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Only Modest Changes in Opioid Prescribing and Addiction Treatment After Overdose for Pa. Medicaid Recipients

PITTSBURGH, Aug. 22, 2017 Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose, revealed a University of Pittsburgh Graduate School of Public Health analysis published today in the Journal of the American Medical Association.
 
“Our findings signal a relatively weak health system response to a potentially life-threatening event,” said senior author Julie M. Donohue, Ph.D., associate professor in Pitt Public Health’s Department of Health Policy and Management and director of the Medicaid Research Center in Pitt’s Health Policy Institute. “However, they also point to opportunities for interventions that could prevent future overdoses in a particularly vulnerable population.”
 
Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC).
 
Donohue and her colleagues analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting.
 
Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points.
 
Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Donohue’s team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.
 
Several interventions that can be initiated within the medical system have been shown to reduce overdose risk, Donohue said. Aside from medication-assisted treatment, these include notifications to clinicians for patients previously treated for overdose so the clinician is more aware when considering an opioid prescription and emergency department-initiated naloxone education and distribution to the patient and their friends or family.
 
“When patients are seen for an overdose, it is a chance for the medical system to not only stabilize them, but engage patients in addiction treatment programs when needed and take steps to reduce the likelihood of another overdose,” said Donohue. “Based on our data, I do not believe this opportunity is being fully realized.”
 
Winfred Frazier, M.D., M.P.H., of Pitt Public Health, is lead author on the study. Additional authors are Gerald Cochran, Ph.D., and Chung-Chou H. Chang, Ph.D., of Pitt; Wei-Hsuan Lo-Ciganic, Ph.D., M.S., M.S.Pharm., of the University of Arizona; Walid F. Gellad, M.D., M.P.H., of the Veterans Affairs Pittsburgh Healthcare System; and Adam J. Gordon, M.D., M.P.H., of the University of Utah.
 
This research was supported by CDC grant U01CE002496 and an intergovernmental agreement between the Pennsylvania Department of Human Services and Pitt.

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