Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies

Background: Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. Methods: Using 2006–2013 Medicaid Analytic eXtra...

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Published in:Drug and alcohol dependence 2022-12, Vol.241, p.109669-109669, Article 109669
Main Authors: Landis, Rachel K., Opper, Isaac, Saloner, Brendan, Gordon, Adam J., Leslie, Douglas L., Sorbero, Mark, Stein, Bradley D.
Format: Article
Language:English
Subjects:
Analgesics
Analgesics, Opioid - therapeutic use
Authorization
Benzodiazepines
Benzodiazepines - therapeutic use
Buprenorphine
Buprenorphine - therapeutic use
Dosage
Drug abuse
Drug addiction
Drugs
Government programs
Health care policy
Humans
Medicaid
Narcotics
Opiate Substitution Treatment
Opioid-Related Disorders - drug therapy
Opioids
Policies
Policy implementation
Policy making
Prescribing
Prior authorization
Quality
Quality of care
Reduction
Substance use disorder
Treatment
United States
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cited_by cdi_FETCH-LOGICAL-c458t-898fa86bed925406e8becca34756995c420f1fadb09a6ef247f45ed7f85e4c4a3
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container_end_page 109669
container_issue
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container_title Drug and alcohol dependence
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creator Landis, Rachel K.
Opper, Isaac
Saloner, Brendan
Gordon, Adam J.
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Sorbero, Mark
Stein, Bradley D.
description Background: Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. Methods: Using 2006–2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14–64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. Results: Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p 
doi_str_mv 10.1016/j.drugalcdep.2022.109669
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Methods: Using 2006–2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14–64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. Results: Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p &lt; 0.01) in the likelihood of episodes with a duration of at least 180 days in the first four years after policy implementation. The policy was not associated with changes in effective dosage or concurrent prescribing of opioid analgesics or benzodiazepines. Conclusions: Buprenorphine prior authorization policies were associated with a sizeable and significant reduction in episodes of at least 180 days duration, underscoring the importance of identifying and removing barriers to effective and appropriate OUD care. •Buprenorphine prior authorization policies reduce use; such policies’ effects on the quality of treatment has not been examined.•Prior authorization policies were associated with lower likelihood of buprenorphine treatment of at least 180 days.•Prior authorization policies were not associated with changes in other potential quality indicators.•Prior authorization policies may reduce duration of buprenorphine treatment episodes.</description><identifier>ISSN: 0376-8716</identifier><identifier>EISSN: 1879-0046</identifier><identifier>DOI: 10.1016/j.drugalcdep.2022.109669</identifier><identifier>PMID: 36332589</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Analgesics ; Analgesics, Opioid - therapeutic use ; Authorization ; Benzodiazepines ; Benzodiazepines - therapeutic use ; Buprenorphine ; Buprenorphine - therapeutic use ; Dosage ; Drug abuse ; Drug addiction ; Drugs ; Government programs ; Health care policy ; Humans ; Medicaid ; Narcotics ; Opiate Substitution Treatment ; Opioid-Related Disorders - drug therapy ; Opioids ; Policies ; Policy implementation ; Policy making ; Prescribing ; Prior authorization ; Quality ; Quality of care ; Reduction ; Substance use disorder ; Treatment ; United States</subject><ispartof>Drug and alcohol dependence, 2022-12, Vol.241, p.109669-109669, Article 109669</ispartof><rights>2022 Elsevier B.V.</rights><rights>Copyright © 2022 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Dec 1, 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-898fa86bed925406e8becca34756995c420f1fadb09a6ef247f45ed7f85e4c4a3</citedby><cites>FETCH-LOGICAL-c458t-898fa86bed925406e8becca34756995c420f1fadb09a6ef247f45ed7f85e4c4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0376871622004069$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3547,27864,27922,27923,30997,45778</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36332589$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Landis, Rachel K.</creatorcontrib><creatorcontrib>Opper, Isaac</creatorcontrib><creatorcontrib>Saloner, Brendan</creatorcontrib><creatorcontrib>Gordon, Adam J.</creatorcontrib><creatorcontrib>Leslie, Douglas L.</creatorcontrib><creatorcontrib>Sorbero, Mark</creatorcontrib><creatorcontrib>Stein, Bradley D.</creatorcontrib><title>Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies</title><title>Drug and alcohol dependence</title><addtitle>Drug Alcohol Depend</addtitle><description>Background: Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. Methods: Using 2006–2013 Medicaid Analytic eXtract (MAX) data from 34 states and the District of Columbia, we identified 294,031 episodes of buprenorphine treatment for OUD among individuals aged 14–64 years. We estimated generalized difference-in-differences models to examine the association between buprenorphine prior authorization policies and changes in buprenorphine treatment quality along four dimensions: (1) duration of at least 180 days, (2) dosage of at least 8 milligrams, and concurrent prescribing of (3) opioid analgesics and (4) benzodiazepines. Results: Buprenorphine prior authorization policies were associated with an 11-percentage point reduction (p &lt; 0.01) in the likelihood of episodes with a duration of at least 180 days in the first four years after policy implementation. The policy was not associated with changes in effective dosage or concurrent prescribing of opioid analgesics or benzodiazepines. Conclusions: Buprenorphine prior authorization policies were associated with a sizeable and significant reduction in episodes of at least 180 days duration, underscoring the importance of identifying and removing barriers to effective and appropriate OUD care. •Buprenorphine prior authorization policies reduce use; such policies’ effects on the quality of treatment has not been examined.•Prior authorization policies were associated with lower likelihood of buprenorphine treatment of at least 180 days.•Prior authorization policies were not associated with changes in other potential quality indicators.•Prior authorization policies may reduce duration of buprenorphine treatment episodes.</description><subject>Analgesics</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Authorization</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Buprenorphine</subject><subject>Buprenorphine - therapeutic use</subject><subject>Dosage</subject><subject>Drug abuse</subject><subject>Drug addiction</subject><subject>Drugs</subject><subject>Government programs</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Medicaid</subject><subject>Narcotics</subject><subject>Opiate Substitution Treatment</subject><subject>Opioid-Related Disorders - drug therapy</subject><subject>Opioids</subject><subject>Policies</subject><subject>Policy implementation</subject><subject>Policy making</subject><subject>Prescribing</subject><subject>Prior authorization</subject><subject>Quality</subject><subject>Quality of care</subject><subject>Reduction</subject><subject>Substance use disorder</subject><subject>Treatment</subject><subject>United States</subject><issn>0376-8716</issn><issn>1879-0046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNqFkk2PFCEQhonRuOPoXzAkXjxsjzRN0-DFuBu_kjVe1jOhoZhh0gMtdG_i_CX_pPTOun5c5AKBp94qql6EcE02Nan5q_3GpnmrB2Nh3FBCabmWnMsHaFWLTlaEMP4QrUjT8Up0NT9DT3Lek7K4JI_RWcObhrZCrtCPi3lMEGIadz4AnhLo6QBhwjD6HC1gOyc9-RjOsY1Zb-Ec62CxicHMKS1gCc8m-d6HLY4O9xCO0Xp9LAIB8i0dRx-9LUc9bCF7k1_j6x1gcA7MlJeoz2C90YUZk48J63naxeSPt5nxGAdvPOSn6JHTQ4Znd_safX3_7vryY3X15cOny7dXlWGtmCohhdOC92AlbRnhIHowRjesa7mUrWGUuNpp2xOpOTjKOsdasJ0TLTDDdLNGb06649wfwJryy6QHVUo76PRdRe3V3y_B79Q23qi6tLelHS0KL-8UUvw2Q57UwWcDw6ADxDkr2jVLaV0Zwxq9-AfdxzmVTi1UxyhrpFgocaJMijkncPfV1EQtllB79dsSarGEOlmihD7_8zf3gb88UICLEwClpzceksql28GUkaQyH2Wj_3-WnxPn0ys</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Landis, Rachel K.</creator><creator>Opper, Isaac</creator><creator>Saloner, Brendan</creator><creator>Gordon, Adam J.</creator><creator>Leslie, Douglas L.</creator><creator>Sorbero, Mark</creator><creator>Stein, Bradley D.</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TK</scope><scope>7TQ</scope><scope>7U7</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20221201</creationdate><title>Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies</title><author>Landis, Rachel K. ; 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Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>PAIS Index</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Drug and alcohol dependence</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Landis, Rachel K.</au><au>Opper, Isaac</au><au>Saloner, Brendan</au><au>Gordon, Adam J.</au><au>Leslie, Douglas L.</au><au>Sorbero, Mark</au><au>Stein, Bradley D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies</atitle><jtitle>Drug and alcohol dependence</jtitle><addtitle>Drug Alcohol Depend</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>241</volume><spage>109669</spage><epage>109669</epage><pages>109669-109669</pages><artnum>109669</artnum><issn>0376-8716</issn><eissn>1879-0046</eissn><abstract>Background: Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD), but the association between prior authorization policies and quality of care for individuals receiving buprenorphine treatment is not well-understood. 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ispartof Drug and alcohol dependence, 2022-12, Vol.241, p.109669-109669, Article 109669
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1879-0046
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source Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Journals; Elsevier; PAIS Index
subjects Analgesics
Analgesics, Opioid - therapeutic use
Authorization
Benzodiazepines
Benzodiazepines - therapeutic use
Buprenorphine
Buprenorphine - therapeutic use
Dosage
Drug abuse
Drug addiction
Drugs
Government programs
Health care policy
Humans
Medicaid
Narcotics
Opiate Substitution Treatment
Opioid-Related Disorders - drug therapy
Opioids
Policies
Policy implementation
Policy making
Prescribing
Prior authorization
Quality
Quality of care
Reduction
Substance use disorder
Treatment
United States
title Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies
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