Few patients use medications for opioid use disorder after overdose
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Key takeaways:
- Only 4.1% of Medicare beneficiaries received medication for opioid use disorder within 12 months of an overdose.
- The data show a need for increased uptake of evidence-based care in settings like EDs.
Few individuals received medications for opioid use disorder or filled a naloxone prescription after a nonfatal drug overdose, despite the benefits of these treatments in reducing the odds for a future fatal overdose, data show.
“Prior nonfatal drug overdose is an important factor in subsequent nonfatal and fatal drug overdoses,” Christopher M. Jones, PharmD, DrPH, MPH, director of the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention, and colleagues wrote in JAMA Internal Medicine. “Yet, many patients treated for a drug overdose do not receive evidence-based services after their overdose.”
In the study, the researchers used data from CMS, the CDC and other sources on 136,762 Medicare beneficiaries (mean age, 68 years; 58.6% women) who experienced a nonfatal drug overdose in 2020. Jones and colleagues then assessed receipts of naloxone, medications for opioid use disorder (MOUD) like buprenorphine or methadone and other behavorial health services within the 12 months following the overdose.
During the 12-month period, 17.4% of participants experienced at least one subsequent nonfatal drug overdose and 1% died of a fatal drug overdose.
Opioids were involved in 72.2% of the fatal drug overdoses, whereas some characteristics tied to a fatal drug overdose after the initial overdose included:
- a subsequent nonfatal drug overdose (adjusted OR = 1.25; 95% CI, 1.1-1.43);
- opioid use disorder, or OUD (aOR = 2.58; 95% CI, 2.24-2.96); and
- cocaine use disorder (aOR = 1.44; 95% CI, 1.21-1.7).
The researchers found that 4.1% and 6.2% of participants received any MOUD or filled a naloxone prescription, respectively, in the 12 months after the initial nonfatal drug overdose, whereas 53.4% received antidepressants.
Although 88.8% of Medicaid beneficiaries received behavioral health services, Jones and colleagues noted that “the majority received these services for less than a week.”
Several interventions were associated with reduced odds for a fatal drug overdose in the 12-month period, including:
- filling a naloxone prescription (aOR = 0.7; 95% CI, 0.56-0.89)
- each additional day receiving methadone (aOR = 0.98; 95% CI, 0.98-0.99) or buprenorphine (aOR = 0.99; 95% CI, 0.98-0.99);
- each additional day receiving antidepressants (aOR = 0.99; 95% CI, 0.99-0.99) or antipsychotics (aOR = 0.99; 95% CI, 0.99-1); and
- receiving behavioral health assessment or crisis services (aOR = 0.25; 95% CI, 0.22-0.28).
“These findings underscore the need to increase the uptake of evidence-based care after a nonfatal drug overdose,” the researchers wrote.
There were multiple limitations to the study, according to Jones and colleagues. For example, the findings may not be generalizable to other populations like Medicaid beneficiaries. Additionally, causality could not be determined due to the study’s observational nature.
Jones and colleagues explained that making drug overdose education and naloxone distribution a standard part of care during substance use disorder- and nonfatal drug overdose-related ED visits “could be an important first step” for improving overdose care.
“In addition, EDs can partner with health systems, community-based health care and social service practitioners, and recovery and peer-support organizations to link overdose survivors and high-risk individuals to care and services for OUD, co-occurring SUD and mental disorder, and chronic medical conditions,” they wrote.
Perspective
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Speaking as a primary care physician, this study draws conclusions that are already well known to be true. The health care system in this country does not effectively provide treatment and support for people suffering from substance use disorders. I would venture to conclude that during the period of this study data, from 2020 and 2021, we significantly underperformed in this area, given the fact that health care systems found themselves vastly overwhelmed while trying to combat the COVID-19 pandemic. And while the last few years have shown an increased awareness of these deficiencies and a push to improve treatment services, our health care system is still overwhelmed with the ever-increasing prevalence of chronic disease and the ever-increasing administrative burden demanded of physicians. Our medical system has become a reactive one in which we provide “sick care” instead of being proactive and providing health care. As the authors noted, Medicare has implemented payment policy changes aimed to provide more coordinated care for those suffering from substance use disorders. However, in my experience, these policy changes often end in more physician documentation requirements in order for health care systems to capture that additional revenue and do nothing to provide meaningful change for patients. To make meaningful change and have the best chance for treatment success, patients need to have the ability to establish rapport and trust with a PCP who knows them, treats their other chronic health conditions, understands their social determinants of health, and works to optimize their overall wellness. In too many instances, treatment for substance use disorders is placed in a separate silo, often in a separate facility and by a separate physician, when it really should be a holistic approach tailored to each individual patient’s needs and coordinated by their PCP.
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