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. 2020 May 1;3(5):e205852.
doi: 10.1001/jamanetworkopen.2020.5852.

Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients

Austin S Kilaru  1   2   3   4 , Aria Xiong  3 , Margaret Lowenstein  1   3   4 , Zachary F Meisel  2   3   4 , Jeanmarie Perrone  2   3 , Utsha Khatri  1   2   3   4 , Nandita Mitra  5 , M Kit Delgado  2   3   4   5
Affiliations

Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients

Austin S Kilaru et al. JAMA Netw Open. .

Abstract

Importance: Timely initiation and referral to treatment for patients with opioid use disorder seen in the emergency department is associated with reduced mortality. It is not known how often commercially insured adults obtain follow-up treatment after nonfatal opioid overdose.

Objective: To investigate the incidence of follow-up treatment following emergency department discharge after nonfatal opioid overdose and patient characteristics associated with receipt of follow-up treatment.

Design, setting, and participants: A retrospective cohort study was conducted using an administrative claims database for a large US commercial insurer, from October 1, 2011, to September 30, 2016. Data analysis was performed from May 1, 2019, to September 26, 2019. Adult patients discharged from the emergency department after an index opioid overdose (no overdose in the preceding 90 days) were included. Patients with cancer and without continuous insurance enrollment were excluded.

Main outcomes and measures: The primary outcome was follow-up treatment in the 90 days following overdose, defined as a combined outcome of claims for treatment encounters or medications for opioid use disorder (buprenorphine and naltrexone). Analysis was stratified by whether patients received treatment for opioid use disorder in the 90 days before the overdose. Logistic regression models were used to identify patient characteristics associated with receipt of follow-up treatment. Marginal effects were used to report the average adjusted probability and absolute risk differences (ARDs) in follow-up for different patient characteristics.

Results: A total of 6451 patients were identified with nonfatal opioid overdose; the mean (SD) age was 45.0 (19.3) years, 3267 were women (50.6%), and 4676 patients (72.5%) reported their race as non-Hispanic white. A total of 1069 patients (16.6%; 95% CI, 15.7%-17.5%) obtained follow-up treatment within 90 days after the overdose. In adjusted analysis of patients who did not receive treatment before the overdose, black patients were half as likely to obtain follow-up compared with non-Hispanic white patients (ARD, -5.9%; 95% CI, -8.6% to -3.6%). Women (ARD, -1.7%; 95% CI, -3.3% to -0.5%) and Hispanic patients (ARD, -3.5%; 95% CI, -6.1% to -0.9%) were also less likely to obtain follow-up. For each additional year of age, patients were 0.2% less likely to obtain follow-up (95% CI, -0.3% to -0.1%).

Conclusions and relevance: Efforts to improve the low rate of timely follow-up treatment following opioid overdose may seek to address sex, race/ethnicity, and age disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Delgado reported an honorarium from United Health Group outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Outcomes Stratified by Overdose Type and Treatment Status Before Overdose
Data shown for status at 90 days before overdose for all patients (A), heroin overdose (B), and prescription opioid overdose (C). MOUD indicates medication for opioid use disorder.
Figure 2.
Figure 2.. Proportion of Index Opioid Overdoses by Quarter, Stratified by Overdose Type and Receipt of Follow-up Treatment
Figure 3.
Figure 3.. Average Adjusted Probability of Follow-up Treatment After Opioid Overdose, by Overdose Type and Race/Ethnicity
Estimated from logistic regression model with interaction term for overdose type and race/ethnicity. Error bars denote 95% confidence intervals for average adjusted probability. Results shown only for patients who had not received treatment for opioid use disorder in the 90 days before the index opioid overdose. Race/ethnicity was self-reported or derived from other administrative data sources.
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Comment in

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