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dc.contributor.authorClark, Robin E.
dc.contributor.authorBaxter, Jeffrey D.
dc.contributor.authorAweh, Gideon
dc.contributor.authorO'Connell, Elizabeth
dc.contributor.authorFisher, William H.
dc.contributor.authorBarton, Bruce A.
dc.date2022-08-11T08:08:34.000
dc.date.accessioned2022-08-23T15:59:18Z
dc.date.available2022-08-23T15:59:18Z
dc.date.issued2015-10-01
dc.date.submitted2016-03-23
dc.identifier.citationJ Subst Abuse Treat. 2015 Oct;57:75-80. doi: 10.1016/j.jsat.2015.05.001. Epub 2015 May 7. <a href="http://dx.doi.org/10.1016/j.jsat.2015.05.001">Link to article on publisher's site</a>
dc.identifier.issn0740-5472 (Linking)
dc.identifier.doi10.1016/j.jsat.2015.05.001
dc.identifier.pmid25997674
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30637
dc.description.abstractClinical trials show that opioid agonist therapy (OAT) with methadone or buprenorphine is more effective than behavioral treatments, but state policymakers remain ambivalent about covering OAT for long periods. We used Medicaid claims for 52,278 Massachusetts Medicaid beneficiaries with a diagnosis of opioid abuse or dependence between 2004 and 2010 to study associations between use of methadone, buprenorphine or other behavioral health treatment without OAT, and time to relapse and total healthcare expenditures. Cox Proportional Hazards ratios for patients treated with either methadone or buprenorphine showed approximately 50% lower risk of relapse than behavioral treatment without OAT. Expenditures per month were from $153 to $233 lower for OAT episodes compared to other behavioral treatment. Co-occurring alcohol abuse/dependence quadrupled the risk of relapse, other non-opioid abuse/dependence doubled the relapse risk and severe mental illness added 80% greater risk compared to those without each of those disorders. Longer current treatment episodes were associated with lower risk of relapse. Relapse risk increased as prior treatment exposure increased but prior treatment was associated with slightly lower total healthcare expenditures. These findings suggest that the effectiveness of OAT that has been demonstrated in clinical trials persists at the population level in a less controlled setting and that OAT is associated with lower total healthcare expenditures compared to other forms of behavioral treatment for patients with opioid addiction. Co-occurring other substance use and mental illness exert strong influences on cost and risk of relapse, suggesting that individuals with these conditions need more comprehensive treatment.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25997674&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560989/
dc.subjectUMCCTS funding
dc.subjectBuprenorphine
dc.subjectCost
dc.subjectEconomic evaluation
dc.subjectLength of treatment
dc.subjectMedicaid
dc.subjectMethadone
dc.subjectOpioid addiction
dc.subjectOpioid agonists
dc.subjectPublic policy
dc.subjectSubstance abuse treatment
dc.subjectTreatment history
dc.subjectClinical Epidemiology
dc.subjectEpidemiology
dc.subjectHealth Policy
dc.subjectHealth Services Research
dc.subjectSubstance Abuse and Addiction
dc.titleRisk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History
dc.typeJournal Article
dc.source.journaltitleJournal of substance abuse treatment
dc.source.volume57
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/913
dc.identifier.contextkey8371000
html.description.abstract<p>Clinical trials show that opioid agonist therapy (OAT) with methadone or buprenorphine is more effective than behavioral treatments, but state policymakers remain ambivalent about covering OAT for long periods. We used Medicaid claims for 52,278 Massachusetts Medicaid beneficiaries with a diagnosis of opioid abuse or dependence between 2004 and 2010 to study associations between use of methadone, buprenorphine or other behavioral health treatment without OAT, and time to relapse and total healthcare expenditures. Cox Proportional Hazards ratios for patients treated with either methadone or buprenorphine showed approximately 50% lower risk of relapse than behavioral treatment without OAT. Expenditures per month were from $153 to $233 lower for OAT episodes compared to other behavioral treatment. Co-occurring alcohol abuse/dependence quadrupled the risk of relapse, other non-opioid abuse/dependence doubled the relapse risk and severe mental illness added 80% greater risk compared to those without each of those disorders. Longer current treatment episodes were associated with lower risk of relapse. Relapse risk increased as prior treatment exposure increased but prior treatment was associated with slightly lower total healthcare expenditures. These findings suggest that the effectiveness of OAT that has been demonstrated in clinical trials persists at the population level in a less controlled setting and that OAT is associated with lower total healthcare expenditures compared to other forms of behavioral treatment for patients with opioid addiction. Co-occurring other substance use and mental illness exert strong influences on cost and risk of relapse, suggesting that individuals with these conditions need more comprehensive treatment.</p>
dc.identifier.submissionpathfaculty_pubs/913
dc.contributor.departmentCenter for Health Policy and Research
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Family Medicine and Community Health
dc.source.pages75-80


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