Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA; Boston University School of Social Work, Boston, MA, USA.
J Subst Use Addict Treat. 2024 Dec;167:209476. doi: 10.1016/j.josat.2024.209476. Epub 2024 Aug 7.
The COVID-19 pandemic disrupted the traditional mode of methadone maintenance treatment (MMT) delivery through the imposition of lockdowns and social distancing measures. In response, policy makers granted flexibilities to providers delivering MMT to change their practices to maintain patient participation while accommodating the measures imposed to prevent the spread of COVID-19. This study examines the utilization of MMT and overdoses of patients receiving MMT during the COVID-19 pandemic in one mid-Atlantic state.
We analyzed Medicaid claims data for 2018-2020, calculating weekly trends for starts, discontinuations, and medically-treated overdoses for beneficiaries receiving MMT who had been continuously enrolled in Medicaid for the previous 12 months, to account for changes in the composition of the Medicaid population following the COVID-19 public health emergency (PHE). We completed data analyses from January to June 2022.
We observed countervailing trends in new starts, which experienced an immediate, non-significant dip of -22.47 per 100,000 Medicaid beneficiaries (95%CI, -50.99 to 6.04) at the outset of the pandemic followed by an increasing upward trend of 1.41 per 100,000 beneficiaries per week (95%CI, 0.37 to 2.46), and in discontinuations, which also experienced an immediate dip of -3.23 per 1000 MMT enrollees (95%CI, -4.49 to -1.97) followed by an increasing upward trend of 0.14 per 1000 MMT enrollees per week (95%CI, 0.09 to 0.19). The net result of these shifts was a stable, slowly increasing rate of MMT treatment of 0.02 % per week before and after the PHE. We also found no statistically significant association of the PHE with medically-treated overdoses among beneficiaries enrolled in MMT (trend change = 0.02 overdoses per 10,000 MMT enrollees, 95%CI, -0.05 to 0.09).
New Jersey achieved overall stability in MMT treatment prevalence following the pandemic's onset, while some changes in treatment dynamics took place. This outcome may reflect that the extensive flexibilities granted to providers of MMT by the state and federal government successfully maintained access to MMT for Medicaid beneficiaries through the pandemic without increasing risk of medically-treated overdose. These findings should inform policy makers developing the post-COVID-19 legal and regulatory landscape.
COVID-19 大流行通过实施封锁和社交距离措施，打乱了美沙酮维持治疗（MMT）的传统模式。作为回应，政策制定者给予了提供 MMT 的提供者灵活性，以改变其做法，在适应预防 COVID-19 传播措施的同时，维持患者的参与。本研究检查了在一个中大西洋州 COVID-19 大流行期间接受 MMT 的患者的 MMT 利用和过量用药情况。
我们分析了 2018-2020 年的医疗补助索赔数据，计算了过去 12 个月内连续参加医疗补助的接受 MMT 的受益人的起始、中断和经医学治疗的过量用药的每周趋势，以说明 COVID-19 公共卫生紧急事件（PHE）后医疗补助人群构成的变化。我们于 2022 年 1 月至 6 月完成了数据分析。
我们观察到新起始的相反趋势，在大流行开始时，新起始人数立即出现了非显著下降-22.47 每 100,000 名医疗补助受益人的趋势（95%CI，-50.99 至 6.04），随后每周每 100,000 名受益人的趋势上升了 1.41（95%CI，0.37 至 2.46），在中断方面，也立即出现了每 1000 名 MMT 参与者下降 3.23 的趋势（95%CI，-4.49 至-1.97），随后每周每 1000 名 MMT 参与者上升了 0.14 的趋势（95%CI，0.09 至 0.19）。这些变化的净结果是，在 PHE 之前和之后，MMT 治疗的速度稳定且缓慢增加，每周增加 0.02%。我们还发现，医疗补助受益人接受 MMT 的治疗中，PHE 与经医学治疗的过量用药之间没有统计学上的显著关联（趋势变化=每 10,000 名 MMT 参与者 0.02 次过量用药，95%CI，-0.05 至 0.09）。
新泽西州在大流行开始后实现了 MMT 治疗流行率的总体稳定，同时治疗动态发生了一些变化。这一结果可能反映出州和联邦政府给予 MMT 提供者的广泛灵活性成功地维持了 Medicaid 受益人的 MMT 获得，而没有增加经医学治疗的过量用药的风险。这些发现应该为制定 COVID-19 后的法律和监管框架的政策制定者提供信息。
