MedicalResearch.com Interview with:
Julie M. Donohue, Ph.D.
Associate professor in Pitt Public Health’s Department of Health Policy and
Management and Director of the Medicaid Research Center
Pitt’s Health Policy Institute
University of Pittsburgh
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC). My colleagues and I analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting.
We found that Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose. Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points.
Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Our team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our findings signal a relatively weak health system response to a potentially life-threatening event. However, they also point to opportunities for interventions that could prevent future overdoses in a particularly vulnerable population. Aside from medication-assisted treatment, these include notifications to clinicians for patients previously treated for overdose so the clinician is more aware when considering an opioid prescription and emergency department-initiated naloxone education and distribution to the patient and their friends or family.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: When patients are seen for an overdose, it is a chance for the medical system to not only stabilize them, but engage patients in addiction treatment programs when needed and take steps to reduce the likelihood of another overdose. Based on our data, I do not believe this opportunity is being fully realized and future research should look into maximizing engagement of patients who have overdosed in treatment and recovery programs, as well as medical system programs that can reduce the likelihood of vulnerable patients receiving prescription opioids when alternative treatments could be more appropriate.
MedicalResearch.com: Is there anything else you would like to add?
Response: Winfred Frazier, M.D., M.P.H., (University of Texas Medical Branch) is lead author on our study and was a Pitt Public Health student when the work was conducted. Additional authors are Gerald Cochran, Ph.D., and Chung-Chou H. Chang, Ph.D., of Pitt; Wei-Hsuan Lo-Ciganic, Ph.D., M.S., M.S.Pharm., of the University of Arizona; Walid F. Gellad, M.D., M.P.H., of the Veterans Affairs Pittsburgh Healthcare System; and Adam J. Gordon, M.D., M.P.H., of the University of Utah.
Disclosures: This research was supported by CDC grant U01CE002496 and an intergovernmental agreement between the Pennsylvania Department of Human Services and Pitt.
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Frazier W, Cochran G, Lo-Ciganic W, Gellad WF, Gordon AJ, Chang CH, Donohue JM. Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid. JAMA. 2017;318(8):750–752. doi:10.1001/jama.2017.7818
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