10/27/2022
PITTSBURGH — Regardless of strong proof for the significance of outpatient care after inpatient residential treatment for opioid use disorder, nearly half of Medicaid recipients are not getting follow-up care or medication-assisted treatment within a month of discharge, according to a brand-new analysis led by University of Pittsburgh School of Public Health researchers.
Discharge from re sidential treatment is a delicate time when people with opioid use disorder are at greater threatto relapse Outpatient treatment with therapy, medication or both can minimize this threat. The findings, released today in Drug and Alcoholism, are the very first to research study patient and episode-level aspects associated to the probability of r eceiving post-discharge follow-up amongst receivers of Medicaid, which is the biggest payer of opioid use disorder- associated inpatient stays and emergency department sees.
” Over the previous couple of years, Medicaid programs have actually actually broadened the scope of substance use disorder treatments they will cover, consisting of residential treatment,” stated lead author Evan Cole, Ph.D., research study associate teacher in the Department of Health Policy and Management at Pitt PublicHealth “However outpatient follow-up is crucial to forecasting long-lasting recovery, and there is extremely little research study– especially in the previous years when the opioid epidemic has actually grasped the U.S.– into whether that crucial follow-up care is really taking place.”
An approximated 10 million Americans have actually misused opioids in the previous year, and m ore than 100,000 people passed away of drug overdoses in the U.S. in 2015, the bulk after taking opioids, according to the U.S. Centers for Illness Control and Prevention Residential treatment for substance use disorder– frequently called “rehab”– consists of 24-hour living assistance with on- website clinical services, which can consist of therapyand addiction treatment The Majority Of residential treatment stays are less than one month.
Medicaid provides health insurance for low-income or handicapped people, and, with more than 88 million enrollees, it is the biggest health insurance company in the U.S. It covers 38%of people with opioid use disorder
Cole and his coworkers looked at information from more than 90,000 residential treatment stays in 2018 and 2019 for Medicaid recipients throughout 10 states— Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia and West Virginia– utilizing the Medicaid Outcomes Dispersed Research StudyNetwork
Previous research study has actually revealed that after leaving residential treatment, prompt follow-up for outpatient addiction treatment, which can consist of medications such as buprenorphine, methadone or naltrexone, decreases relapse and reduces threat of death.
Cole’s group discovered that 47% of the time, Medicaid recipients released from residential treatment did not receive follow-up care or a medication for opioid use disorder within one month. Medicaid enrollees who were male, lived in backwoods or were members of racial and ethnic minority groups were the least most likely to receive follow-upcare
” This was not what we ‘d hoped to see,” stated Cole, who is likewise research study director of the Medicaid Proving Ground at Pitt “I make sure Medicaid programs desire people to be engaged in outpatient care to continue their treatment and effectively handle opioid use disorder after residential treatment.”
On a favorable note, patients who had actually been recommended medications to reward opioid use disorder prior to they ‘d been confessed to residential treatment were 24% most likely to get follow-up care and medication after discharge than their equivalents who had not had such a prescription prior to getting inresidential treatment
Cole assumed that previous engagement in addiction treatment made it simpler for patients to browse to treatment after discharge. He stated future research study might evaluate this by checking out whether patients were seeing the very same outpatient provider prior to and after residential treatment, and, if so, more effort might be made to link patients to outpatient provider s prior to they get inresidential treatment
Because Medicaid registration skyrocketed by 25% throughout the COVID-19 pandemic, it will be fascinating to see if that affected connection with care after residential treatment, Cole stated He likewise kept in mind that some states, consisting of Pennsylvania, have actually ended up being more dedicated to “ warm handoffs,” producing procedures planned to help with a smooth shift to addiction treatment afteran emergency
” While our research study wasn’t created to see the effect of warm hand-off procedures, it definitely suggests that checking out whether or not these programs are working might be beneficial for future research study,” Cole stated.
Extra authors of this research study are Lindsay Allen, Ph.D., of Northwestern University; Anna Austin, Ph.D., and Paul Lanier, Ph.D., both of the University of North Carolina, Chapel Hill; Andrew Barnes, Ph.D., and Peter Cunningham, Ph.D., of Virginia Commonwealth University; Chung-Chou H. Chang, Ph.D., Joo Yeon Kim, M.S., Lu Tang, Ph.D., and Julie Donohue, Ph.D., all of Pitt; Sarah Clark, M.P.H., and Kara Zivin, Ph.D., both of the University of Michigan; Dushka Crane, Ph.D., and Rachel Mauk, Ph.D., both of The Ohio State University; Carrie E. Fry, Ph.D., of Vanderbilt University; Adam J. Gordon, M.D., M.P.H., of the University of Utah; Lindsey Hammerslag, Ph.D., and Jeff Talbert, Ph.D., both o f the University of Kentucky; David Idala, M.A., and Shamis Mohamoud, M.A., both of the Hill Institute in Baltimore; Susan Kennedy, M.P.P., M.S.W., and Sunita Krishnan, M.P.H., of Academy Health in Washington, D.C.; Shyama Mahakalanda, Ph.D., of West Virginia University; and Mary Joan McDuffie, M.A., of the University of Delaware
This research study was moneyed by National Institute on Substance Abuse grant R01DA048029.
Left picture:
PICTURE INFORMATION: (click images for high-res variations)
CREDIT: University of Pittsburgh
CAPTION: Evan Cole, Ph.D.
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PICTURE INFORMATION: (click images for high-res variations)
CREDIT: Cole, et al. Drug and Alcoholism (2022 )
CAPTION: Visual Research Study Abstract