Ned J Presnall1, D A Patterson Silver Wolf2, Derek S Brown3, Sara Beeler-Stinn4, Richard A Grucza5. 1. Brown School of Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, United States of America; Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States of America. Electronic address: npresnall@wustl.edu. 2. Brown School of Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, United States of America. Electronic address: dpatterson22@wustl.edu. 3. Brown School of Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, United States of America. Electronic address: dereksbrown@wustl.edu. 4. Brown School of Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, United States of America. Electronic address: sbeeler@wustl.edu. 5. Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110, United States of America. Electronic address: rick@wustl.edu.
Abstract
BACKGROUND: Facing an epidemic of opioid-related mortality, many government health departments, insurers, and treatment providers have attempted to expand patient access to buprenorphine in psychosocial substance use disorder (SUD) programs and medical settings. METHODS: With Missouri Medicaid data from 2008 to 2015, we used Cox proportional hazard models to estimate the relative hazards for treatment attrition and SUD-related emergency department (ED) visits or hospitalizations associated with buprenorphine in psychosocial SUD programs and medical settings. We also tested the association of buprenorphine with hours of psychosocial treatment during the first 30 days of psychosocial SUD treatment. The analytic sample included claims from 7606 individuals with an OUD diagnosis. RESULTS: Compared to psychosocial treatment without buprenorphine (PSY), the addition of buprenorphine (PSY-B) was associated with a significantly reduced hazard for treatment attrition (adjusted hazard ratio: 0.67, 95% CI: 0.62-0.71). Among buprenorphine episodes, office-based (B-OBOT), outpatient hospital (B-OPH), and no documented setting (B-PHA) were associated with reduced hazards for treatment attrition when compared to the psychosocial SUD setting (B-PSY) (adjusted hazard ratios: 0.27, 95% CI: 0.24-0.31; 0.46, 95% CI: 0.39-0.54; 0.70, 95% CI: 0.61-0.81). Compared to B-PSY, B-OBOT and B-PHA were associated with significantly reduced hazards for a SUD-related ED visits or hospitalization (adjusted hazard ratios: 0.59, 95% CI: 0.41-0.85; 0.53, 95% CI: 0.36-0.78). There was no significant difference between B-PSY and B-OPH or B-PSY and PSY in hazard for an SUD-related ED visit or hospitalization. CONCLUSIONS: Our findings support the conclusion that adding buprenorphine to Medicaid-covered psychosocial SUD treatment reduces patient attrition and SUD-related ED visits or hospitalizations but that buprenorphine treatment in office-based medical settings is even more effective in reducing these negative outcomes. Policy-makers should consider ways to expand buprenorphine access in all settings, but particularly in office-based medical settings. Buprenorphine treatment in an unbilled setting was associated with an increased hazard for patient attrition when compared to treatment in billed medical settings, indicating the importance of Medicaid-covered provider visits for patient retention.
BACKGROUND: Facing an epidemic of opioid-related mortality, many government health departments, insurers, and treatment providers have attempted to expand patient access to buprenorphine in psychosocial substance use disorder (SUD) programs and medical settings. METHODS: With Missouri Medicaid data from 2008 to 2015, we used Cox proportional hazard models to estimate the relative hazards for treatment attrition and SUD-related emergency department (ED) visits or hospitalizations associated with buprenorphine in psychosocial SUD programs and medical settings. We also tested the association of buprenorphine with hours of psychosocial treatment during the first 30 days of psychosocial SUD treatment. The analytic sample included claims from 7606 individuals with an OUD diagnosis. RESULTS: Compared to psychosocial treatment without buprenorphine (PSY), the addition of buprenorphine (PSY-B) was associated with a significantly reduced hazard for treatment attrition (adjusted hazard ratio: 0.67, 95% CI: 0.62-0.71). Among buprenorphine episodes, office-based (B-OBOT), outpatient hospital (B-OPH), and no documented setting (B-PHA) were associated with reduced hazards for treatment attrition when compared to the psychosocial SUD setting (B-PSY) (adjusted hazard ratios: 0.27, 95% CI: 0.24-0.31; 0.46, 95% CI: 0.39-0.54; 0.70, 95% CI: 0.61-0.81). Compared to B-PSY, B-OBOT and B-PHA were associated with significantly reduced hazards for a SUD-related ED visits or hospitalization (adjusted hazard ratios: 0.59, 95% CI: 0.41-0.85; 0.53, 95% CI: 0.36-0.78). There was no significant difference between B-PSY and B-OPH or B-PSY and PSY in hazard for an SUD-related ED visit or hospitalization. CONCLUSIONS: Our findings support the conclusion that adding buprenorphine to Medicaid-covered psychosocial SUD treatment reduces patient attrition and SUD-related ED visits or hospitalizations but that buprenorphine treatment in office-based medical settings is even more effective in reducing these negative outcomes. Policy-makers should consider ways to expand buprenorphine access in all settings, but particularly in office-based medical settings. Buprenorphine treatment in an unbilled setting was associated with an increased hazard for patient attrition when compared to treatment in billed medical settings, indicating the importance of Medicaid-covered provider visits for patient retention.
Authors: Scott E Hadland; J Frank Wharam; Mark A Schuster; Fang Zhang; Jeffrey H Samet; Marc R Larochelle Journal: JAMA Pediatr Date: 2017-08-01 Impact factor: 16.193
Authors: T V Parran; C A Adelman; B Merkin; M E Pagano; R Defranco; R A Ionescu; A G Mace Journal: Drug Alcohol Depend Date: 2009-08-29 Impact factor: 4.492
Authors: Jan Gryczynski; Shannon Gwin Mitchell; Jerome H Jaffe; Kevin E O'Grady; Yngvild K Olsen; Robert P Schwartz Journal: J Subst Abuse Treat Date: 2013-10-14
Authors: Matthias Pierce; Sheila M Bird; Matthew Hickman; John Marsden; Graham Dunn; Andrew Jones; Tim Millar Journal: Addiction Date: 2015-11-25 Impact factor: 6.526
Authors: Carrie M Mintz; Ned J Presnall; John M Sahrmann; Jacob T Borodovsky; Paul E A Glaser; Laura J Bierut; Richard A Grucza Journal: Drug Alcohol Depend Date: 2020-06-18 Impact factor: 4.492
Authors: Elizabeth C Saunders; Sarah K Moore; Olivia Walsh; Stephen A Metcalf; Alan J Budney; Patricia Cavazos-Rehg; Emily Scherer; Lisa A Marsch Journal: Addict Sci Clin Pract Date: 2021-01-27