State variation in opioid treatment policies and opioid-related hospital readmissions

• Published in: BMC health services research Vol. 18; no. 1; pp. 971 - 12
• Main Authors: Blanchard, Janice, Weiss, Audrey J, Barrett, Marguerite L, McDermott, Kimberly W, Heslin, Kevin C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.12.2018; BioMed Central; BMC
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Care and treatment; Codes; Comorbidity; Complications and side effects; Costs and Cost Analysis; Demographic aspects; Dosage and administration; Drug abuse; Drug abuse treatment; Drug dosages; Drug overdose; Drug Overdose - prevention & control; Female; Good samaritans; Health care policy; Health Policy; Health services; Heroin; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Insurance Coverage - statistics & numerical data; Insurance, Health - statistics & numerical data; Laws, regulations and rules; Male; Medicaid; Medicaid - statistics & numerical data; Medicare - statistics & numerical data; Medication-assisted treatment; Mental health; Methadone; Middle Aged; Naloxone; Naloxone - therapeutic use; Narcotics; Opioid abuse; Opioid readmissions; Opioid-Related Disorders - rehabilitation; Patient Readmission - statistics & numerical data; Patients; Pharmacy; Poisoning; Retrospective Studies; Software; State opioid treatment policies; Substance abuse treatment; United States; United States; Washington DC; United States > US; Opioid readmissions; State opioid treatment policies; Medication-assisted treatment; Opioid abuse
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3703-8

State policy approaches designed to provide opioid treatment options have received significant attention in addressing the opioid epidemic in the United States. In particular, expanded availability of naloxone to reverse overdose, Good Samaritan laws intended to protect individuals who attempt to provide or obtain emergency services for someone experiencing an opioid overdose, and expanded coverage of medication-assisted treatment (MAT) for individuals with opioid abuse or dependence may help curtail hospital readmissions from opioids. The objective of this retrospective cohort study was to evaluate the association between the presence of state opioid treatment policies-naloxone standing orders, Good Samaritan laws, and Medicaid medication-assisted treatment (MAT) coverage-and opioid-related hospital readmissions. We used 2013-2015 hospital inpatient discharge data from 13 states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. We examined the relationship between state opioid treatment policies and 90-day opioid-related readmissions after a stay involving an opioid diagnosis. Our sample included 383,334 opioid-related index hospitalizations. Patients treated in states with naloxone standing-order policies at the time of the index stay had higher adjusted odds of an opioid-related readmission than did those treated in states without such policies; however, this relationship was not present in states with Good Samaritan laws. Medicaid methadone coverage was associated with higher odds of readmission among all insurance groups except Medicaid. Medicaid MAT coverage generosity was associated with higher odds of readmission among the Medicaid group but lower odds of readmission among the Medicare and privately insured groups. More comprehensive Medicaid coverage of substance use disorder treatment and a greater number of opioid treatment programs were associated with lower odds of readmission. Differences in index hospitalization rates suggest that states with opioid treatment policies had a higher level of need for opioid-related intervention, which also may account for higher rates of readmission. More research is needed to understand how these policies can be most effective in influencing acute care use.