Availability of Extended-Release Buprenorphine to Treat Opioid Use Disorders Among Medicaid-Covered Patients

Prescribing of extended release buprenorphine injection for Medicaid beneficiaries, 2018-2022

BACKGROUND AND AIMS

Extended release buprenorphine injection (INJ-BUP) has been available in the United States since 2018. INJ-BUP has the potential to positively impact opioid use disorder (OUD) treatment outcomes by providing additional treatment options. As one of the largest payers of OUD treatment in the US, Medicaid coverage is important for access and uptake of INJ-BUP. Uptake of INJ-BUP among Medicaid beneficiaries has not been described since 2019 and variation in uptake by state has not previously been explored. We aimed to measure prescribing of INJ-BUP for Medicaid beneficiaries since 2018, nationwide and by state.

METHODS

We analyzed State Drug Utilization Data from 2017 to 2022 and calculated the number of prescription fills for INJ-BUP and oral buprenorphine paid by Medicaid. To compare across states, we calculated the number of prescription fills per 100 Medicaid beneficiaries treated for OUD using data from Transformed Medicaid Statistical Information System Substance Use Disorder (T-MSIS SUD) Data Books. Data sources are publicly available.

RESULTS

The number of prescription fills for INJ-BUP paid by Medicaid increased from 4322 (0.1% of all buprenorphine prescription fills) in 2018 to 186 861 (2.0%) in 2022. Each year the increase in fills exceeded the prior year change, indicating accelerating uptake. There was notable variability across states.

CONCLUSIONS

The number of extended release buprenorphine injection prescriptions among US Medicaid beneficiaries treated for opioid use disorder increased from over 4000 prescriptions in 2018 to over 185 000 in 2022 but uptake is much less than observed in other countries over shorter time periods.

Quantitative and qualitative outcomes associated with inpatient addiction consultation: a scoping review

Background: Rates of acute care use, including hospital admission and readmission, are high for people who misuse substances. Hospitalization provides a valuable opportunity for intervention, but addiction treatment is often not addressed in the inpatient setting. Addiction consult services are a novel intervention intended to change hospital practices.Objectives: Comprehensively summarize outcomes (quantitative and qualitative) associated with inpatient addiction consult services.Methods: English-language searches of: Medline, CINAHL, Embase, The Cochrane Database of Systematic Reviews, PubMed, PsychInfo and Google Scholar were conducted from 2000 to November 2022. Studies reporting outcomes associated with addiction specialist consultation in the hospital setting were included. Four independent reviewers screened abstracts, and three reviewers screened full-text articles.Results: A total of 1,113 results underwent title and abstract screening and 43 studies were included. Outcomes associated with addiction specialist consultation were heterogeneous. Quantitative clinical outcomes focused on pharmacotherapy, healthcare utilization, and outpatient follow-up. Consultation improved rates of pharmacotherapy use, but had inconsistent effects on health care use, and overall follow-up rates were low. Consultation was associated with reduced overdose rates and 90-day mortality. Additional outcomes related to medical learners' educational achievements and qualitative results described positive effects on trainees, healthcare providers, and patients seen by specialized consult services. Access to dedicated providers improved experiences in hospitals for both people who misuse substances and their healthcare providers.Conclusion: Addiction specialist consultations are related to several clinical metrics, but some outcomes (e.g. pharmacotherapy initiation) may be more amenable to intervention than others (healthcare utilization). Qualitative findings provide important context for quantitative clinical results.

Availability of Long-Acting Injectable Buprenorphine at Substance Use Treatment Facilities in 2021

This study assesses the proportion of US substance use and mental health care facilities that offered any medications for opioid use disorder and, specifically, long-acting injectable buprenorphine in 2021.

Opioid use disorder treatment for people experiencing homelessness: A scoping review

BACKGROUND

The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment.

METHODS

We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized.

RESULTS

60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit.

CONCLUSIONS

PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.