Relatively Few Medicare Beneficiaries Receive MOUD After Non-Fatal Overdose

In the 12 months following a non-fatal drug overdose, only a small percentage of Medicare beneficiaries fill a naloxone prescription or receive medications for opioid use disorder (MOUD), according to study findings published in JAMA Internal Medicine.

Although patients with a prior non-fatal overdose are at increased risk for subsequent overdoses, many patients who are treated for a drug overdose do not receive evidence-based interventions following their overdose. To provide an updated estimate of overdose intervention service use in the United States, investigators conducted a longitudinal cohort study to evaluate receipt of MOUD, naloxone, and behavioral health services in the 12 months following an index nonfatal drug overdose.

The investigators analyzed collected between January 2020 to December 2021 data from the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention to identify Medicare fee-for-service (FFS) adult beneficiaries at least 18 years of age who experienced a nonfatal drug overdose. Included individuals were continuously enrolled in Medicare parts A, B, and D from 90 days before to 12 months after their index non-fatal drug overdose. The primary exposures of interest were demographic and clinical characteristics, history of substance use disorder, and psychiatric comorbidities. The primary outcomes of interest included subsequent fatal and nonfatal drug overdoses. Secondary endpoints included receipt of MOUD, naloxone, and behavioral health services interventions.

Data from a total of 136,762 Medicare beneficiaries was included in the present analysis. Individuals had a mean (SD) age of 68.2 (15.0) years, 58.6% were women, and 78.8% were non-Hispanic White. The investigators observed that 21.4% of the cohort had substance use disorder for 2 or more substances, 11.9% had alcohol use disorder, 17.2% had opioid use disorder, and 29.0% had tobacco use disorder. Additionally, 49.2% of beneficiaries had 2 or more psychiatric diagnoses, the most common of which were anxiety disorder (56.1%) and major depressive disorder (55.4%).

The investigators found that among Medicare beneficiaries who experienced an index non-fatal drug overdose, 17.4% (n=23,815) experienced at least 1 subsequent non-fatal drug overdose, and 1.0% (n=1323) experienced a fatal drug overdose. Opioids were involved in 72.2% of the fatal overdoses. Only 4.1% of Medicare beneficiaries who experienced a non-fatal overdose received any MOUD and 6.2% filled a naloxone prescription in the 12 months following the index nonfatal overdose.

The investigators also found that the odds of a subsequent fatal drug overdose were significantly lower among individuals who filled a naloxone prescription (adjusted odds ratio [aOR], 0.70; 95% CI, 0.56-0.89) and those who received methadone (aOR, 0.98; 95% CI, 0.98-0.99), buprenorphine (aOR, 0.99; 95% CI, 0.98-0.99), or a behavioral health assessment or crisis services (aOR, 0.25; 95% CI, 0.22-0.28)

“Despite their known association with reduced risk of a fatal drug overdose, only a small percentage of Medicare beneficiaries received MOUD or filled a naloxone prescription in the 12 months after a nonfatal drug overdose,” the investigators concluded. “Efforts to improve the provision of life-saving behavioral health services; MOUD; and overdose-prevention strategies, such as prescribing naloxone in the ED and other health care settings as well as linking individuals to community-based practitioners for ongoing care, are urgently needed to address historically high rates of drug overdose in the US.”

Study limitations include a lack of generalizability from a Medicare FFS-only study population, inherent issues in electronic coding or missing data, and the use of prescriptions as a proxy for adherence.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor