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
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- 1Department of Family Medicine and Community Health, University of Massachusetts Medical School; Department of Quantitative Health Sciences, University of Massachusetts Medical School. Electronic address: robin.clark@umassmed.edu.
- 2Department of Family Medicine and Community Health, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
- 3Center for Health Policy and Research, University of Massachusetts Medical School.
- 4School of Criminology and Justice Studies, University of Massachusetts Lowell.
- 5Department of Quantitative Health Sciences, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
- J Subst Abuse Treat. 2015 Oct;57:75-80. doi: 10.1016/j.jsat.2015.05.001. Epub 2015 May 7.
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