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Research Letter
August 22/29, 2017

Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid

Author Affiliations
  • 1Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
  • 2School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3College of Pharmacy, University of Arizona, Tucson
  • 4Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 5University of Utah School of Medicine, Salt Lake City
  • 6University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA. 2017;318(8):750-752. doi:10.1001/jama.2017.7818

For every fatal opioid overdose, there are approximately 30 nonfatal overdoses. Nonfatal overdoses that receive medical attention represent intervention opportunities for clinicians to mitigate risk by reducing opioid prescribing or advocating addiction treatment. Studies evaluating commercially insured patients suggest these potential interventions are underutilized. For example, a 2000-2012 study1 reported high rates of opioid prescribing for patients even after they had sustained a nonfatal opioid overdose. Another study2 of patients with opioid use disorder (OUD) showed low rates of buprenorphine treatment after hospitalization for overdose. However, little is known about how opioid prescribing and medication-assisted treatment (MAT) changes from before to after overdose among Medicaid enrollees, who have a 3-times higher risk of opioid overdose.3 We used data from a large Medicaid program to compare (1) prescription opioid use, (2) duration of opioid use, and (3) rates of MAT (buprenorphine, methadone, or naltrexone) among enrollees before and after an overdose event.4