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Original Investigation
July 13, 2021

Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

The Medicaid Outcomes Distributed Research Network (MODRN)
JAMA. 2021;326(2):154-164. doi:10.1001/jama.2021.7374
Key Points

Question  Did treatment of opioid use disorder (OUD) among Medicaid enrollees change from 2014 to 2018?

Findings  In this exploratory serial cross-sectional study using data from 1 024 301 Medicaid enrollees in 11 states, the prevalence of medication treatment for OUD increased from 47.8% (138 918 of 290 638 enrollees with OUD) in 2014 to 57.1% (301 499 of 527 983) in 2018. There was substantial variation across and within states in any use and continuity (for 180 days) of medications for OUD by age, race/ethnicity, eligibility group, behavioral health comorbidity, and rural vs urban residence.

Meaning  From 2014 through 2018, use of medications for opioid use disorder increased among Medicaid enrollees in 11 US states, but the pattern in the other states is not known.

Abstract

Importance  There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.

Objective  To examine the use of medications for OUD and potential indicators of quality of care in multiple states.

Design, Setting, and Participants  Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses.

Exposures  Calendar year, demographic characteristics, eligibility groups, and comorbidities.

Main Outcomes and Measures  Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines).

Results  In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (−0.01 prevalence difference, 95% CI, −0.03 to 0.02) with state variability in trend (90% prediction interval, −0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups.

Conclusions and Relevance  Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.

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