Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon

Rachel Springer, Miguel Marino, Steffani Bailey, Heather Angier, Jean P. O'Malley, Megan Hoopes, Stephan Lindner, Jennifer Devoe, Nathalie Huguet

Research output: Contribution to journalArticle

Abstract

Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12-month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements: Any opioid-dispensed, chronic (> 90-days) and high-dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings: Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re-enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication-assisted treatment for opioid use disorder.

Original languageEnglish (US)
JournalAddiction
DOIs
StatePublished - Jan 1 2019

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Medicaid
Opioid Analgesics
Prescriptions
Confidence Intervals
Therapeutics
Patient Protection and Affordable Care Act
Cross-Sectional Studies
Hospice Care
Health Insurance
Insurance
Morphine

Keywords

  • Affordable care act
  • Medicaid
  • medication-assisted treatment
  • opioid epidemic
  • opioid use disorder
  • prescribed opioid use

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon. / Springer, Rachel; Marino, Miguel; Bailey, Steffani; Angier, Heather; O'Malley, Jean P.; Hoopes, Megan; Lindner, Stephan; Devoe, Jennifer; Huguet, Nathalie.

In: Addiction, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon",
abstract = "Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12-month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements: Any opioid-dispensed, chronic (> 90-days) and high-dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings: Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3{\%}, 95{\%} confidence interval (CI) = 42.0–42.7{\%}; returning: 49.3{\%}, 95{\%} CI = 48.8–49.7{\%}; continuously: 52.5{\%}, 95{\%} CI = 52.0–53.0{\%}], use opioids chronically (newly: 12.8{\%}, 95{\%} CI = 12.4–13.1{\%}; returning: 11.9{\%}, 95{\%} CI = 11.5–12.3{\%}, continuously: 15.8{\%}, 95{\%} CI = 15.4–16.2{\%}), have OUD diagnoses (newly: 3.6{\%}, 95{\%} CI = 3.4–3.7{\%}; returning: 3.9{\%}, 95{\%} CI = 3.8–4.1{\%}, continuously: 4.7{\%}, 95{\%} CI = 4.5–4.9{\%}) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95{\%} CI = 0.53–0.61; hazard ratio returning: 0.60, 95{\%} CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re-enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication-assisted treatment for opioid use disorder.",
keywords = "Affordable care act, Medicaid, medication-assisted treatment, opioid epidemic, opioid use disorder, prescribed opioid use",
author = "Rachel Springer and Miguel Marino and Steffani Bailey and Heather Angier and O'Malley, {Jean P.} and Megan Hoopes and Stephan Lindner and Jennifer Devoe and Nathalie Huguet",
year = "2019",
month = "1",
day = "1",
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journal = "Addiction",
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T1 - Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon

AU - Springer, Rachel

AU - Marino, Miguel

AU - Bailey, Steffani

AU - Angier, Heather

AU - O'Malley, Jean P.

AU - Hoopes, Megan

AU - Lindner, Stephan

AU - Devoe, Jennifer

AU - Huguet, Nathalie

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12-month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements: Any opioid-dispensed, chronic (> 90-days) and high-dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings: Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re-enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication-assisted treatment for opioid use disorder.

AB - Background/Aims: Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion. Design: Cross-sectional study using inverse-propensity weights to adjust for differences among insurance groups. Setting: Oregon. Participants: A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12-month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses. Measurements: Any opioid-dispensed, chronic (> 90-days) and high-dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt. Findings: Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)]. Conclusions: Residents of Oregon, United States who enrolled or re-enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication-assisted treatment for opioid use disorder.

KW - Affordable care act

KW - Medicaid

KW - medication-assisted treatment

KW - opioid epidemic

KW - opioid use disorder

KW - prescribed opioid use

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