I want to share an exciting data project led by and . Collaboration with at and supported by through the Bloomberg Opioid Initiative. Partners included . urban.org/policy-centers 1/7
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Lisa Clemans-Cope
@LisaClemansCope
Senior Fellow, Health Economist, Urban Institute Health Policy Center. Substance/Opioid Use & Disorder, Medicaid, Fed & State Reform, Disadvantaged Pops
Lisa Clemans-Cope’s Tweets
Expanding treatment for the opioids crisis is critical to saving lives, but isn't enough
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135+ senior colleagues & I urge President Sarah Rosen Wartell to voluntarily recognize the . Read the full statement (which does not represent the Urban Institute or the Urban Institute Employees’ Union):
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Good morning! We just informed our management that a supermajority of eligible @UrbanInstitute staff have formed the Urban Institute Employees Union, organized with the @NonprofitUnion. Read our press release here:
npeu.org/news/2021/4/13
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Join , Dr. Terence Keel, , and on Friday, November 20th from 12pm-1pm PT/3pm-4pm ET! Register here: bit.ly/10YrCRTandPubl… #CriticalRaceTheory #CRT #HealthCrit #Racism #RacialHealthEquity
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Repealing the Affordable Care Act Would Take Opioid Use Disorder Treatment Away from More Than a Half Million People: urbn.is/31OSONT via
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We're hiring a communications manager to work on health equity, well-being, & & safety net initiatives. Learn more & apply: urbn.is/2YeisL7 #sdoh
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Powerful call for "structurally competent care" to address the systemic injustices of racism like housing and food insecurity, from Morgan Medlock MD of Howard University Psychiatry
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Medicaid prescriptions for Opioid Use Disorder and opioid overdose in Fee-for-Service vs Managed-Care in 2018, based on SDUD and enrollment data urbn.is/2zh43mZ
plus methods appendix urbn.is/2xJHUNI
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And to for sharing his expertise about the Medicaid SDUD data and his brilliant suggestion that we file a DUA to access the suppressed data!
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We are very grateful to , Anna Anderson-Cook, Andrea Noda, , and Richard Frank for generously sharing their expertise 8/8
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Download our data used in the briefs urbn.is/2V6yGnK; the suppressed publicly available Medicaid State Drug Utilization Data bit.ly/3bbcIp9 & apply get unsuppressed data via CMS DUA 7/8
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Estimated federal rebates are much larger for brand vs generic 2011-2018: 39% brand vs 6% generic for buprenorphine, 54% brand vs 7% generic naltrexone, 60% brand vs generic 21% naloxone 6/8
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The second brief uses public data to estimate basic & inflationary federal rebates in Medicaid for rx related to opioid use disorder 2011-2018. After rebate adjustment, buprenorphine spending is lower by 34%, naltrexone by 50%, naloxone by 56% urbn.is/2xfITVL 5/8
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And they may be more cost-effective than thought since federal rebates from manufacturers lower Medicaid net drug costs a lot: pre/post rebate cost per rx decreased $1,206 to $589 for Vivitrol, $1,522 to $1,147 for Sublocade, $2,650 to $2,038 for Probuphine 4/8
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For example, Medicaid in 2018 paid for 4,134 Sublocade injections (a monthly buprenorphine injection for moderate to severe OUD) and half were in just 5 states WI (540) OH (516) PA (424) MI (367) MD (234) 3/8
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We found that Medicaid enrollees rarely receive extended-release buprenorphine (Probuphine and Sublocade) but extended-release naltrexone (Vivitrol) is extensive 2/8
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2 new briefs! First, extended-release rx for opioid use disorder in Medicaid may reduce face-to-face visits & improve treatment retention during #COVID19 -- we examine prescribing & spending to 2018 in Medicaid urbn.is/2wERWiE 1/8
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CA county treatment gaps for opioid use disorder: how many additional prescribers are needed to fill Opioid-Agonist Medication Treatment gaps urbn.is/2FzhXQt
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Only 49% of substance use treatment facilities in NJ offered any type of medication treatment for opioid use disorder in 2018, see our new brief urbn.is/308lrXv
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Me in Quarterly-- ripping into a recent account of the agony in southern Ohio. || Opioid Use by Pregnant and ParentingWomen: Let’s Not Repeat the Mistakes of 25 Years Ago rdcu.be/bLtur
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10 policy options for leveraging the MaineCare expansion to address substance/opioid use disorder in Maine - our expedited review for the Greater Portland Addiction Collaborative urbn.is/2X5MvoQ
Plz RT! is seeking a senior research manager to support our new Prison Research & Innovation Initiative. Professional and/or lived experience highly desirable. Apply by 6/1. urbn.is/2WTLnRh #TransformPrison
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“more than half a million (623,000) adults with opioid use disorder are parents living with children younger than 18” — latest blog and research w/colleagues
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Mental health emergency among parents with opioid use disorder: 1 in 5 had suicidal thoughts & behaviors in 2015-2017. More in our new paper bit.ly/2LHPJJO
Despite increases in treatment, opioid-related death rates remain high, suggesting that treatment rates for OUD and opioid overdose remain low and are not meeting demand, even among Medicaid expansion states. Viz, data, brief & updates: urbn.is/2Em8o8i /6
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Per capita Medicaid-covered medications related to OUD increased 2013 to 2017, rose from 48 to 102 rx per 1,000 Medicaid enrollees for buprenorphine, and increases were larger in Medicaid expansion states than in nonexpansion states. /5
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From 2013 (before the ACA took effect) to 2017, Medicaid spending on Rx for OUD and overdose nearly tripled or more in states that expanded Medicaid by 2017, while spending in nonexpansion states nearly doubled. /4
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Buprenorphine treatment was dominant, but spending on naltrexone grew to almost one-fifth of Medicaid spending on buprenorphine for OUD, naltrexone, and naloxone by 2017. /3
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Between 2010-2017, Medicaid spending on OUD treatment prescriptions for buprenorphine, naltrexone, naloxone increased from $190m to $888m after adjusting for average rebates drug manufacturers paid to states, with ~25% increases each year. Brief: urbn.is/2EgQvYz /2
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New analysis & interactive tool tracking Medicaid-covered Rx to treat opioid use disorder and overdose 2010-2018 Q1 with quarterly updates & annual data for US & states. Viz & data download: urbn.is/2Em8o8i /1
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Deeply important essay on combining research, integrity, & transparency with policy advocacy & being true to yourself, from a wonderful human being & scholar
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Our new paper! Pregnant Women with Opioid Use Disorder (OUD) and Their Infants in Three State Medicaid Programs in 2013-2016 shows mother/infant dyads are in urgent need of comprehensive, evidence-based OUD treatment bit.ly/2FKjwxG #CMMI /1 (fixed link!)
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We find inadequate treatment/MAT for pregnant women with OUD. Initiation & support of evidence-based treatment during birth hospitalization could improve outcomes & cost, but may depend on provider/patient attitudes/knowledge of effective tx bit.ly/2FKjwxG /6
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Health care costs for women with an OUD were high—hospitalization/birth month expenditures were $22k for women with an OUD, $17k for women with another SUD and $11k for those without an SUD /5
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Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other SUDs. Infants of mothers with OUD had similar preterm & low birth weight, but higher NICU rates and longer birth stays compared to infants of mothers with other SUDs /4
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In the year pre/post birth, 2% of mothers had OUD dx, 6% had another SUD dx. 73% of women with OUD had some type of SUD treatment pre/post birth, but most had no tx and only 9% received any methadone tx an average enrolled month /3
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We linked maternal/infant Medicaid claims/payment and infant birth records in 3 states 2013-2016 to examine health care use, tx, neonatal outcomes in the year pre/post birth for mothers with OUD and other SUDs bit.ly/2FKjwxG /2
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While many of the treatment expansions in the new SUPPORT Act are targeted and temporary, there are important provisions for Medicare, Medicaid. We look at what the bill does to fill gaps in treatment for opioid use disorder & why it matters
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