Identifying Extended-Release Naltrexone Treatment for Opioid Use Disorder in US Medicaid Data
Rachael K Ross1, Anne M Butler2, Marissa J Seamans3
1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Pharmacoepidemiology and Drug Safety
|December 26, 2025
Summary
Coding for extended-release naltrexone (XR-NTX) for opioid use disorder (OUD) varies significantly across states. Claim data analysis reveals inconsistent use of drug and procedure codes, impacting accurate tracking of XR-NTX treatment delivery.
Area of Science:
- Health Services Research
- Pharmacoeconomics
- Addiction Medicine
Background:
- Extended-release naltrexone (XR-NTX) is a key treatment for opioid use disorder (OUD).
- Accurate identification of XR-NTX treatment in claims data relies on specific drug or procedure codes.
- State Medicaid policies can influence coding practices for OUD treatments.
Purpose of the Study:
- To examine the documentation and coding patterns of XR-NTX in multi-state Medicaid claims data.
- To identify variations in XR-NTX coding across different US states.
Main Methods:
- Analysis of 2016-2019 National Medicaid data (TAF) from 26 states.
- Identification of patients with XR-NTX codes and OUD diagnosis during continuous enrollment.
- Description of state-level variations in coding types, file sources, and injection procedure codes.
Main Results:
- XR-NTX drug codes were primary identifiers for 98% of patients.
- Only 25% of patients had injection procedure codes (specific or non-specific) during initial XR-NTX treatment, with wide state variation (7%-87%).
- Patients with initial injection codes had higher rates of subsequent XR-NTX treatment (61% vs. 49%).
Conclusions:
- Inconsistent XR-NTX coding patterns across states necessitate considering both drug and procedure codes for comprehensive service delivery capture.
- Substantial variability in state coding practices highlights the need for multiple definitions in sensitivity analyses for OUD treatment research.
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