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Medication-assisted treatment and opioid use response to opioid overdose sentinel events

Frazier, Winfred (2017) Medication-assisted treatment and opioid use response to opioid overdose sentinel events. Master Essay, University of Pittsburgh.

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Abstract

Introduction
A nonfatal overdose due to opioids can be viewed as a failure to adequately treat addiction or as an opportunity to start or improve treatment for opioid use disorder (OUD). It is important to determine how patients are being treated before and after an overdose. Primary care providers are at the forefront of the opioid epidemic and have the potential to influence opioid prescribing habits and treatment of OUD. Evaluation of the opioid epidemic leading to potential solutions has significant public health relevance.
Objective
To determine treatment utilization before and after nonfatal overdoses.
Methods
We conducted a longitudinal retrospective cohort study of Pennsylvania Medicaid patients aged 12-64 with a nonfatal opioid or heroin overdose event between 2008-2013. We measured unduplicated patient-level univariate descriptive statistics for demographic and treatment utilization 6 months before and 6 months after an overdose. We identified inpatient, outpatient, and pharmacy claims data from Pennsylvania’s managed care and fee-for-service Medicaid programs. We excluded Non-Pennsylvania residents, those dually-eligible for Medicare, age < 12 or age > 64, and non-opioid or non-heroin overdoses for a total of 7,690 enrollees. We evaluated the following demographic factors: age, gender, and race. The main outcome measure was OUD medication-assisted treatment (MAT) utilization: methadone, buprenorphine, and naltrexone. Secondary outcome measures included the length (days) supply of prescription opioids pre and post-overdose.
Results
Among 3,009 enrollees who had a heroin overdose and 4,989 who had a prescription opioid overdose, most were <40 years old and white. Among those who survived after the non-fatal overdose, opioid use did not change in the heroin group (40.6% pre and 39.7% post, P = 0.12). Whereas enrollees in the opioid group were less likely to fill opioid prescriptions post-overdose (65.4% to 59.6% p < 0.001). Likewise, the percent of enrollees with >90 days duration of opioids did not change in the heroin group pre- to post-overdose (9.4% to 9.0%, P =0.07) but decreased in the opioid group (32.2% to 28.3%, P < 0.001). MAT increased after overdose in the heroin (28.7% to 33.0%, P < 0.001) and opioid group (from 13.6% to 15.1%, P = 0.001).
Conclusions
Overall, we saw similar OUD medication and treatment utilization rates before and after overdose events. These findings are concerning because they show a lack of addiction treatment escalation after an overdose.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Frazier, WinfredWTF8@pitt.eduWTF8
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairDonohue, Juliejdonohue@pitt.edujdonohueUNSPECIFIED
Committee MemberHan, Jonathanhanxjk@UPMC.EDUhanxjkUNSPECIFIED
Date: 29 April 2017
Date Type: Submission
Number of Pages: 37
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 10 Aug 2017 21:42
Last Modified: 10 Aug 2017 21:42
URI: http://d-scholarship.pitt.edu/id/eprint/31236

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