Dissertations, Theses, and Capstone Projects

Date of Degree

9-2015

Document Type

Dissertation

Degree Name

D.P.H.

Program

Public Health

Advisor

William T. Gallo

Keywords

Buprenorphine; Health services research; Medicaid; Medication assisted treatment; Methadone; Substance use

Abstract

Opioid use and dependence have increased dramatically since the early 2000s. As of 2013, an estimated 2.4 million people were considered to be dependent on opioids. Medication assisted treatment (MAT), such as methadone and buprenorphine, is the most effective form of treatment for opioid dependence; yet, since 2002, MAT use has decreased steadily.

Medicaid is the largest purchaser of MAT in the United States; however, Medicaid coverage of MAT varies by state. As of 2008, fourteen states did not cover either methadone or buprenorphine, or both. This dissertation examines the factors associated with Medicaid coverage of methadone and buprenorphine, and explores the impact of this coverage on the length of time individuals waited to enter substance use treatment, and the extent to which Medicaid coverage of methadone is associated with MAT utilization.

This dissertation utilized a combination of individual-level, program-level and state-level data. Individual-level data came from the Treatment Episodes Data Set-Admissions (TEDS-A). Program-level data were obtained from the Uniform Facility Data Set (UFDS) and the National Survey of Substance Abuse Treatment Services (N-SSATS). State-level data regarding Medicaid coverage of MAT were obtained from three sources: (1) McCarty et al's study, 'Methadone Maintenance and State Medicaid Managed Care Programs'; (2) Ducharme at al's study, 'State policy influence on the early diffusion of buprenorphine in community treatment programs'; and, (3) the State Financing for Medication Assisted Treatment study.

The main findings of this study indicate that state wealth is correlated with Medicaid coverage of MAT, Medicaid coverage of MAT is associated with an increase in treatment wait time and Medicaid coverage of methadone is associated with greater odds of MAT use. This dissertation did not include any analyses since the passage of the Patient Protection and Affordable Care Act (PPACA), which in 2014, required that all public and private health insurance programs cover substance use treatment services. While this prioritization will undoubtedly increase access to substance use treatment, not all services must be covered. Given this, variability in the accessibility of treatment will likely persist. Further research should continue to monitor the accessibility and utilization of substance use treatment, with particular focus on MAT.

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