TOPLINE: 

US opioid treatment programs had low retention rates in 2023, with a median rate of 61% at 30 days, dropping to 27.5% at 180 days, a new study of Medicaid beneficiaries showed. Even at the programs’ peak performance in 2021, the 30-day retention rate was only 65%, highlighting significant room for improvement in patient engagement, the researchers noted.

METHODOLOGY:

• The cohort study included more than 261,000 adult beneficiaries of Medicaid with a primary opioid use disorder diagnosis (mean age, 39 years; 54% men) from June 2018 to December 2023.
• Opioid treatment program retention rates were evaluated at 30, 90, and 180 days across 5 measurement years (2019-2023).
• Claims and enrollment information data were obtained from the Centers for Medicare & Medicaid Services Transformed Medicaid Statistical Information System Analytic Files.

TAKEAWAY:

• In measurement year 2023, 1138 opioid treatment programs and nearly 433,000 total episodes of treatment were identified.
• Opioid treatment programs had median retention rates of 61% at 30 days, 41.5% at 90 days, and 27.5% at 180 days in measurement year 2023.
• The highest retention rate across all measures and years was observed in 2021, with a 30-day retention rate of 65%.
• Factors positively associated with 30-day retention included an older age and hospitalization for reasons other than substance use disorder in the 60 days prior to treatment initiation; negative associations included receipt of buprenorphine, methadone, or a mental health diagnosis.

IN PRACTICE:

The authors of an accompanying editorial wrote that the findings provide “a timely and important call to action for OTP [opioid treatment program] operators, payers, and public health leaders. Implementing and measuring retention must become a core strategy in improving opioid use disorder treatment outcomes.”

SOURCE:

The study was led by Dylan E. DeLisle, MPH, research public health analyst at RTI International, Durham, North Carolina. The accompanying editorial was authored by Ka Ming Gordon Ngai, MD, Wayne State University, Detroit. Both articles were published online on January 23 in JAMA Network Open.

LIMITATIONS: 

No current standard approach for attributing patients to opioid treatment programs for quality measurement was available. Specific assumptions were made about periods of new treatment episodes (30 days with no prior visits) and discontinuation (15 days without services), which could be adjusted for different goals and practices. Retention was only captured at treatment initiation. Additionally, only Medicaid beneficiaries were included.

DISCLOSURES:

The study was funded by the National Institutes of Health’s Helping to End Addiction Long-term Initiative. The investigators and the editorialist reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.