD (47.0%) use, and 25.9% reported using all three substances. Approximately half of those reporting drinking, 6.6% reporting cocaine use, and 27% of reporting BZD use expected to abstain from using that substance following heroin withdrawal. Prior opioid withdrawal was associated with a lower likelihood of expecting to stop using alcohol and BZDs, and more days of BZD use was associated with a greater likelihood of expecting to abstain from BZDs following discharge. Conclusion: Persons with opioid use disorder often do not expect to stop using other substances following withdrawal management, with very few planning cocaine cessation. Scientific Significance: Inpatient heroin withdrawal programs need to address and educate patients about how polysubstance use complicates recovery from heroin use. (Am J Addict

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Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid

Abstract: Author Contributions: Drs Kazi and Bibbins-Domingo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 59 publications

References 5 publications

Changes in Outpatient Services and Medication Use Following a Non-fatal Opioid Overdose in the West Virginia Medicaid Program

Changes in Outpatient Services and Medication Use Following a Non-fatal Opioid Overdose in the West Virginia Medicaid Program

Developing an opioid use disorder treatment cascade: A review of quality measures

Expectations about alcohol, cocaine, and benzodiazepine abstinence following inpatient heroin withdrawal management

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