Characteristics and treatment patterns of US commercially insured and Medicaid patients with opioid dependence or abuse

Bernd A. Wollschlaeger, MD, FAAFP, FASAM; Tina M. Willson, PhD; Leslie B. Montejano, MA, CCRP; Naoko A. Ronquest, PhD; Vijay R. Nadipelli, BPharm, MS

doi:10.5055/jom.2017.0389

Authors

Bernd A. Wollschlaeger, MD, FAAFP, FASAM
Tina M. Willson, PhD
Leslie B. Montejano, MA, CCRP
Naoko A. Ronquest, PhD
Vijay R. Nadipelli, BPharm, MS

DOI:

https://doi.org/10.5055/jom.2017.0389

Keywords:

opioid dependence, opioid abuse, opioid use disorder, medication-assisted treatment, commercial insurance, Medicaid

Abstract

Objective: To identify the demographic and clinical characteristics of commercially insured and Medicaid patients with a diagnosis of opioid dependence or abuse and to describe the pharmacological and nonpharmacological treatments received by these patients.

Design: This was a retrospective observational study using de-identified administrative claims data.

Setting: The analysis included commercially insured and Medicaid patient data extracted from the Truven Health MarketScan® Commercial and Medicaid Databases.

Patients: Patients with a diagnosis of opioid dependence or abuse from 2008 to 2014 (earliest diagnosis = index date) and a minimum of 6 months of pre-index and postindex continuous enrollment in the database.

Main Outcome Measure(s): Baseline demographic and clinical characteristics, medication-assisted treatment (MAT), and treatment other than MAT received following diagnosis, and the clinical practice setting in which patients received any opioid dependence-related care were reported.

Results: Data from commercially insured (N = 103,768) and Medicaid (N = 50,552) patients were analyzed. Common comorbid conditions included chronic pain (48.6 percent Commercial, 56.8 percent Medicaid), depressive disorder (24.0 percent Commercial, 32.8 percent Medicaid), and other substance abuse disorders (13.3 percent Commercial, 23.7 percent Medicaid). Nearly one third of both Commercial (31.6 percent) and Medicaid (33.6 percent) patients did not have any claims for psychosocial therapy or MAT during the follow-up period. Only 24.3 percent of Commercial patients and 20.4 percent of Medicaid patients had evidence of claims for both MAT and psychosocial treatment anytime following diagnosis.

Conclusions: The results suggest that there are opportunities to improve care through comprehensive and coordinated treatment for opioid dependence/abuse. Policies aimed at improving treatment access may be warranted.

Author Biographies

Bernd A. Wollschlaeger, MD, FAAFP, FASAM

Physician, Aventura Family Health Center, North Miami Beach, Florida

Tina M. Willson, PhD

Tina M. Willson, PhD, Senior Research Analyst, Truven Health Analytics Inc., an IBM Company, Cambridge, Massachusetts; Now Data Manager III with Division of Epidemiology, University of Utah, Salt Lake City, Utah

Leslie B. Montejano, MA, CCRP

Researcher, Truven Health Analytics Inc., an IBM Company, Cambridge, Massachusetts

Naoko A. Ronquest, PhD

Senior Manager, Health Economics & Outcomes Research, Indivior Inc, Richmond, Virginia

Vijay R. Nadipelli, BPharm, MS

Global Director, Health Economics & Outcomes Research, Indivior Inc , Richmond, Virginia

References

Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2014 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

Rudd RA, Aleshire N, Zibbell JE, et al.: Increases in drug and opioid overdose deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016; 64(50-51): 1378-1382.

Birnbaum HG, White AG, Schiller M, et al.: Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011; 12(4): 657-667.

Florence CS, Zhou C, Luo F, et al.: The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; 54(10): 901-906.

Hansen RN, Oster G, Edelsberg J, et al.: Economic costs of nonmedical use of prescription opioids. Clin J Pain. 2011; 27(3): 194-202.

McAdam-Marx C, Roland CL, Cleveland J, et al.: Costs of opioid abuse and misuse determined from a Medicaid database. J Pain Palliat Care Pharmacother. 2010; 24(1): 5-18.

Oderda GM, Lake J, Rudell K, et al.: Economic burden of prescription opioid misuse and abuse: A systematic review. J Pain Palliat Care Pharmacother. 2015; 29(4): 388-400.

Strassels SA: Economic burden of prescription opioid misuse and abuse. J Manag Care Pharm. 2009; 15(7): 556-562.

White AG, Birnbaum HG, Mareva MN, et al.: Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm. 2005; 11(6): 469-479.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. DSM-5. Washington, DC: American Psychiatric Publishing, 2013.

Center for Substance Abuse Treatment: SAMHSA/CSAT Treatment Improvement Protocols. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.

Kampman K, Jarvis M: American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015; 9(5): 358-367.

Becker WC, Fiellin DA, Merrill JO, et al.: Opioid use disorder in the United States: Insurance status and treatment access. Drug Alcohol Depend. 2008; 94(1-3): 207-213.

Blanco C, Iza M, Schwartz RP, et al.: Probability and predictors of treatment-seeking for prescription opioid use disorders: A national study. Drug Alcohol Depend. 2013; 131(1-2): 143-148.

Saloner B, Karthikeyan S: Changes in substance abuse treatment use among individuals with opioid use disorders in the United States, 2004-2013. JAMA. 2015; 314(14): 1515-1517.

Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6): 613-619.

Barry DT, Savant JD, Beitel M, et al.: Pain and associated substance use among opioid dependent individuals seeking office-based treatment with buprenorphine-naloxone: A needs assessment study. Am J Addict. 2013; 22(3): 212-217.

Stein MD, Herman DS, Bailey GL, et al.: Chronic pain and depression among primary care patients treated with buprenorphine. J Gen Intern Med. 2015; 30(7): 935-941.

Brooner RK, King VL, Kidorf M, et al.: Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry. 1997; 54(1): 71-80.

Savant JD, Barry DT, Cutter CJ, et al.: Prevalence of mood and substance use disorders among patients seeking primary care office-based buprenorphine/naloxone treatment. Drug Alcohol Depend. 2013; 127(1-3): 243-247.

The Kaiser Commission on Medicaid and the Uninsured: Medicaid: A Primer—Key Information on the Nation's Health Coverage Program for Low-Income People. 2013. Available at http://kff.org/medicaid/issue-brief/medicaid-a-primer/. Accessed November 22, 2016.

Baxter JD, Clark RE, Samnaliev M, et al.: Factors associated with Medicaid patients' access to buprenorphine treatment. J Subst Abuse Treat. 2011; 41(1): 88-96.

Molfenter T, Sherbeck C, Zehner M, et al.: Buprenorphine prescribing availability in a sample of Ohio specialty treatment organizations. J Addict Behav Ther Rehabil. 2015; 4(2): 1000140.

Mattson ME, Lynch S: Medication prescribing and behavioral treatment for substance use disorders in physician office settings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. The CBHSQ Report.

Suboxone (R) [package insert]. Richmond, VA: Indivior Inc. June 2016. Available at http://www.suboxone.com/content/pdfs/prescribing-information.pdf. Accessed November 22, 2016.

Substance Abuse and Mental Health Services Administration (SAMHSA): Receipt of Services for Behavioral Health Problems: Results from the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

Mark TL, Lubran R, McCance-Katz EF, et al.: Medicaid coverage of medications to treat alcohol and opioid dependence. J Subst Abuse Treat. 2015; 55: 1-5.

Rinaldo SG, Rinaldo DW: Advancing Access to Addiction Medications. Report I: Availability Without Accessibility? State Medicaid Coverage and Authorization Requirements for Opioid Dependence Medications. American Society of Addiction Medicine: Rockville, MD, 2013: 1–53. Available at http://www.asam.org/docs/default-source/advocacy/aaam_implicationsfor-opioid-addiction-treatment_final. Accessed October 1, 2016.

Hutchinson E, Catlin M, Andrilla CH, et al.: Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014; 12(2): 128-133.

Netherland J, Botsko M, Egan JE, et al.: Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009; 36(3): 244-251.

Reif S, Horgan CM, Hodgkin D, et al.: Access to addiction pharmacotherapy in private health plans. J Subst Abuse Treat. 2016; 66: 23-29.

Chalk M, Alanis-Hirsch K, Woodworth A, et al.: Advancing Access to Addiction Medications. Report II: Report of Commercial Health Plan Medication Coverage and Benefits Survey. American Society of Addiction Medicine: Rockville, MD, 2013: 71-106. Available at http://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final. Accessed October 1, 2016.

Rosenblatt RA, Andrilla CH, Catlin M, et al.: Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015; 13(1): 23-26.

Jones CM, Campopiano M, Baldwin G, et al.: National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015; 105(8): e55-63.

Substance Abuse and Mental Health Services Administration (SAMHSA): Understanding the Final Rule for a Patient Limit of 275. 2016. Available at http://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/understandingpatient-limit275.pdf. Accessed November 17, 2016.

Arfken CL, Johanson CE, di Menza S, et al.: Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians. J Subst Abuse Treat. 2010; 39(2): 96-104.

The Comprehensive Addiction and Recovery Act of 2016, Public Law No: 114-198 (July 22, 2016).

Kim HM, Smith EG, Stano CM, et al.: Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Serv Res. 2012; 12(1): 18.