Cited by 995Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

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Comparative effectiveness of different treatment pathways for opioid use disorder.

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Wakeman, Sarah E., Larochelle, Marc R., Ameli, Omid, Chaisson, Christine E., McPheeters, Jeffrey Thomas, Crown, William H., Azocar, Francisca, Sanghavi, Darshak M.·2020·JAMA Network Open

DOI 10.1001/jamanetworkopen.2019.20622PMC PMC11143463

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Abstract

Importance: Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking. Objective: To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence. Design, Setting, and Participants: This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019. Exposures: One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health. Main Outcomes and Measures: Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment. Results: A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up. Conclusions and Relevance: Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.

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Figure 1. Probability of Opioid Overdose and Acute Care Use During the 3-Month Follow-up Period BH indicates behavioral health; CE, continuous enrollment; BH IOP, intensive behavioral health (intensive outpatient or partial hospitalization); IP detox/RTC, inpatient detoxification or residential services; and MOUD, medication for opioid use disorder.CC BY-NC-ND · PubMed Central

Figure 2. Probability of Opioid Overdose and Acute Care Use During the 12-Month Follow-up Period CE indicates continuous enrollment; MOUD, medication for opioid use disorder.CC BY-NC-ND · PubMed Central

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Authors: Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M.
Affiliations: Harvard University (US)
Boston University (US)
Integrated Programs, OptumLabs Inc, Cambridge, Massachusetts
Optum (United States) (US)
Department of Research, OptumLabs, Cambridge, Massachusetts
Department of Research, Optum Behavioral Health, Cambridge, Massachusetts
UnitedHealth Group (United States) (US)
Corresponding author: Wakeman, Sarah E.
ORCID: Wakeman, Sarah E.
Larochelle, Marc R.
Ameli, Omid
Chaisson, Christine E.
Crown, William H.
Azocar, Francisca
Sanghavi, Darshak M.
Venue: JAMA Network Open
Publisher: American Medical Association (AMA)
Published: 2020-02-05
Volume: 3
Issue: 2
Pages: e1920622
ISSN: 2574-3805 (ISSN-L)
DOI: 10.1001/jamanetworkopen.2019.20622
PMC: PMC11143463
OpenAlex: W3005454586
Cited by: 995
References: 39
Citations by year: 2026: 137 · 2025: 170 · 2024: 192 · 2023: 161 · 2022: 158 · 2021: 128 · 2020: 49
FWCI: 92.82
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc-nd
Locations: JAMA Network Open (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Funders: Massachusetts General Hospital
School of Medicine, Boston University (1UL1TR001430)
Laura and John Arnold Foundation
Office of National Drug Control Policy (G1799ONDCP06B)
Hamilton Health Sciences Foundation
National Institutes of Health (UL1TR001430)
Centers for Disease Control and Prevention (U01CE002780)
U.S. Food and Drug Administration (HHSF223200910006I)
Substance Abuse and Mental Health Services Administration (1H79TI081442-01)
National Institute on Drug Abuse (K23DA042168, R01DA044526, UG1DA015831, G1799ONDCP06B)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: opioid use disorder, medication-assisted treatment, buprenorphine, methadone, naltrexone, inpatient detoxification, residential treatment, opioid overdose, acute care utilization, treatment pathways, comparative effectiveness, real-world evidence, injection-related infections
MeSH terms: Adolescent, Adult, Analgesics, Opioid, Behavior Therapy, Buprenorphine, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Retrospective Studies, United States, Proportional Hazards Models, Substance Abuse Treatment Centers, Treatment Outcome, Critical Pathways, Young Adult, Comparative Effectiveness Research, Opiate Substitution Treatment

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Comparative effectiveness of different treatment pathways for opioid use disorder.

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