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Jaiswal J, Griffin M, LoSchiavo C, Cox A, Hascher K, Dunlap K, Walters S, Burton WM, Grin B, Mumba M, Eaton E. Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma. Subst Use Misuse 2023; 58:1866-1873. [PMID: 37818832 PMCID: PMC10873058 DOI: 10.1080/10826084.2023.2257308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. METHODS Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. CONCLUSION To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.
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Affiliation(s)
- Jessica Jaiswal
- Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Caleb LoSchiavo
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Amanda Cox
- Institute of Data and Analytics, University of Alabama, Tuscaloosa, AL, USA
| | | | - Kandyce Dunlap
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
| | | | - Wanda M Burton
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Benjamin Grin
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Mercy Mumba
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Ellen Eaton
- Division of Infectious Diseases, University of Alabama-Birmingham, Birmingham, AL, USA
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Frimpong JA, Parish CL, Feaster DJ, Gooden LK, Nelson MC, Matheson T, Siegel K, Haynes L, Linas BP, Assoumou SA, Tross S, Kyle T, Liguori TK, Toussaint O, Annane D, Metsch LR. A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs. Trials 2023; 24:609. [PMID: 37749635 PMCID: PMC10521543 DOI: 10.1186/s13063-023-07602-8] [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: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND People with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the USA offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance. METHODS/DESIGN In this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based "practice coaching" (PC) interventions on the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e.g., HIV and HCV testing at 6-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7-12 months after randomization. DISCUSSION Innovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health. TRIAL REGISTRATION ClinicalTrials.gov NCT03135886. Registered on 2 May 2017.
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Affiliation(s)
- Jemima A Frimpong
- New York University Abu Dhabi, Saadiyat Island, PO BOX 129188, Abu Dhabi, UAE.
| | - Carrigan L Parish
- Department of Sociomedical Sciences Miami Research Center, Columbia University, 1120 NW 14 Street Room 1030, Miami, FL, 33136, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Room 1059, Miami, FL, 33136, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences Miami Research Center, Columbia University, 1120 NW 14 Street Room 1030, Miami, FL, 33136, USA
| | - Mindy C Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Room 1059, Miami, FL, 33136, USA
| | - Tim Matheson
- San Francisco Dept of Public Health (SFDPH), 25 Van Ness Avenue; Suite 500, San Francisco, CA, 94102, USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University, 722 West 168 Street, NY, NY, 10032, USA
| | - Louise Haynes
- Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Benjamin P Linas
- Boston Medical Center, Crosstown Building, 801 Massachusetts Ave Office 2007, Boston, MA, 02118, USA
| | - Sabrina A Assoumou
- Boston Medical Center, Crosstown Building, 801 Massachusetts Ave Office 2007, Boston, MA, 02118, USA
| | - Susan Tross
- HIV Center For Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, N.Y., 10032, USA
| | - Tiffany Kyle
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Room 1059, Miami, FL, 33136, USA
| | - Terri K Liguori
- Department of Sociomedical Sciences Miami Research Center, Columbia University, 1120 NW 14 Street Room 1030, Miami, FL, 33136, USA
| | - Oliene Toussaint
- Department of Sociomedical Sciences Miami Research Center, Columbia University, 1120 NW 14 Street Room 1030, Miami, FL, 33136, USA
| | - Debra Annane
- Health Foundation of South Florida, 2 South Biscayne Blvd., Suite 1710, Miami, FL, 33131, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences and Columbia School of General Studies, Columbia University, 2970 Broadway, 612 Lewisohn Hall, New York, NY, 10026, USA
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Frimpong JA, Parish C, Feaster DJ, Gooden LK, Matheson T, Haynes L, Linas BP, Assoumou SA, Tross S, Kyle T, Nelson CM, Liguori TK, Toussaint O, Siegel K, Annane D, Metsch LR. A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs. RESEARCH SQUARE 2023:rs.3.rs-3059783. [PMID: 37461594 PMCID: PMC10350190 DOI: 10.21203/rs.3.rs-3059783/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background People with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the United States offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance. Methods/Design In this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based "practice coaching" (PC) interventions on: the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e,g., HIV and HCV testing at six-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7-12 months after randomization. Discussion Innovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health. Trial registration ClinicalTrials.gov: NCT03135886. (02 05 2017).
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Affiliation(s)
- Jemima A Frimpong
- Jemima A. Frimpong, New York University Abu Dhabi, PO BOX 129188, Saadiyat Island, Abu Dhabi, UAE
| | - Carrigan Parish
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1030, Miami, FL 33136
| | - Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1059, Miami, FL 33136
| | - Lauren K Gooden
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1030, Miami, FL 33136
| | - Tim Matheson
- San Francisco Dept of Public Health (SFDPH), 25 Van Ness Avenue; Suite 500, San Francisco, CA 94102
| | - Louise Haynes
- Medical University of South Carolina, 67 President Street, Charleston, SC 29425
| | - Benjamin P Linas
- Boston Medical Center, Crosstown Building, 801 Massachusetts Ave office 2007, Boston, MA, 02118
| | | | - Susan Tross
- HIV Center For Clinical and Behavioral Studies, NYS Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, N.Y. 10032
| | - Tiffany Kyle
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1064, Miami, FL 33136
| | - C Mindy Nelson
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th Street, Room 1064, Miami, FL 33136
| | - Terri K Liguori
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1031, Miami, FL 33136
| | - Oliene Toussaint
- Columbia University, Department of Sociomedical Sciences Miami Research Center, 1120 NW 14 Street Room 1031, Miami, FL 33136
| | - Karolynn Siegel
- Columbia University, Department of Sociomedical Sciences, 722 West 168 Street, NY, NY 10032
| | - Debra Annane
- Health Foundation of South Florida, 2 South Biscayne Blvd., Suite 1710, Miami, FL 33131
| | - Lisa R Metsch
- Columbia University, Department of Sociomedical Sciences and Columbia School of General Studies, 2970 Broadway, 612 Lewisohn Hall, New York, NY 10026
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Jakubowski A, Fowler S, Fox AD. Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature. Addict Sci Clin Pract 2023; 18:40. [PMID: 37301953 PMCID: PMC10256972 DOI: 10.1186/s13722-023-00394-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD. METHODS We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants' SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs. RESULTS SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs. CONCLUSIONS SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.
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Affiliation(s)
- Andrea Jakubowski
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
| | - Sabrina Fowler
- Present Address: Ascension St. John Hospital, 22101 Moross Road, Detroit, MI 48236 USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Aaron D. Fox
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY 10467 USA
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Ahrens K, Sharbaugh M, Jarlenski MP, Tang L, Allen L, Austin AE, Barnes AJ, Burns ME, Clark S, Zivin K, Mack A, Liu G, Mohamoud S, McDuffie MJ, Hammerslag L, Gordon AJ, Donohue JM. Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016-2019. Clin Infect Dis 2023; 76:1793-1801. [PMID: 36594172 PMCID: PMC10209438 DOI: 10.1093/cid/ciac981] [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: 07/07/2022] [Revised: 10/21/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Limited information exists about testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among Medicaid enrollees after starting medication for opioid use disorder (MOUD), despite guidelines recommending such testing. Our objectives were to estimate testing prevalence and trends for HIV, HBV, and HCV among Medicaid enrollees initiating MOUD and examine enrollee characteristics associated with testing. METHODS We conducted a serial cross-sectional study of 505 440 initiations of MOUD from 2016 to 2019 among 361 537 Medicaid enrollees in 11 states. Measures of MOUD initiation; HIV, HBV, and HCV testing; comorbidities; and demographics were based on enrollment and claims data. Each state used Poisson regression to estimate associations between enrollee characteristics and testing prevalence within 90 days of MOUD initiation. We pooled state-level estimates to generate global estimates using random effects meta-analyses. RESULTS From 2016 to 2019, testing increased from 20% to 25% for HIV, from 22% to 25% for HBV, from 24% to 27% for HCV, and from 15% to 19% for all 3 conditions. Adjusted rates of testing for all 3 conditions were lower among enrollees who were male (vs nonpregnant females), living in a rural area (vs urban area), and initiating methadone or naltrexone (vs buprenorphine). Associations between enrollee characteristics and testing varied across states. CONCLUSIONS Among Medicaid enrollees in 11 US states who initiated medications for opioid use disorder, testing for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and all 3 conditions increased between 2016 and 2019 but the majority were not tested.
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Affiliation(s)
- Katherine Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Michael Sharbaugh
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marian P Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lindsay Allen
- Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew J Barnes
- Health Behavior and Policy Department, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah Clark
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aimee Mack
- Government Resource Center, Ohio Colleges of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Gilbert Liu
- Government Resource Center, Ohio Colleges of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Shamis Mohamoud
- Hilltop Institute, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Mary Joan McDuffie
- Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, Newark, Delaware, USA
| | - Lindsey Hammerslag
- College of Medicine, Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
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Taylor EA, Cantor JH, Bradford AC, Simon K, Stein BD. Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes. JAMA Netw Open 2023; 6:e2314328. [PMID: 37204793 PMCID: PMC10199341 DOI: 10.1001/jamanetworkopen.2023.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023] Open
Abstract
Importance A significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020. Objective To examine trends in methadone and buprenorphine dispensing among Medicare Advantage (MA) enrollees after 2 policy changes in 2020 related to methadone access. Design, Setting, and Participants This cross-sectional analysis of temporal trends in methadone and buprenorphine treatment dispensing assessed MA beneficiary claims from January 1, 2019, through March 31, 2022, captured by Optum's Clinformatics Data Mart. Of 9 870 791 MA enrollees included in the database, 39 252 had at least 1 claim for methadone, buprenorphine, or both during the study period. All available MA enrollees were included. Subanalyses by age and dual eligibility for Medicare and Medicaid status were conducted. Exposures Study exposures were (1) the Centers for Medicare & Medicaid Services (CMS) Medicare bundled payment reimbursement policy for OUD treatment and (2) the Substance Abuse and Mental Health Administration and CMS Medicare policies designed to facilitate access to treatment for OUD, specifically during the COVID-19 pandemic. Main Outcomes and Measures Study outcomes were trends in methadone and buprenorphine dispensing by beneficiary characteristics. National methadone and buprenorphine dispensing rates were calculated as claims-based dispensing rates per 1000 MA enrollees. Results Among the 39 252 MA enrollees with at least 1 MOUD dispensing claim (mean age, 58.6 [95% CI, 58.57-58.62] years; 45.9% female), 195 196 methadone claims and 540 564 buprenorphine pharmacy claims were identified, for a total of 735 760 dispensing claims. The methadone dispensing rate for MA enrollees was 0 in 2019 because the policy did not allow any payment until 2020. Claims rates per 1000 MA enrollees were low initially, increasing from 0.98 in the first quarter of 2020 to 4.71 in the first quarter of 2022. Increases were primarily associated with dually eligible beneficiaries and beneficiaries younger than 65 years. National buprenorphine dispensing rates were 4.64 per 1000 enrollees in quarter 1 of 2019, increasing to 7.45 per 1000 enrollees in quarter 1 of 2022. Conclusions and Relevance This cross-sectional study found that methadone dispensing increased among Medicare beneficiaries after the policy changes. Rates of buprenorphine dispensing did not provide evidence that beneficiaries substituted buprenorphine for methadone. The 2 new CMS policies represent an important first step in increasing access to MOUD treatment for Medicare beneficiaries.
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Affiliation(s)
| | | | - Ashley C. Bradford
- The Paul H. O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
| | - Kosali Simon
- The Paul H. O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
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