Developing and validating measures of take-home methadone with administrative data

Area of Science:

• Health Services Research
• Substance Abuse Treatment
• Health Informatics

Background:

• Take-home methadone (THM) has become more flexible since 2020, offering innovative treatment for opioid use disorder.
• Current insurance claims data lack established methods for accurately measuring THM.
• This study aimed to develop and validate candidate measures for THM using claims data.

Purpose of the Study:

• To propose and validate candidate indicators for measuring take-home methadone (THM) treatment using Medicaid insurance claims data.
• To assess the performance of these candidate indicators against a gold-standard measure.
• To determine the extent to which variation between treatment programs explains overall variation in THM receipt.

Main Methods:

• Utilized 2020 Medicaid data from four states, analyzing treatment episodes for individuals aged 18-64.
• Defined THM receipt based on a gold-standard indicator (≥6 consecutive days of THM in the second month of treatment).
• Developed four candidate indicators based on intervals between in-clinic methadone administrations and evaluated their sensitivity and specificity against the gold-standard.

Main Results:

• The study analyzed 4836 treatment episodes, with 14% involving THM.
• Candidate indicators demonstrated high sensitivity (65-100%) and specificity (80-96%).
• The most sensitive indicator identified THM with any ≥7-day gap between administrations; the most specific required two consecutive ≥7-day gaps of equal length. Between-program variation accounted for 38.6-48.3% of THM receipt variation.

Conclusions:

• Two proposed indicators for measuring THM using Medicaid claims data show excellent performance.
• These validated measures provide a reliable method for assessing THM uptake and patient outcomes in opioid use disorder treatment.