Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

E. Jennifer Edelman

Second Advisor

Gregg Gonsalves

Abstract

The opioid crisis has been impacting millions of lives in the United States every day. Most research focuses on the Medicaid population, and those enrolled in Medicare are often overlooked. Those enrolled in Medicare also do not typically have the same coverage benefits as those enrolled in Medicaid or commercial insurance. To address this, the Centers for Medicare and Medicaid Services passed a ruling that Medicare Part B will cover Opioid Use Disorder (OUD) services in an opioid treatment program (OTP). The current study aims to understand if the Medicare Part B expansion improved access to OUD treatment. In this study, access to treatment is measured by MOUD (medications for Opioid Use Disorder) as part of the treatment plan and days waiting for treatment. The main hypothesis is that there will be greater OUD treatment access at OTPs for Medicare beneficiaries due to the Medicare Part B expansion. The Medicare Part B policy change went into effect on January 1, 2020 therefore data from calendar year 2018 was compared to data from calendar year 2020. The study primarily uses data from the Treatment Episodes Data Set (TEDS). The current study found that admissions with MOUD as part of their treatment plan with opioids as the secondary substance of use at admission were significantly lower in 2018 compared to 2020 for Medicare beneficiaries. The study also found that admissions with zero days waiting for treatment for those admissions whose secondary substance of use was opioids was significantly lower in 2018 compared to 2020 for Medicare beneficiaries. These national results may have been driven by the northeast, midwestern and western regions of the United States. It is interesting to note that the proportion of admissions was lower in 2018 compared to 2020 for those whose secondary substance of use at admission was opioids, not those whose primary substance of use at admission was opioids. This may reflect the growing understanding of MOUD as the golden standard for OUD treatment as well as shying from abstinence-only treatment plans. The most common primary substance of use for those whose secondary substance of use was opioids was stimulants. More research is needed as to why people co-use stimulants and opioids, as well as how to better treat these co-occurring substance use disorders.

Comments

This is an Open Access Thesis.

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