Research finds gaps in care following nonfatal overdoses amongst Medicare beneficiaries

Researchers from the Substance Abuse and Psychological Well being Companies Administration (SAMHSA), the Nationwide Institutes of Well being’s (NIH) Nationwide Institute on Drug Abuse (NIDA), Facilities for Medicare & Medicaid Companies (CMS), and the Facilities for Illness Management and Prevention (CDC) discovered that amongst a cohort of 137,000 Medicare beneficiaries who skilled a nonfatal overdose in 2020, virtually 24,000 (17.4%) skilled a subsequent nonfatal overdose, and about 1,300 (1%) died from overdose within the following yr.

Outcomes have been printed in JAMA Inside Medication, figuring out each efficient interventions and important gaps in care.

“Individuals who have skilled one overdose usually tend to expertise one other,” stated Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Psychological Well being and Substance Use and the chief of SAMHSA.

“However we discovered that when survivors acquired gold-standard care reminiscent of drugs for opioid use dysfunction and naloxone, the probabilities of dying from an overdose within the following yr drop dramatically. In brief, drugs for opioid use dysfunction, opioid overdose reversal drugs, and behavioral well being helps save lives.”

The examine identifies efficient, lifesaving interventions following preliminary nonfatal overdoses. The chances of dying from a subsequent deadly overdose decreased amongst cohort members who acquired methadone (58% decrease odds), buprenorphine (52% decrease odds), or behavioral well being evaluation or disaster companies (75% decrease odds). The danger of overdose mortality amongst those that crammed a prescription for naloxone was additionally lowered by 30%.

Nonetheless, important gaps in care have been additionally famous. Solely 4.1% of the cohort acquired drugs for opioid use dysfunction (MOUD), and solely 6.2% crammed a prescription for naloxone, generally referred to as Narcan, regardless of these being gold-standard interventions. Beneficiaries receiving MOUD waited a imply of 72 days between their nonfatal overdose and receiving treatment.

Total, 89% of beneficiaries within the cohort acquired behavioral well being companies within the 12 months following their nonfatal overdose for a median period of 15 days all year long.

“These findings underscore the significance of high-quality care following an overdose, and the alternatives that stay to attach individuals with wanted care. Solely 4% of beneficiaries acquired these drugs after experiencing a nonfatal overdose and—for individuals who did obtain the drugs—there was a major delay starting from six to 105 days,” stated Dr. Dora Hughes, Performing Chief Medical Officer and Performing Director of the Middle for Medical Requirements and High quality for CMS.

“Growing the variety of beneficiaries accessing these drugs in a well timed method will save lives.”

These findings contribute to the rising physique of analysis displaying that whereas MOUD and overdose reversal drugs save lives, they’re not often included into care following an overdose.

“At a time when over 100,000 individuals proceed to die every year from overdose, we should prioritize making efficient therapies and instruments accessible—particularly to those that are on the highest threat,” stated Nora D. Volkow, M.D., Director of the Nationwide Institute on Drug Abuse.

“Connecting with somebody in an emergency division or after they’ve skilled a nonfatal overdose gives a beneficial alternative to each help them acutely in that second, in addition to supply lifesaving instruments that may defend them from future overdoses, hyperlink them into therapy, and foster restoration.”

President Biden’s Unity Agenda for the Nation prioritizes delivering lifesaving treatment and care throughout America so as to beat the opioid epidemic.

The US Division of Well being and Human Companies Overdose Prevention Technique helps evidence-based therapies, together with entry to methadone and buprenorphine, and hurt discount methods reminiscent of saturation of opioid overdose reversal drugs.

For the reason that finish of the analyzed cohort, important coverage and programmatic modifications have been made throughout the federal authorities to save lots of lives and help communities:

• The Consolidated Appropriations Act of 2023 eliminated federal necessities for suppliers to have specialised waivers to prescribe buprenorphine for opioid use dysfunction. Now, any supplier with Schedule III prescribing authority could prescribe buprenorphine merchandise.
• The Meals and Drug Administration (FDA) has permitted a number of naloxone drugs as over-the-counter, eradicating the necessity for a prescription.
• In 2024, SAMHSA made the primary rule updates to 42 CFR Half 8—the federal regulation that governs opioid therapy packages (OTP)—in additional than 20 years. This alteration made many COVID-era flexibilities for MOUD everlasting, growing entry to drugs in rural areas and for individuals with transportation challenges. OTP admission standards additionally have been up to date to take away important obstacles to entry.
• In August 2023, CDC awarded new five-year cooperative agreements to 90 state and native well being departments below two distinct Overdose Knowledge to Motion (OD2A) packages. The cooperative agreements fund well being departments in any respect ranges of presidency to increase drug overdose information and prevention efforts and construct partnerships throughout public well being, behavioral well being, well being methods, communities, and public security.

CMS is executing a Behavioral Well being Technique to ship elevated protection and entry to behavioral well being care, together with strengthened entry by means of faculties for Medicaid and CHIP eligible youngsters, grants and steering to help community-based cellular disaster intervention companies, elevated telehealth companies by means of Medicare for behavioral well being and buprenorphine initiation, and expanded entry to behavioral well being suppliers within the Market.

CMS additionally continues to check modern care supply and fee fashions such because the Innovation in Behavioral Well being, Making Care Major, Worth in Opioid Use Problems Therapy and Maternal Opioid Misuse Fashions.

“CDC has a robust concentrate on stopping well being issues earlier than they happen, together with within the overdose house,” stated Allison Arwady, M.D., M.P.H., director of CDC’s Harm Middle.

“We work carefully with our state and native companions throughout the nation to gather information and drive native prevention actions, and simply as carefully to coordinate our work with our different federal company companions. This examine highlights that as a society, we’re nonetheless lacking many alternatives to stop deadly overdoses, and we should proceed to work collectively in any respect ranges to save lots of lives.”