A major study of opioid use disorder treatment co-authored by Optum and OptumLabs researchers found that using buprenorphine or methadone medication is the most effective treatment for opioid use disorder (OUD), but few patients have access to such medications. The study, published Feb. 5 in JAMA Network Open, used OptumLabs data. The lead author was Sarah E. Wakeman, M.D. (MGH); co-authors included Marc R. LaRochelle, M.D., M.P.H. (BMC), Omid Ameli, M.D., D.Sc. (OptumLabs), Christine E. Chaisson, M.P.H. (OptumLabs), Jeffrey Thomas McPheeters, B.A. (OptumLabs), William H. Crown, Ph.D. (OptumLabs), Francisca Azocar, Ph.D. (Optum Behavioral Health) and Darshak M. Sanghavi, M.D. (UnitedHealthcare).
What the Study Examined
Working with de-identified claims data from the OptumLabs Data Warehouse, researchers analyzed a cohort of more than 40,000 patients with an opioid use disorder diagnosis between 2015 and 2017 who were commercially insured or on a Medicare Advantage plan. They compared those who received buprenorphine or methadone to those receiving no treatment and to patients whose initial treatment was inpatient detoxification or residential rehabilitation, outpatient counseling, intensive outpatient treatment or partial treatment in a hospital setting, and medication with naltrexone.
What the Study Found
Researchers found that patients who initiated treatment with buprenorphine or methadone were 76% less likely to overdose within three months and 59% less likely in 12 months compared to those who received no treatment. The same patients were 32% less likely to have an opioid-related emergency department visit or inpatient hospitalization in three months and 26% less likely in 12 months.
However, only 12.5% of patients analyzed initiated OUD treatment using buprenorphine or methadone. Researchers cited “a lack of access to waivered practitioners, high co-payments, (and) prior authorization requirements” among common barriers to these medications.
“These clinical outcomes reinforce that medication for opioid use disorder (MOUD) is the evidence-based standard in the treatment of opioid use disorder,” said co-author Darshak M. Sanghavi, chief medical officer, UnitedHealthcare. “The relatively low use of MOUD that we see in this OptumLabs study as well as many other recently published studies makes the strong case for the need for continued investment in MOUD expansion. That includes waiver training for providers to enable buprenorphine prescribing in many settings and increased efforts to educate patients and clinicians about the value of MOUD.”
How Optum Supports Increasing Access to Medication Assisted Treatment for Opioid Use Disorder
The study findings underscore Optum’s ongoing efforts to increase access to Medication Assisted Treatment (MAT) as the standard of care for OUD:
- Removing prior authorizations for medications approved for the treatment of OUD.
- Piloting a “bundled payment” model that decreases administrative burden on MAT providers and enables patients to access MAT services through one monthly copay.
- Conducting trainings with behavioral health providers on the value of medications to treat OUD, and encouraging referrals to settings where medications can be prescribed.
- Educating and encouraging providers to pursue training to administer MAT. In September 2018, Congress underscored the importance of these efforts when it passed the SUPPORT for Patients and Communities Act that increases flexibility for providers and makes MAT more available via telemedicine.
- Using advanced analytics and geomapping to monitor the demand for MAT, and working with facilities in these regions to develop comprehensive MAT programs.
- Offering the toll-free Substance Use Disorder Helpline and web-based live chat.
The JAMA Network Open published study is the latest major report from OptumLabs, a collaborative research and innovation center. In 2019 alone, OptumLabs published 49 peer-reviewed research papers in diverse domain areas including cancer, Alzheimer’s, diabetes, cardiovascular disease, mental health, opioids/pain management and hearing loss.