PROVIDENCE, R.I. [Brown University] — For people living with opioid use disorder, the path to treatment is not always clear-cut. Sometimes, there’s no path at all.
The gap between those recommended for medications for opioid use disorder — with methadone, buprenorphine or other medications prescribed — and those who ultimately receive it is wide and persisting. At the epicenter, accounting for more than one third of individuals with an opioid use disorder, are Medicaid recipients.
In an effort to gather information that might help to close that gap, researchers at the Brown University School of Public Health analyzed Medicaid databases to identify predictors of timely enrollment in treatment for those who experienced an opioid overdose or were diagnosed with opioid use disorder.
The findings, published in the journal Drug and Alcohol Dependence, show that 58% of Medicaid recipients did not enroll in treatment within six months of an overdose, and that prior overdose, alcohol use disorder and back problems were predictors of non-enrollment. Conversely, frequent visits to the emergency room or a primary care provider were associated with timely enrollment.
The researchers used multiple linked, state-level databases available through the Rhode Island Executive Office of Health and Human Services to conduct the study of 17,449 Medicaid recipients in Rhode Island.
“These findings underscore the need to enhance pathways to treatment, and we provide several recommendations to that end,” said Alexandria Macmadu, study author and a Brown doctoral candidate in epidemiology.
By pinpointing predictors of enrollment, and non-enrollment, researchers and physicians can get a clearer sense of where they need to connect with people to encourage treatment: in settings that provide mental health care, emergency departments, treatment programs for other substance use disorders, and even pain clinics.
Based on the findings, the researchers generated a two-tiered approach to enhance existing systems of care and ensure maximum exposure to pathways to treatment for OUD at the state level.