Research points to treatment gap after overdoses
Medicaid recipients keep access to opioids
Even if an individual in the Medicaid system has suffered an overdose of heroin or another opioid, the incident has minimal impact on the person’s access to prescription opioids afterward, according to a new University of Pittsburgh study.
The research into repeated access to legal opioids by those who have been treated for overdoses points to a gap in the addiction treatment system for those on Medicaid, said Julie M. Donohue, a Pitt associate professor of health policy and management. She was senior author of the study by her and six colleagues published Tuesday by the Journal of the American Medical Association.
“We’ve got a real missed opportunity to change opioid prescribing and increase access to treatment following these life-altering events,” Ms. Donohue said.
Medicaid enrollees have traditionally experienced a far higher rate of overdose than the public, due to various health and socioeconomic issues. The Pitt-based researchers examined Pennsylvania Medicaid records from 2008 to 2013, focusing on 6,013 people who were treated at hospitals for drug overdoses and who were Medicaid beneficiaries six months before and
after those incidents.
The study found that among those who had experienced heroin overdoses, the percentage who were later prescribed opioids fell from 43.2 percent to 39.7 percent. For those with non-heroin forms of opioid overdoses, the share of those wit hop io ids prescribed afterward de- creased from 66.1 percent to 59.6 percent.
Although those numbers represent declines in opioid prescribing for this seriously at-risk population, the study noted the change to be modest, “signaling a relatively weak health system response to a life-threatening event.”
Ms. Donohue said that if the health system were operating as it should, there would be far better connections of hospitals and their emergency departments to addiction treatment centers. That would get people to proper help afterward instead of leaving them on their own, returning them to the same doctors who may continue prescribing opioids to them while unaware of the overdoses. She said better communication would also lead to more use of medication-assisted treatment — the use of buprenorphine, methadone or naltrexone — that are prescribed by physicians to reduce overdose risks.
“We keep hearing the statistic that for every fatal overdose there are 30 non-fatal overdoses, and we were interested in what happened to people after non-fatal overdoses,” Ms. Donohue said. “This is a window of opportunity to intervene, either by bringing the person into treatment if they have an underlying addiction or by cutting back on the amount of opioids prescribed.”
She said recent changes undertaken in Pennsylvania in response to the opioid crisis could have a beneficial effect, compared with the 20082013 period. Those include recognition of addiction centers of excellence to drive more treatment and use of an electronic records system tracking each individual’s history of prescription opioid use.
“Both of those will probably take a couple of years to fully implement, and then time is needed to evaluate their effects,” Ms. Donohue said. “Unfortunately, the epidemic continues to grow rapidly.”