Duration of Medication Treatment for Opioid-Use Disorder and Risk of Overdose among Medicaid Enrollees in Eleven States: A Retrospective Cohort Study
BACKGROUND AND AIMS: Medication for opioid use disorder (MOUD) reduces harms associated with opioid use disorder (OUD), including risk of overdose. Understanding how variation in MOUD duration influences overdose risk is important as health care payers increasingly remove barriers to treatment continuation (e.g., prior authorization). This study measured the association between MOUD continuation, relative to discontinuation, and opioid-related overdose among Medicaid beneficiaries. DESIGN: Retrospective cohort study using landmark survival analysis. We estimated the association between treatment continuation and overdose risk at 5 points after the index, or first, MOUD claim. Censoring events included death and disenrollment. SETTING: Medicaid programs in eleven US states: Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, and Wisconsin. PARTICIPANTS: 293,180 Medicaid beneficiaries aged 18-64 with a diagnosis of OUD and had a first MOUD claim between 2016 - 2017. MEASUREMENTS: MOUD formulations included methadone, buprenorphine, and naltrexone. We measured medically-treated opioid-related overdose within claims within 12-months of the index MOUD claim. FINDINGS: Results were consistent across states. In pooled results, 5.1% of beneficiaries had an overdose, and 67% discontinued MOUD before an overdose or censoring event within 12-months. Beneficiaries who continued MOUD beyond 60 days had a lower relative hazard of overdose (HR), compared with those who discontinued by day 60, (HR .39; 95% confidence interval [CI], .36-.42; P <.0001). MOUD continuation was associated with lower overdose risk at 120 days (HR .34; 95% CI, .31-.37; P <.0001), 180 days (HR .31; 95% CI, .29-.34; P <.0001), 240 days (HR .29; 95% CI, .26-.31; P <.0001), and 300 days (HR .28; 95% CI, .24-.32; P <.0001). The hazard of overdose was 10% lower with each additional 60 days of MOUD (95% CI, .88-.92; P < .0001). CONCLUSIONS: Continuation of medication for opioid use disorder (MOUD) in US Medicaid beneficiaries was associated with a substantial reduction in overdose risk up to 12 months after the first claim for MOUD.