Receipt of Addiction Treatment After Opioid Overdose Among Medicaid-Enrolled Adolescents and Young Adults - PubMed (original) (raw)
Receipt of Addiction Treatment After Opioid Overdose Among Medicaid-Enrolled Adolescents and Young Adults
Rachel H Alinsky et al. JAMA Pediatr. 2020.
Abstract
Importance: Nonfatal opioid overdose may be a critical touch point when youths who have never received a diagnosis of opioid use disorder can be engaged in treatment. However, the extent to which youths (adolescents and young adults) receive timely evidence-based treatment following opioid overdose is unknown.
Objective: To identify characteristics of youths who experience nonfatal overdose with heroin or other opioids and to assess the percentage of youths receiving timely evidence-based treatment.
Design, setting, and participants: This retrospective cohort study used the 2009-2015 Truven-IBM Watson Health MarketScan Medicaid claims database from 16 deidentified states representing all US census regions. Data from 4 039 216 Medicaid-enrolled youths aged 13 to 22 years were included and were analyzed from April 20, 2018, to March 21, 2019.
Exposures: Nonfatal incident and recurrent opioid overdoses involving heroin or other opioids.
Main outcomes and measures: Receipt of timely addiction treatment (defined as a claim for behavioral health services, for buprenorphine, methadone, or naltrexone prescription or administration, or for both behavioral health services and pharmacotherapy within 30 days of incident overdose). Sociodemographic and clinical characteristics associated with receipt of timely treatment as well as with incident and recurrent overdoses were also identified.
Results: Among 3791 youths with nonfatal opioid overdose, 2234 (58.9%) were female, and 2491 (65.7%) were non-Hispanic white. The median age was 18 years (interquartile range, 16-20 years). The crude incident opioid overdose rate was 44.1 per 100 000 person-years. Of these 3791 youths, 1001 (26.4%) experienced a heroin overdose; the 2790 (73.6%) remaining youths experienced an overdose involving other opioids. The risk of recurrent overdose among youths with incident heroin involvement was significantly higher than that among youths with other opioid overdose (adjusted hazard ratio, 2.62; 95% CI, 2.14-3.22), and youths with incident heroin overdose experienced recurrent overdose at a crude rate of 20 700 per 100 000 person-years. Of 3606 youths with opioid-related overdose and continuous enrollment for at least 30 days after overdose, 2483 (68.9%) received no addiction treatment within 30 days after incident opioid overdose, whereas only 1056 youths (29.3%) received behavioral health services alone, and 67 youths (1.9%) received pharmacotherapy. Youths with heroin overdose were significantly less likely than youths with other opioid overdose to receive any treatment after their overdose (adjusted odds ratio, 0.64; 95% CI, 0.49-0.83).
Conclusions and relevance: After opioid overdose, less than one-third of youths received timely addiction treatment, and only 1 in 54 youths received recommended evidence-based pharmacotherapy. Interventions are urgently needed to link youths to treatment after overdose, with priority placed on improving access to pharmacotherapy.
Conflict of interest statement
Conflict of Interest Disclosures: Dr Alinsky reported receiving a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr Zima reported receiving support from the California Behavioral Health Center of Excellence. Dr Bagley reported receiving support from the National Institute on Drug Abuse and the Department of Medicine at Boston University School of Medicine. Dr Matson reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Larochelle reported receiving support from Boston University School of Medicine Department of Medicine during the conduct of the study, grants from the National Institute on Drug Abuse, and research funding from OptumLabs outside the submitted work. Dr Hadland reported receiving support from the National Institute on Drug Abuse, the Thrasher Research Fund, and the Academic Pediatric Association. No other disclosures were reported.
Figures
Figure.. Kaplan-Meier Survival Curve of Time Free From Recurrent Overdose in 3606 Youths After Incident Overdose, by Type of Opioid Involved in Incident Overdose
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