Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database

75 Pages Posted: 22 Apr 2021

See all articles by Mary A. Burke

Mary A. Burke

Federal Reserve Bank of Boston

Riley Sullivan

Federal Reserve Bank of Boston

Katherine Grace Carman

US Securities and Exchange Commission

Hefei Wen

Emory University

James Wharam

Harvard Pilgrim Health Care

Hao Yu

Harvard University - Harvard Medical School

Date Written: April 22, 2021

Abstract

This paper uses the all-payer claims database (APCD) for Rhode Island to study three questions about the use of medication-assisted treatment (MAT) for opioid use disorder (OUD): (1) Does MAT reduce the risk of opioid overdose; (2) are there systematic differences in the uptake of MAT by observable patient-level characteristics; and (3) how successful were federal policy changes implemented in 2016 that sought to promote increased use of buprenorphine, one of three medication options within MAT? Regarding the first question, we find that MAT as practiced in Rhode Island is associated with a reduced risk of repeated opioid overdose among patients who had an initial nonfatal opioid overdose, consistent with the strong endorsement of MAT by public health officials. Concerning the second, we find that factors such as age, gender, health insurance payer, and the poverty rate in one’s residential Zip code are associated with significant differences in the chance of receiving methadone and/or buprenorphine, suggesting that certain groups may face unwarranted disparities in access to MAT. About the third question, we find that a 2016 federal rule change enabled at least some experienced Rhode Island buprenorphine prescribers to reach more patients, and a separate 2016 policy aimed at recruiting new buprenorphine prescribers was also found to be effective. However, the data also suggest that many more patients in the state could be treated with buprenorphine if prescribers took full advantage of their prescribing limits.

Keywords: medication-assisted treatment; opioid use disorder; overdose; Rhode Island; all-payer claims database; methadone; buprenorphine

JEL Classification: I12; I13; I14; I18

Suggested Citation

Burke, Mary A. and Sullivan, Riley and Carman, Katherine Grace and Wen, Hefei and Wharam, James and Yu, Hao, Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database (April 22, 2021). FRB of Boston Working Paper No. 21-3, Available at SSRN: https://ssrn.com/abstract=3832267 or http://dx.doi.org/10.2139/ssrn.3832267

Mary A. Burke (Contact Author)

Federal Reserve Bank of Boston ( email )

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Boston, MA 02210
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Riley Sullivan

Federal Reserve Bank of Boston ( email )

600 Atlantic Avenue
Boston, MA 02210
United States

Katherine Grace Carman

US Securities and Exchange Commission ( email )

450 Fifth Street, NW
Washington, DC 20549-1105
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Hefei Wen

Emory University ( email )

201 Dowman Drive
Atlanta, GA 30322
United States

James Wharam

Harvard Pilgrim Health Care ( email )

93 Worcester Street
Wellesley, 02481
United States

Hao Yu

Harvard University - Harvard Medical School

25 Shattuck St
Boston, MA 02115
United States

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