Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study.
Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study.
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DOI：
10.1111/add.15959
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发表时间：
2022-12
期刊：
影响因子：
6
通讯作者：
Donohue, Julie
中科院分区：
文献类型：
--
作者：
Burns, Marguerite;Tang, Lu;Chang, Chung-Chou H.;Kim, Joo Yeon;Ahrens, Katherine;Allen, Lindsay;Cunningham, Peter;Gordon, Adam J.;Jarlenski, Marian P.;Lanier, Paul;Mauk, Rachel;McDuffie, Mary Joan;Mohamoud, Shamis;Talbert, Jeffery;Zivin, Kara;Donohue, Julie
关键词：
阿片类药物使用障碍药物治疗（MOUD）可减少与阿片类药物使用障碍（OUD）相关的危害，包括过量用药的风险。随着医疗支付方越来越多地消除持续治疗的障碍（例如预先授权），了解MOUD治疗时长的差异如何影响过量用药风险至关重要。本研究测量了医疗补助受益人中MOUD持续治疗（相对于停药）与阿片类药物相关过量用药之间的关联。
采用标志性生存分析的回顾性队列研究。我们估算了在首次MOUD索赔（索引索赔）之后的5个时间点上治疗持续与过量用药风险之间的关联。删失事件包括死亡和退保。
美国11个州的医疗补助计划：特拉华州、肯塔基州、马里兰州、缅因州、密歇根州、北卡罗来纳州、俄亥俄州、宾夕法尼亚州、弗吉尼亚州、西弗吉尼亚州和威斯康星州。
293,180名年龄在18 - 64岁之间、被诊断患有OUD且在2016 - 2017年期间有首次MOUD索赔的医疗补助受益人。
MOUD配方包括美沙酮、丁丙诺啡和纳曲酮。我们测量了在首次MOUD索赔后的12个月内索赔记录中经医学治疗的阿片类药物相关过量用药情况。
各州的结果一致。综合结果显示，5.1%的受益人出现过量用药情况，67%的人在12个月内过量用药或发生删失事件之前停止了MOUD治疗。与在第60天停药的人相比，持续使用MOUD超过60天的受益人过量用药的相对风险（HR）更低（HR为0.39；95%置信区间[CI]为0.36 - 0.42；P < 0.0001）。在120天（HR为0.34；95% CI为0.31 - 0.37；P < 0.0001）、180天（HR为0.31；95% CI为0.29 - 0.34；P < 0.0001）、240天（HR为0.29；95% CI为0.26 - 0.31；P < 0.0001）和300天（HR为0.28；95% CI为0.24 - 0.32；P < 0.0001）时，MOUD持续治疗与较低的过量用药风险相关。MOUD每多持续60天，过量用药的风险就降低10%（95% CI为0.88 - 0.92；P < 0.0001）。
美国医疗补助受益人持续使用阿片类药物使用障碍药物治疗（MOUD）与首次MOUD索赔后长达12个月的过量用药风险大幅降低相关。
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. 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. Medicaid programs in eleven US states: Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, and Wisconsin. 293,180 Medicaid beneficiaries aged 18–64 with a diagnosis of OUD and had a first MOUD claim between 2016 – 2017. MOUD formulations included methadone, buprenorphine, and naltrexone. We measured medically-treated opioid-related overdose within claims within 12-months of the index MOUD claim. 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). 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.
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