B40-10 High Levels of Opioid Use Disorder and Low Rates of Treatment in Critically Ill Medicaid Beneficiaries in Eight States

Rationale

Opioid use disorder (OUD) impacts critically ill patients throughout their care and is treatable with medications for OUD (MOUD). Medicaid pays for an increasing share of intensive care unit (ICU) stays and is the primary payor for OUD treatment, yet little is known about how common OUD, opioid overdose and MOUD treatment are among hospitalized Medicaid beneficiaries. We quantified OUD/opioid overdose prevalence and MOUD treatment among Medicaid ICU beneficiaries compared to non-ICU hospitalized and general Medicaid beneficiaries.

Methods

Using a distributed research network with a common data model for Medicaid claims from 8 states (DE, KY, MD, MI, NC, PA, TN, VA) in 2022-2023, we analyzed beneficiaries aged 18-64. We compared the prevalence of OUD/MOUD among hospitalized and non-hospitalized beneficiaries. Among those hospitalized, we compared patients with and without an ICU stay. For hospitalized patients, we assessed the prevalence of OUD/overdose using ICD-10 codes for OUD or opioid overdose in any position in the 180 days before or during hospitalization (randomly selecting one stay per beneficiary). Among beneficiaries with an OUD/overdose and discharged to home or a nursing facility, we looked at MOUD receipt (buprenorphine, naltrexone, or methadone, as identified by national drug code and procedures codes) in the 180 days pre-hospitalization and 30 days post-discharge. For the non-hospitalized cohort, we examined the prevalence of OUD/overdose in a randomly selected 180-day period and among those with a diagnosis, receipt of MOUD in a randomly selected 30-day period.

Results

Across the 8 states we identified 195,636 hospitalized Medicaid beneficiaries with an ICU stay, 333,452 with a non-ICU hospitalization and 8,554,726 total beneficiaries in 2022-2023. OUD/overdose prevalence was highest among beneficiaries with an ICU stay (16.7%), followed by non-ICU patients (14.2%) with a prevalence of 4.3% among general beneficiaries. Receipt of MOUD lowest among ICU beneficiaries (35.1%) compared to both non-ICU hospitalized beneficiaries (40.2%) and general beneficiaries (60.2%) (Table). ICU beneficiaries had lower pre-hospital receipt of MOUD than non-ICU beneficiaries (46.6% vs. 52.0%), and, conditional on pre-hospital MOUD use, lower continuation post-hospitalization (64.5% vs. 70.6%). Among beneficiaries with no MOUD in the 180 days pre-hospitalization, beneficiaries with an ICU stay were less likely to initiate MOUD than those with non-ICU stays (12.0% vs. 9.4%).

Conclusions

Despite OUD/overdose being highly prevalent among Medicaid beneficiaries in the ICU, these beneficiaries were far less to receive MOUD treatment. Further work is needed to connect critically ill Medicaid beneficiaries with OUD to MOUD treatment.

This abstract is funded by: NIH