Patterns of Follow‐up Treatment for Medicaid Beneficiaries with Opioid Use Disorder Who Received Medication Treatment during Residential Care
Authors: Creedon T. , Lin J. , Mulvaney‐Day N. 
Published: August 2020

Research Objective

Although medication treatment (MT) is an evidence‐based treatment for opioid use disorders (OUD), it is often not included in the treatment package received in residential settings. The goal of this research was to examine the prevalence of MT in residential treatment among Medicaid beneficiaries with OUD and patterns of follow‐up OUD treatment associated with receipt of MT in residential settings.

Study Design

We conducted a retrospective, observational study using Medicaid claims data with a 4‐year study period from 2011 to 2015. We identified individuals with new OUD residential treatment episodes and split the sample based on whether MT was included in the residential treatment episode by identifying any buprenorphine or naltrexone pharmacy claims that occurred during time frame of the residential treatment episode. We used propensity scores to account for nonrandom treatment assignment and balance the distribution of baseline characteristics between individuals who did and did not receive MT as part of their initial residential treatment episode The propensity score analysis accounted for demographics; other SUD, mental health, and general medical comorbidities; type of insurance; rurality; and utilization and health care spending 12 months prior to the initial treatment episode. We estimated rates of follow‐up utilization of high‐intensity treatment (eg, partial hospitalization, intensive outpatient) and low‐intensity treatment types (eg, outpatient, medication management).

Population Studied

The study sample included all adult Medicaid beneficiaries aged 18‐64 years who had OUD diagnoses and initiated new OUD treatment episodes 2013 and 2014. We required continuous Medicaid enrollment 12 months before and 12 months after the new treatment episode index date.

Principal Findings

After adjusting for compositional differences, those who received MT as part of their residential treatment had higher rates of any follow‐up treatment compared with those who did not receive MT (95.9% versus 60.8%, P < .001). These patterns were consistent for both high‐intensity follow‐up treatment (77.0% versus 47.3%, P < .001) as well as low‐intensity treatment (90.5% versus 52.8%, P < .001). Higher proportions of those who received MT received follow‐up care in an emergency room setting for OUD (28.4% versus 13.1%, P < .003). Only 16.5 percent of those who did not receive MT during their new episode received MT in the follow‐up period compared with 75.5% of those who started MT during their new episode (P < .001).

Conclusions

Receipt of MT as part of an initial episode of OUD treatment in a residential setting was associated with increased rates of follow‐up MT. Although the receipt of low‐intensity treatment for those receiving MT was high, a substantial proportion also received follow‐up care in high‐intensity settings such as residential treatment re‐admissions and emergency department visits.

Implications for Policy or Practice

Given that almost three‐quarters of those who started MT treatment in residential settings continued to receive it as part of follow‐up outpatient care suggests that initiating care in high acuity conditions may combat barriers to receipt of MT in community settings. Policymakers and clinicians should re‐examine the factors that limit residential treatment facilities from providing MT as part of their OUD treatment package.

Primary Funding Source

SAMHSA.