Timely Receipt of New Medication Treatment After Acute Care Encounters for Opioid Overdose in the U.S. Medicaid...

Acute care encounters for opioid overdose are increasingly recognized as critical opportunities to connect patients to opioid use disorder (OUD) treatment. However, national data on receipt of medication for OUD (MOUD) after overdose events are limited, particularly for new MOUD initiation.

To examine MOUD receipt and timing after emergency department or inpatient encounters for opioid overdose, including patient characteristics associated with new MOUD initiation.

Retrospective analysis of 2014-2019 national Medicaid claims data.

Acute care opioid overdose events among non-dual eligible Medicaid enrollees aged 18-64 with continuous enrollment during the 180-day (6-month) baseline period preceding the overdose.

The primary outcome was any MOUD (buprenorphine, methadone, naltrexone) receipt in the 180 days after discharge. Baseline MOUD receipt was categorized by the proportion of days covered (PDC): none (reference), very low (> 0 to < 20%), low (20 to < 50%), moderate (50 to < 80%), high (≥ 80%).

Of 318,536 opioid overdose events, 22.8% and 26.0% had MOUD in the 6 months before and after the event, respectively. Prior MOUD had the strongest association with follow-up MOUD, with a gradient by baseline exposure levels. In Cox models adjusting for patient sociodemographic and clinical covariates, overdose characteristics, and community-level factors, the likelihood of follow-up MOUD was 3.58 times higher for very low (95% CI = 3.50-3.66), 5.47 times higher for low (95% CI = 5.35-5.60), 7.36 times higher for moderate (95% CI = 7.17-7.56), and 16.35 times higher for high (95% CI = 15.92-16.80) baseline MOUD exposure compared to no prior MOUD. Timely follow-up MOUD within 30 days was also higher among those with (76.0%) than without (32.4%) prior MOUD.

Substantial gaps in MOUD receipt after opioid overdose indicate an urgent need to expand acute care interventions for treatment initiation, engagement, and referral as well as broader efforts to increase MOUD prescribing and uptake.