scholarly journals ­­Access to Health Insurance and Treatment Utilization for Opioid Use Disorder: Evidence From State Medicaid Expansions

2022 ◽  
Author(s):  
Anusua Datta ◽  
Willie Oglesby ◽  
Brandon George
Keyword(s):  
Substance Use ◽  
State Level ◽  
Opioid Use Disorder ◽  
Treatment Utilization ◽  
Medicaid Expansion ◽  
Opioid Use ◽  
Access To Health ◽  
Medicaid Beneficiaries ◽  
The Impact ◽  
Medicaid Expansions

Abstract Background. Medicaid is a major payer of substance use disorder treatment, yet the impact of Medicaid expansion on the opioid epidemic has not been sufficiently quantified. This study exploits state-level differences in Medicaid expansion to assess the impact of access to health insurance on treatment utilization for opioid use disorder (OUD) for adults in need.Method. We use admissions data from Treatment Episode Data Sets (TEDS) to fit a multivariate difference-in-difference model, with non-expanding states as controls, adjusting for age, gender, race/ethnicity, education, and other state-level factors. Results. Medicaid expansion led to substantial gain in OUD treatment utilization. Admissions for substance use disorder among Medicaid beneficiaries increased by 20-33 percentage points in expansion states. Admissions were significantly higher for the newly eligible Medicaid beneficiaries in the 30-34 age group. We also see an increase in treatment admissions for opioid and heroin use among the elderly over the age of 55. Uninsurance rates show a commensurate decline in the expansion states. Finally, we do not find strong evidence of crowding-out of private insurance. Conclusions. Overall, our findings suggest that Medicaid expansions had a positive impact on the financing and utilization of opioid use treatment.

scholarly journals Adapting inpatient addiction medicine consult services during the COVID-19 pandemic

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Miriam T. H. Harris ◽  
Alyssa Peterkin ◽  
Paxton Bach ◽  
Honora Englander ◽  
Emily Lapidus ◽  
...  
Keyword(s):  
Substance Use ◽  
Discharge Planning ◽  
Medical Center ◽  
Health Care Systems ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
New Haven ◽  
Opioid Use ◽  
Addiction Medicine ◽  
The Impact

Abstract Background We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul’s Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. Experiences ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. Recommendations for the future We believe that ACS were essential to hospitals’ readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

scholarly journals A state-level study of opioid use disorder treatment access and neonatal abstinence syndrome

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth R. Wolf ◽  
Sebastian T. Tong ◽  
Roy T. Sabo ◽  
Steven H. Woolf ◽  
Kassie Abbinanti ◽  
...  
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Illicit Drug ◽  
State Level ◽  
Opioid Use Disorder ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Opioid Use ◽  
Treatment Access ◽  
Disorder Treatment

Abstract Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS. Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of NAS was defined as ICD-9 code 779.5 (drug withdrawal syndrome in newborn) from any discharge diagnosis field per 1000 live births in that state. Results Unmet need for substance use disorder treatment correlated with NAS (r = 0.54, 95% CI: 0.26–0.73). The correlation between adult illicit drug use/dependence and NAS was higher in states with a lower density of buprenorphine-waivered physicians and individuals in OTPs. Conclusions Measures of opioid use disorder treatment access dampened the correlation between illicit drug use/dependence and NAS. Future studies using community- or individual-level data may be better poised to answer the question of whether or not opioid use disorder treatment access improves NAS relative to adult opioid use.

scholarly journals Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States

2019 ◽  
Vol 109 ◽  
pp. 327-333 ◽  
Author(s):  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Medicaid Expansion ◽  
Access To Health ◽  
Interview Survey ◽  
Using Data ◽  
The Impact ◽  
Medicaid Expansions

This paper evaluates the impact of the Affordable Care Act Medicaid expansions four years after implementation using data from the 2010-2017 National Health Interview Survey. We find that low-income adults in states that implemented the Medicaid expansions experienced increases in insurance and Medicaid coverage and improvements in access to health care across several measures.

Impact of Personality Disorder on the Treatment of Psychiatric Disorders in People Receiving Methadone-Assisted Treatment

2019 ◽  
pp. 1-13
Author(s):  
Michael Kidorf ◽  
Stephanie Salazzo ◽  
Robert K. Brooner ◽  
Jessica Peirce ◽  
Jim Gandotra ◽  
...  
Keyword(s):  
Substance Use ◽  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Axis Ii ◽  
Hopkins Symptom Checklist ◽  
Axis I ◽  
Dsm Iv ◽  
The Impact

This study evaluates personality disorder as a moderator of psychiatric treatment response in people receiving methadone-assisted treatment. Participants (N = 125) were enrolled in a 12-week parent study that evaluated the impact of incentives on attendance to psychiatric care. All participants had a current DSM IV-R Axis I disorder and were classified based on presence of an Axis II disorder: Axis I-only (n = 46) versus Axis I + II (n = 79). All participants received an identical protocol of psychiatric and substance use disorder care. Although Axis I + II participants endorsed more psychiatric distress (on the Hopkins Symptom Checklist–Revised) throughout treatment, they reported significant reductions in distress that paralleled reductions reported by Axis I-only participants. Rates of substance use were low and similar across groups. Results support the benefits of integrated psychiatric and substance use care for people with opioid use disorder, with or without a co-occurring personality disorder.

scholarly journals Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach

2021 ◽  
Vol 18 (11) ◽  
pp. 6163
Author(s):  
Rosemarie Martin ◽  
Augustine W. Kang ◽  
Audrey A. DeBritz ◽  
Mary R. Walton ◽  
Ariel Hoadley ◽  
...  
Keyword(s):  
Substance Use ◽  
Mixed Methods ◽  
Telephone Counseling ◽  
Opioid Use Disorder ◽  
Appropriate Technology ◽  
Counseling Services ◽  
Opioid Use ◽  
Qualitative Evidence ◽  
Positive Experiences ◽  
Anxiety Depression

Using quantitative and qualitative evidence, this study triangulates counselors’ perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors’ experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients’ anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

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