Urine drug testing among Medicaid enrollees initiating buprenorphine treatment for opioid use disorder within 9 MODRN states

被引：2

作者：

Hammerslag, Lindsey ^{[1
,14
]}

Talbert, Jeffery ^{[2
]}

Donohue, Julie M. ^{[3
]}

Sharbaugh, Michael ^{[4
]}

Ahrens, Katherine ^{[5
]}

Allen, Lindsay ^{[6
]}

Austin, Anna E. ^{[7
,8
]}

Gordon, Adam J. ^{[9
]}

Jarlenski, Marian ^{[4
]}

Kim, Joo Yeon ^{[4
]}

Mohamoud, Shamis ^{[10
,11
]}

Tang, Lu ^{[12
]}

Burns, Marguerite ^{[13
]}

机构：

[1] Univ Kentucky, Coll Med, Div Biomed Informat, Lexington, KY USA

[2] Univ Kentucky, Inst Biomed Informat, Coll Med, Lexington, KY USA

[3] Univ Pittsburgh, Hlth Policy & Management, Sch Publ Hlth, Pittsburgh, PA USA

[4] Univ Pittsburgh, Dept Hlth Policy & Management, Sch Publ Hlth, Pittsburgh, PA USA

[5] Univ Southern Maine, Muskie Sch Publ Serv, Portland, ME USA

[6] Northwestern Univ, Feinberg Sch Med, Chicago, IL USA

[7] Univ North Carolina Chapel Hill, Gillings Sch Global Publ Hlth, Chapel Hill, NC USA

[8] Univ North Carolina Chapel Hill, Injury Prevent Res Ctr, Chapel Hill, NC USA

[9] Univ Utah, Dept Internal Med, Program Addict Res Clin Care Knowledge & Advocacy, Sch Med, Salt Lake City, UT USA

[10] VA Salt Lake City Hlth Care Syst, Salt Lake City, UT USA

[11] Univ Maryland Baltimore Cty, Hilltop Inst, Catonsville, MD USA

[12] Univ Pittsburgh, Dept Biostat, Sch Publ Hlth, Pittsburgh, PA USA

[13] Univ Wisconsin, Sch Med & Publ Hlth, Dept Populat Hlth Sci, Madison, WI USA

[14] Univ Kentucky, Div Biomed Informat, HKRB 363, Lexington, KY 40536 USA

来源：

DRUG AND ALCOHOL DEPENDENCE | 2023年 / 250卷

关键词：

Drug testing; Urinalysis; Buprenorphine; Medicaid; Opioid use disorder; Overdose; MANAGEMENT; TRENDS; PAIN;

D O I：

10.1016/j.drugalcdep.2023.110875

中图分类号：

R194 [卫生标准、卫生检查、医药管理];

学科分类号：

摘要：

Background: Treatment guidelines recommend regular urine drug testing (UDT) for persons initiating bupre-norphine for opioid use disorder (OUD). However, little is known about UDT utilization. We describe state variation in UDT utilization and examine demographic, health, and health care utilization factors associated with UDT in Medicaid.Methods: We used Medicaid claims and enrollment data from persons initiating buprenorphine treatment for OUD during 2016-2019 in 9 states (DE, KY, MD, ME, MI, NC, PA, WI, WV). The main outcome was at least 1 UDT within 180 days of buprenorphine initiation, the secondary outcome was at least 3. Logistic regression models included demographics, pre-initiation comorbidities, and health service use. State estimates were pooled using meta-analysis.Results: The study cohort included 162,437 Medicaid enrollees initiating buprenorphine. The percent receiving & GE;1 UDT varied from 62.1% to 89.8% by state. In the pooled analysis, enrollees with pre-initiation UDT had much higher odds of & GE;1 UDT after initiation (aOR=3.83, 3.09-4.73); odds were also higher for enrollees with HIV, HCV, and/or HBV infection (aOR=1.25, 1.05-1.48) or who initiated in later years (2018 v 2016: aOR=1.39, 1.03-1.89; 2019 v 2016: aOR=1.67, 1.24-2.25). The odds of having & GE;3 UDT were lower with pre-initiation opioid overdose (aOR=0.79, 0.64-0.96) and higher with pre-initiation UDT (aOR=2.63, 2.13-3.25) or OUD care (aOR=1.35, 1.04-1.74). The direction of associations with demographics varied by state.Conclusions: Rates of UDT increased over time and there was variability among states in UDT rates and de-mographic predictors of UDT. Pre-initiation conditions, UDT, and OUD care were associated with UDT.

引用

页数：8

共 34 条

[1] The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update [J].