Medications for Opioid Use Disorder after Entering Residential Treatment: Evidence from Louisiana Medicaid.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Wenshu Li, Matthew Eisenberg, Minna Song, Alene Kennedy-Hendricks, Brendan Saloner
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引用次数: 0

Abstract

Objective: Policies have attempted to increase the use of medication for opioid use disorder (MOUD) during an admission to a residential treatment program, but little is known about the association of residential admission with subsequent MOUD use.

Methods: In a cohort study of Louisiana Medicaid beneficiaries age 18-64 with diagnosed opioid use disorder (OUD), weekly MOUD use and overdose for 20 weeks before and after an admission to residential treatment was analyzed using comparative interrupted time series regression. Participants with residential treatment admission between January 1, 2018, and December 31, 2020 (N = 12,222) were compared against a demographically similar group of people with OUD without residential treatment during the study period.

Results: The samples with residential treatment were largely male (61.9%), White (47.2%), and aged 30 to 39 years (41.4%). At baseline, people admitted to residential treatment were much less likely to use MOUD than the comparison group (4.2% lower, CI: 3.8%, 4.5%, P < 0.01). After admission, use of any MOUD initially increased by 3.1% (P < 0.01) relative to the comparison group, which reverted to the counterfactual trend by 20 weeks. Post-admission MOUD use differed widely by medication. Overdose incidence was highest in the weeks right before admission, but otherwise, it did not change during the study period.

Conclusions: Admission to residential treatment for OUD was associated with a temporary increase in MOUD use. Policy initiatives should focus on both boosting use of MOUD during residential treatment and sustaining access to MOUD in outpatient care in the weeks following discharge.

进入住院治疗后阿片类药物使用障碍的药物治疗:路易斯安那州医疗补助的证据。
目标:相关政策曾试图提高住院治疗项目中阿片类药物使用障碍(MOUD)药物的使用率,但人们对住院治疗项目与后续阿片类药物使用障碍之间的关系知之甚少:在一项针对路易斯安那州 18-64 岁确诊阿片类药物使用障碍(OUD)的医疗补助受益人的队列研究中,采用比较间断时间序列回归法分析了入院治疗前后 20 周内每周的 MOUD 使用情况和用药过量情况。将在 2018 年 1 月 1 日至 2020 年 12 月 31 日期间接受住院治疗的参与者(N = 12,222 人)与在研究期间未接受住院治疗的人口统计学相似的 OUD 患者群体进行了比较:接受住院治疗的样本大多为男性(61.9%)、白人(47.2%)、30 至 39 岁(41.4%)。在基线时,接受住院治疗的人使用 MOUD 的可能性远低于对比组(低 4.2%,CI:3.8%,4.5%,P <0.01)。入院后,与对比组相比,使用任何MOUD的人数最初增加了3.1%(P < 0.01),但到20周后又恢复到反事实趋势。入院后使用的 MOUD 因药物不同而有很大差异。入院前几周用药过量的发生率最高,但除此之外,研究期间用药过量的发生率没有变化:结论:接受住院治疗治疗 OUD 与 MOUD 使用的暂时增加有关。政策措施应侧重于在住院治疗期间促进 "MOUD "的使用,并在出院后的几周内在门诊治疗中维持 "MOUD "的使用。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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