Medicaid expansion and treatment for opioid use disorders in Oregon

an interrupted time-series analysis

Dennis McCarty, Yifan Gu, John W. McIlveen, Bonnie Lind

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The study examined the association of the Affordable Care Act's 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients. METHODS: Logistic regression analysis examined utilization of care before (January 1, 2010-December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014-December 31, 2016). RESULTS: Adult membership in the Oregon Health Plan (Medicaid) increased 180% following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69% to 65%) and the percent of individuals receiving pharmacotherapy (57% to 45%) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41%; 2014 = 33%). Odds of accessing any psychosocial service increased by 8% per year from 2010 to 2013 (AOR = 1.08; 95% CI 1.06-1.11) with an 18% immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95% CI 0.76-0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8% per year (2014 through 2016) (AOR = 1.08; 95% CI 1.06-1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36% (AOR = 0.64; 95% CI 0.60-0.68) decline in 2014, and a 13% increase per year in 2015 and 2016 (AOR = 1.13; 95% CI 1.09-1.16). CONCLUSION: The number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon's Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume14
Issue number1
DOIs
StatePublished - Aug 15 2019

Fingerprint

Medicaid
Opioid Analgesics
Therapeutics
Interrupted Time Series Analysis
Patient Protection and Affordable Care Act
Drug Therapy
Logistic Models
Regression Analysis
Pharmacology

Keywords

  • Medicaid expansion
  • Medication for opioid use disorder
  • Opioid agonist therapy
  • Opioid antagonist therapy
  • Opioid use disorder
  • Psychosocial services for opioid use disorder

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Medicaid expansion and treatment for opioid use disorders in Oregon : an interrupted time-series analysis. / McCarty, Dennis; Gu, Yifan; McIlveen, John W.; Lind, Bonnie.

In: Addiction science & clinical practice, Vol. 14, No. 1, 15.08.2019.

Research output: Contribution to journalArticle

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title = "Medicaid expansion and treatment for opioid use disorders in Oregon: an interrupted time-series analysis",
abstract = "BACKGROUND: The study examined the association of the Affordable Care Act's 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients. METHODS: Logistic regression analysis examined utilization of care before (January 1, 2010-December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014-December 31, 2016). RESULTS: Adult membership in the Oregon Health Plan (Medicaid) increased 180{\%} following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69{\%} to 65{\%}) and the percent of individuals receiving pharmacotherapy (57{\%} to 45{\%}) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41{\%}; 2014 = 33{\%}). Odds of accessing any psychosocial service increased by 8{\%} per year from 2010 to 2013 (AOR = 1.08; 95{\%} CI 1.06-1.11) with an 18{\%} immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95{\%} CI 0.76-0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8{\%} per year (2014 through 2016) (AOR = 1.08; 95{\%} CI 1.06-1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36{\%} (AOR = 0.64; 95{\%} CI 0.60-0.68) decline in 2014, and a 13{\%} increase per year in 2015 and 2016 (AOR = 1.13; 95{\%} CI 1.09-1.16). CONCLUSION: The number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon's Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.",
keywords = "Medicaid expansion, Medication for opioid use disorder, Opioid agonist therapy, Opioid antagonist therapy, Opioid use disorder, Psychosocial services for opioid use disorder",
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T2 - an interrupted time-series analysis

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AU - Lind, Bonnie

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N2 - BACKGROUND: The study examined the association of the Affordable Care Act's 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients. METHODS: Logistic regression analysis examined utilization of care before (January 1, 2010-December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014-December 31, 2016). RESULTS: Adult membership in the Oregon Health Plan (Medicaid) increased 180% following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69% to 65%) and the percent of individuals receiving pharmacotherapy (57% to 45%) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41%; 2014 = 33%). Odds of accessing any psychosocial service increased by 8% per year from 2010 to 2013 (AOR = 1.08; 95% CI 1.06-1.11) with an 18% immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95% CI 0.76-0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8% per year (2014 through 2016) (AOR = 1.08; 95% CI 1.06-1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36% (AOR = 0.64; 95% CI 0.60-0.68) decline in 2014, and a 13% increase per year in 2015 and 2016 (AOR = 1.13; 95% CI 1.09-1.16). CONCLUSION: The number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon's Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.

AB - BACKGROUND: The study examined the association of the Affordable Care Act's 2014 Medicaid expansion on the use of psychosocial services and pharmacotherapies for opioid use disorders among Oregon Medicaid recipients. METHODS: Logistic regression analysis examined utilization of care before (January 1, 2010-December 31, 2013) and after Medicaid expansion in Oregon (January 1, 2014-December 31, 2016). RESULTS: Adult membership in the Oregon Health Plan (Medicaid) increased 180% following Medicaid expansion (2013 = 172,539; 2014 = 482,081) and the number with a diagnosis of OUD nearly doubled (2013 = 6808; 2014 = 13,418). More individuals received psychosocial services (2013 = 4714; 2014 = 8781) and medications (2013 = 3464; 2014 = 6093) for opioid use disorder. The percent of patients receiving psychosocial services (69% to 65%) and the percent of individuals receiving pharmacotherapy (57% to 45%) declined primarily because of a decline in the proportion receiving care in an opioid treatment program (2013 = 41%; 2014 = 33%). Odds of accessing any psychosocial service increased by 8% per year from 2010 to 2013 (AOR = 1.08; 95% CI 1.06-1.11) with an 18% immediate decline associated with Medicaid expansion in 2014 (AOR = 0.82; 95% CI 0.76-0.87). Following Medicaid expansion, the odds of accessing psychosocial services increased 8% per year (2014 through 2016) (AOR = 1.08; 95% CI 1.06-1.11). Use of medications for opioid use disorder found no change in the odds of use in the years prior to Medicaid expansion, an immediate 36% (AOR = 0.64; 95% CI 0.60-0.68) decline in 2014, and a 13% increase per year in 2015 and 2016 (AOR = 1.13; 95% CI 1.09-1.16). CONCLUSION: The number of Medicaid recipients with an opioid use disorder who received psychosocial and pharmacological services increased substantially following Oregon's Medicaid expansion in 2014. There was a decline, however, in the proportion of individuals with an opioid use disorder receiving care in opioid treatment programs.

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