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Patterns and Quality of Buprenorphine Opioid Agonist Treatment in a Large Medicaid Program

Gordon, Adam J. MD, MPH; Lo-Ciganic, Wei-Hsuan PhD; Cochran, Gerald PhD; Gellad, Walid F. MD, MPH; Cathers, Terri PharmD; Kelley, David MD; Donohue, Julie M. PhD

doi: 10.1097/ADM.0000000000000164
Original Research

Objectives: Use of buprenorphine – an effective treatment for opioid use disorders (OUDs) – has increased rapidly in recent years and is often financed by Medicaid. We investigated predictors of buprenorphine treatment, patterns of care, and quality of care in a large state Medicaid program.

Methods: Data from Pennsylvania Medicaid from 2007 to 2012 provided information regarding diagnoses, demographic characteristics, enrollment, and use of inpatient and outpatient services, and prescription drugs. We identified adult enrollees using buprenorphine, and examined prevalence of OUD diagnosis and patterns of use (duration and dose) and quality of care (physician visits, receipt of behavioral health counseling, urine drug screens, and other prescription drug use). We use a mixed logistic regression model to examine enrollee characteristics associated with buprenorphine use.

Results: The share of enrollees with OUD filling prescriptions for buprenorphine increased from 2985 (9.8%) to 12,691 (25.2%) from 2007 to 2012. Between 26.2 and 32.0% of enrollees using buprenorphine had no diagnosis of OUD, depending on the year. Only 60.1% of enrollees with buprenorphine use received at least one urine drug screen, 41.0% had behavioral health counseling services, and 34.7 and 38.0% had other opioid and benzodiazepine claims, respectively, concomitant with buprenorphine use. Quality of care was lower among those with no OUD diagnosis recorded. The mean daily doses of buprenorphine decreased over time. We found wide variation in likelihood of buprenorphine use among those with OUD based upon age, sex, and race.

Conclusions: Increases in buprenorphine treatment in a Medicaid population were observed across time; however, increases varied by age, sex, and rate, and the quality of care received seemed to be generally poor. The quality of the provision of buprenorphine treatment occurring in Medicaid populations should be further explored.

University of Pittsburgh School of Medicine (A.J.G., G.C., W.F.G.), Pittsburgh, PA; VA Pittsburgh Healthcare System (A.J.G., W.F.G.), Pittsburgh, PA; University of Pittsburgh Center for Pharmaceutical Policy and Prescribing (A.J.G., W.-H.L.-C., G.C., W.F.G., J.M.D.), Pittsburgh, PA; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (J.M.D.), Pittsburgh, PA; University of Arizona, College of Pharmacy (W.-H.L.-C.), Tucson, AZ; University of Pittsburgh School of Social Work (G.C.), Pittsburgh, PA; Pennsylvania Department of Human Services (T.C., D.K.).

Send correspondence and reprint requests to Adam J. Gordon, MD, MPH, FACP, FASAM, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, Building 30 (151-C), Room 2a133, University Drive C, Pittsburgh, PA 15240-1001, USA. E-mail:

Received 24 April, 2015

Accepted 30 July, 2015

Conflicts of interest and source of funding: This work was supported in part by an intergovernmental agreement between the Pennsylvania Department of Human Services and the University of Pittsburgh. Authors (A.J.G., G.C., W.F.G., J.M.D.) are currently receiving grant support from the NIH, CDC (U01-CE002496), and/or the VA. W.G. is supported by a VA HSR&D Career Development Award (09-207). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. No other substantial conflicts of interest occur from the authors for the work contained within this manuscript.

© 2015 American Society of Addiction Medicine