Pharmacotherapy and overdose risk following new opioid use disorder diagnosis among Medicaid beneficiaries

作者：Peter Treitler, Hillary Samples, Richard Hermida, Jennifer Miles, Elizabeth M. Stone, Stephen Crystal · 发表于：The American Journal of Drug and Alcohol Abuse · 年份：2025 · DOI：10.1080/00952990.2025.2557917 · 被引用次数：2 · 研究领域：Opioid Use Disorder Treatment、HIV, Drug Use, Sexual Risk、Substance Abuse Treatment and Outcomes

Background: Timely initiation and continuation of medications for opioid use disorder (MOUD) following a new opioid use disorder (OUD) diagnosis reduces overdose risk.Objectives: To examine patient- and community-level factors associated with timely MOUD receipt and the association of these factors and MOUD modality (buprenorphine, methadone, naltrexone) with subsequent overdose.Methods: This cohort study included Medicaid enrollees in 44 states aged 18–64 with a new OUD diagnosis between April 2016 and December 2019. Multivariable Cox Proportional Hazards models assessed time (in days) to MOUD receipt and medically-treated nonfatal overdose stratified by involvement of heroin/synthetic vs. other (primarily prescription) opioids only. Models adjusted for patient, county, and state-level covariates, and models examining overdose additionally adjusted for time-varying (daily) MOUD receipt.Results: Of 1,172,200 Medicaid enrollees with a new OUD diagnosis, 51.8% were female, 55.8% White, and 42.2% aged 30–44. Most (69.2%) did not receive MOUD within 180 days. MOUD receipt was lower among Black (Hazard Ratio [HR] = 0.68, 95% Confidence Interval [CI] 0.67–0.69) and Hispanic (HR = 0.91, 95%CI = 0.90–0.92) compared to White enrollees. During follow-up, 3.2% of enrollees experienced heroin/synthetic opioid overdose, with reduced risk more strongly associated with methadone (HR = 0.14, 95%CI = 0.12–0.15) and buprenorphine (HR = 0.23, 95%CI = 0.22–0.25) than naltrexone (HR = 0.70, 95%CI...