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(Reuters Health) – New study suggests more and more low-income people with opioid dependence are diagnosed and treated with effective drugs
As part of the ACA, also known as Obamacare, some US states have extended their coverage through Medicaid – the common federal and state insurance program for the poor – to from 2014. Previous studies have linked the development of Medicaid to the increase in the number of people treated for addiction. this study provides new evidence that the law has helped improve access to buprenorphine, a drug for the treatment of opioid addiction.
"When people sign up for Medicaid, it increases the chances that they are looking for all types of medical care, including more visits to the primary care physician, and even when patients do not. do not explicitly seek care for opioid addiction, closer contact with the health system creates more opportunities for screening and diagnosis, "said lead author Brendan Saloner, of the Johns Hopkins Bloomberg School of Public Health in Baltimore.
"Our study did not examine the consequences of overdose or death, but there is a clear advantage that buprenorphine therapy is badociated with a reduced risk of overdose," he says. said Saloner by email.
For the study, the researchers focused on West Virginia, one of the states hardest hit by the opioid crisis.
In 2016, West Virginia had a fatal opioid overdose rate of 43.4 deaths per 100,000 population, more than triple the US average of 13.3 deaths per 100,000 people, the researchers said. in Health Affairs.
According to the study, during the first three years of Medicaid's expansion in West Virginia, an average of 5.5% of all enrollees were diagnosed with opioid use disorder every year. During this same period, the monthly diagnosis of opioid use disorder nearly tripled.
During the study, the proportion of people diagnosed with opioid use disorder and who prescribed buprenorphine increased from about one-third to three-quarters. During this period, the average duration of treatment also increased from 161 to 185 days.
Most people completing buprenorphine prescriptions also received counseling and drug testing.
Naltrexone, another drug against addiction, has not experienced dramatic gains in use during the study and people tend to take it for a shorter time than buprenorphine.
"Methadone and buprenorphine have the strongest evidence to support their efficacy in opioid use disorder, but there are reasons why a patient may prefer naltrexone," said Lucas Hill. from the University of Texas to Austin College of Pharmacy.
"The optimal duration of drug treatment related to opioid-use disorders has not yet been identified, but the available data indicate that longer treatment is generally better," Hill said. , who did not participate in the study, by e-mail.
The study was not designed to determine the effectiveness of the treatments received. It is also unclear how accessibility or affordability of substance abuse treatment may have changed for people with other types of insurance.
"Buprenorphine / naloxone is more accessible through doctors' offices, but it is expensive if you are not insured," said Dr. Stefan Kertesz of the University of Alabama at the Birmingham School of Medicine.
"The problem is who will pay for the doctor's visit, the prescription drugs and the additional services needed," said Kertesz, who was not involved in the study, by e-mail.
Talia Puzantian, of the Keck Graduate Institute, also said that many patients may need treatment for health problems that contribute to opioid misuse, such as chronic pain or mental illness, as well as for conditions that may result from needle-sharing among addicts such as hepatitis and AIDS in Claremont, California.
"Medicaid clearly has a role to play in facilitating access to treatment," said Puzantian, who did not participate in the study, by e-mail. "Repealing the ACA or imposing new barriers to obtaining or maintaining Medicaid – for example, work requirements or bonuses – would be an obstacle. important to life-saving treatment for already weak use. "
SOURCE: bit.ly/2WDiFmY Health Affairs, online April 1, 2019.
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