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Zhu Y, Baldwin LM, Mooney LJ, Saxon AJ, Kan E, Hser YI. Co-occurring substance use disorders among patients with opioid use disorder in rural primary care clinics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209269. [PMID: 38097045 DOI: 10.1016/j.josat.2023.209269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. METHODS Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. RESULTS We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor. CONCLUSIONS More than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.
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Affiliation(s)
- Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States of America
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States of America
| | - Emily Kan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America.
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Bosak J, Drainoni M, Bryer C, Goodman D, Messersmith L, Declercq E. 'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme. Health Expect 2024; 27:e13908. [PMID: 37920874 PMCID: PMC10726284 DOI: 10.1111/hex.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. METHODS A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. RESULTS The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. CONCLUSION These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. PATIENT CONTRIBUTION Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.
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Affiliation(s)
- Julie Bosak
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Mari‐Lynn Drainoni
- Department of Medicine, Section of Infectious DiseasesBoston University Aram V. Chobanian & Edward Avedisian School of MedicineBostonMassachusettsUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Cheri Bryer
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Daisy Goodman
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Lisa Messersmith
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Eugene Declercq
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
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Rawy M, Abdalla G, Look K. Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999-2018. BMC Public Health 2024; 24:112. [PMID: 38184563 PMCID: PMC10771660 DOI: 10.1186/s12889-023-17563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Psychoactive drug combinations are increasingly contributing to overdose deaths among White and Black Americans. To understand the evolving nature of overdose crisis, inform policies, and develop tailored and equitable interventions, this study provides a comprehensive assessment of polysubstance mortality trends by race and sex during the opioid epidemic. METHODS We used serial cross-sectional US mortality data for White and Black populations from 1999 through 2018 to calculate annual age-adjusted death rates (AADR) involving any opioid, opioid subtypes, benzodiazepines, cocaine, psychostimulants, or combinations of these drugs, stratified by race and sex. Trend changes in AADR were analyzed using joinpoint regression models and expressed as average annual percent change (AAPC) during each period of the three waves of the opioid epidemic: 1999-2010 (wave 1), 2010-2013 (wave 2), and 2013-2018 (wave 3). Prevalence measures assessed the percent co-involvement of an investigated drug in the overall death from another drug. RESULTS Polysubstance mortality has shifted from a modest rise in death rates due to benzodiazepine-opioid overdoses among White persons (wave 1) to a substantial increase in death rates due to illicit drug combinations impacting both White and Black populations (wave 3). Concurrent cocaine-opioid use had the highest polysubstance mortality rates in 2018 among Black (5.28 per 100,000) and White (3.53 per 100,000) persons. The steepest increase in death rates during wave 3 was observed across all psychoactive drugs when combined with synthetic opioids in both racial groups. Since 2013, Black persons have died faster from cocaine-opioid and psychostimulant-opioid overdoses. Between 2013 and 2018, opioids were highly prevalent in cocaine-related deaths, increasing by 33% in White persons compared to 135% in Blacks. By 2018, opioids contributed to approximately half of psychostimulant and 85% of benzodiazepine fatal overdoses in both groups. The magnitude and type of drug combinations with the highest death rates differed by race and sex, with Black men exhibiting the highest overdose burden beginning in 2013. CONCLUSIONS The current drug crisis should be considered in the context of polysubstance use. Effective measures and policies are needed to curb synthetic opioid-involved deaths and address disparate mortality rates in Black communities.
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Affiliation(s)
- Marwa Rawy
- University of Wisconsin-Madison, Madison, USA.
| | | | - Kevin Look
- University of Wisconsin-Madison, Madison, USA
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Apsley HB, Santos-Lozada AR, Gray J, Hard G, Jones AA. Substance Use Treatment Utilization Among Individuals With Substance Use Disorders in the United States During the COVID-19 Pandemic: Findings on the Role of Polysubstance Use, Criminal Justice Involvement, and Mental Illness From the National Survey on Drug Use and Health. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241259947. [PMID: 38881556 PMCID: PMC11177729 DOI: 10.1177/29768357241259947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Abstract
This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs.
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Affiliation(s)
- Hannah B. Apsley
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Alexis R. Santos-Lozada
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Joy Gray
- Department of Educational Psychology, Counseling, & Special Education College of Education, Pennsylvania State University, University Park, PA, USA
| | - Gregory Hard
- MGH Institute of Health Professions, Boston, MA, USA
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, Penn State University, University Park, PA, USA
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El Hajouji O, Sun RS, Zammit A, Humphreys K, Asch SM, Carroll I, Curtin CM, Hernandez-Boussard T. Prediction of opioid-related outcomes in a medicaid surgical population: Evidence to guide postoperative opiate therapy and monitoring. PLoS Comput Biol 2023; 19:e1011376. [PMID: 37578969 PMCID: PMC10449152 DOI: 10.1371/journal.pcbi.1011376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/24/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Treatment of surgical pain is a common reason for opioid prescriptions. Being able to predict which patients are at risk for opioid abuse, dependence, and overdose (opioid-related adverse outcomes [OR-AE]) could help physicians make safer prescription decisions. We aimed to develop a machine-learning algorithm to predict the risk of OR-AE following surgery using Medicaid data with external validation across states. METHODS Five machine learning models were developed and validated across seven US states (90-10 data split). The model output was the risk of OR-AE 6-months following surgery. The models were evaluated using standard metrics and area under the receiver operating characteristic curve (AUC) was used for model comparison. We assessed calibration for the top performing model and generated bootstrap estimations for standard deviations. Decision curves were generated for the top-performing model and logistic regression. RESULTS We evaluated 96,974 surgical patients aged 15 and 64. During the 6-month period following surgery, 10,464 (10.8%) patients had an OR-AE. Outcome rates were significantly higher for patients with depression (17.5%), diabetes (13.1%) or obesity (11.1%). The random forest model achieved the best predictive performance (AUC: 0.877; F1-score: 0.57; recall: 0.69; precision:0.48). An opioid disorder diagnosis prior to surgery was the most important feature for the model, which was well calibrated and had good discrimination. CONCLUSIONS A machine learning models to predict risk of OR-AE following surgery performed well in external validation. This work could be used to assist pain management following surgery for Medicaid beneficiaries and supports a precision medicine approach to opioid prescribing.
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Affiliation(s)
- Oualid El Hajouji
- Department of Medicine, Stanford University, Stanford California, United States of America
- Institute for Computational & Mathematical Engineering, Stanford University, Stanford California, United States of America
| | - Ran S. Sun
- Department of Medicine, Stanford University, Stanford California, United States of America
| | - Alban Zammit
- Department of Medicine, Stanford University, Stanford California, United States of America
- Institute for Computational & Mathematical Engineering, Stanford University, Stanford California, United States of America
| | - Keith Humphreys
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Healthcare System, Palo Alto California, United States of America
- Department of Psychiatry and the Behavioral Sciences, Stanford University, Stanford California, United States of America
| | - Steven M. Asch
- Department of Medicine, Stanford University, Stanford California, United States of America
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Healthcare System, Palo Alto California, United States of America
| | - Ian Carroll
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford California, United States of America
| | - Catherine M. Curtin
- Department of Surgery, VA Palo Alto Health Care System, Menlo Park California, United States of America
- Department of Surgery, Stanford University, Stanford California, United States of America
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford California, United States of America
- Department of Surgery, Stanford University, Stanford California, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford California, United States of America
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Smart R, Kim JY, Kennedy S, Tang L, Allen L, Crane D, Mack A, Mohamoud S, Pauly N, Perez R, Donohue J. Association of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder. J Subst Abuse Treat 2023; 144:108921. [PMID: 36327615 PMCID: PMC10664516 DOI: 10.1016/j.jsat.2022.108921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/22/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention. METHODS Using Medicaid data for 2017-2018 from four states participating in a distributed research network, this retrospective cohort study documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and assesses the extent to which different SUD presentations are associated with differential patterns of MOUD and psychosocial treatments. RESULTS We find that more than half of enrollees with OUD had a co-occurring SUD, and the most prevalent co-occurring SUD was for "other psychoactive substances", indicated among about one-quarter of enrollees with OUD in each state. We also find some substantial gaps in MOUD treatment receipt and engagement for individuals with OUD and a co-occurring SUD, a group representing more than half of individuals with OUD. In most states, enrollees with OUD and alcohol, cannabis, or amphetamine use disorder are significantly less likely to receive MOUD compared to enrollees with OUD only. In contrast, enrollees with OUD and other psychoactive SUD were significantly more likely to receive MOUD treatment. Conditional on MOUD receipt, enrollees with co-occurring SUDs had 10 % to 50 % lower odds of having a 180-day period of continuous MOUD treatment, an important predictor of better patient outcomes. Associations with concurrent receipt of MOUD and behavioral counseling were mixed across states and varied depending on co-occurring SUD type. CONCLUSIONS Overall, ongoing progress toward increasing access to and quality of evidence-based treatment for OUD requires further efforts to ensure that individuals with co-occurring SUDs are engaged and retained in effective treatment. As the opioid crisis evolves, continued changes in drug use patterns and populations experiencing harms may necessitate new policy approaches that more fully address the complex needs of a growing population of individuals with OUD and other types of SUD.
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Affiliation(s)
- Rosanna Smart
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, United States of America.
| | - Joo Yeon Kim
- Department of Health Policy and Management, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA 15261, United States of America.
| | - Susan Kennedy
- AcademyHealth, 1666 K Street NW, Suite 1100, Washington, DC 20006, United States of America.
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States of America.
| | - Lindsay Allen
- Department of Emergency Medicine, Buehler Center for Health Policy & Economics, Northwestern University, 750 N. Lake Shore Drive, Evanston, IL 60611, United States of America.
| | - Dushka Crane
- Government Resource Center, The Ohio State University, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States of America.
| | - Aimee Mack
- Government Resource Center, The Ohio State University, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States of America.
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland Baltimore County, Sondheim Hall, Third Floor, 1000 Hilltop Circle, Baltimore, MD 21250, United States of America.
| | - Nathan Pauly
- Manatt Health Strategies, 151 N Franklin Street, Suite 2600, Chicago, IL 60606, United States of America.
| | - Rosa Perez
- The Hilltop Institute, University of Maryland Baltimore County, Sondheim Hall, Third Floor, 1000 Hilltop Circle, Baltimore, MD 21250, United States of America.
| | - Julie Donohue
- Department of Health Policy and Management, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA 15261, United States of America.
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Alegría M, Falgas-Bague I, Fukuda M, Zhen-Duan J, Weaver C, O’Malley I, Layton T, Wallace J, Zhang L, Markle S, Neighbors C, Lincourt P, Hussain S, Manseau M, Stein BD, Rigotti N, Wakeman S, Kane M, Evins AE, McGuire T. Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York. JAMA HEALTH FORUM 2022; 3:e221771. [PMID: 35977217 PMCID: PMC9250047 DOI: 10.1001/jamahealthforum.2022.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/28/2022] [Indexed: 11/14/2022] Open
Abstract
Importance There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. Objective To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. Design Setting and Participants This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned. Exposures Plan assignment. Main Outcomes and Measures Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment. Results Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans. Conclusions and Relevance The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Cole Weaver
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Isabel O’Malley
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Timothy Layton
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jacob Wallace
- Yale School of Public Health, New Haven, Connecticut
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Sheri Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston
| | - Charles Neighbors
- Grossman School of Medicine, New York University, New York
- Wagner School of Public Service, New York University, New York
| | - Pat Lincourt
- New York State Office of Alcoholism and Substance Abuse Services, Albany, New York
| | - Shazia Hussain
- New York State Office of Alcoholism and Substance Abuse Services, Albany, New York
| | - Marc Manseau
- Grossman School of Medicine, New York University, New York
- New York State Office of Mental Health, New York
| | | | - Nancy Rigotti
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Sarah Wakeman
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Substance Use Disorder Initiative, Massachusetts General Hospital, Boston
| | - Martha Kane
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Addictions Services Unit, Massachusetts General Hospital, Boston
| | - A. Eden Evins
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Addiction Medicine, Massachusetts General Hospital, Boston
| | - Thomas McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Roux AM, Tao S, Marcus S, Lushin V, Shea LL. A national profile of substance use disorder among Medicaid enrollees on the autism spectrum or with intellectual disability. Disabil Health J 2022; 15:101289. [DOI: 10.1016/j.dhjo.2022.101289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
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O'Brien P, Henke RM, Schaefer MB, Lin J, Creedon TB. Adverse events among adult Medicaid enrollees with opioid use disorder and co-occurring substance use disorders. Drug Alcohol Depend 2021; 221:108555. [PMID: 33596496 DOI: 10.1016/j.drugalcdep.2021.108555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is common for adults with opioid use disorder (OUD) to misuse additional substances, and these individuals may be particularly at risk for adverse events, including mortality. Less is known about how continued receipt of prescription opioids or risk of adverse events (e.g., suicidality, overdose, poisoning) differs for people with co-occurring OUD and additional substance use disorders (SUDs). METHODS We conducted a retrospective study using IBM® MarketScan® Multi-State Medicaid Database enrollment/claims data. We used logistic regression to measure the association between sample characteristics and our dependent variables. The sample consisted of non-Medicare-eligible adults aged 18-64 years who were continuously enrolled in Medicaid in 2016-2017 with an OUD diagnosis on at least one claim in 2016. RESULTS Adults with OUD and a co-occurring SUD were more likely than adults with OUD only to have an opioid-related poisoning event (odds ratio [OR] = 1.488, p = .0052), all-cause poisoning (OR = 1.756, p < .0001), or suicidal ideation (OR = 1.796, p < .0001) but not to receive ongoing opioid prescriptions (OR = 0.973, p = .1626). Adverse events varied by OUD-SUD combination. For example, adults with OUD and cocaine use disorder had the highest odds of all-cause (OR = 2.393, p < .0001) or opioid-related (OR = 1.890, p = .0027) poisoning among those with a drug-specific diagnosis and were most likely to be diagnosed with suicidal ideation (OR = 2.465, p < .0001). CONCLUSIONS This study provides evidence that adults with OUD and a co-occurring additional SUD have increased risk for several adverse events. Multisubstance use should be screened for and identified to determine the most appropriate course of treatment.
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Affiliation(s)
- Peggy O'Brien
- IBM Watson Health, 5425 Hollister Avenue, Suite 140, Santa Barbara, CA 93111, USA.
| | | | | | - Janice Lin
- IBM Watson Health, 7700 Old Georgetown Road, Suite 650, Bethesda, MD 20814, USA
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02141, USA.
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