States With Opioid Treatment Policies See Higher Hospital Readmission Rates

States that made the opioid overdose drug naloxone more accessible had a higher likelihood of opioid-related hospital readmissions than states that restricted availability of the drug, according to an AHRQ-funded study in BMC Health Services Research. Researchers used data from more than 383,000 initial opioid hospitalizations in 13 states from AHRQ’s Healthcare Cost and Utilization Project to examine the relationship between opioid-related readmissions and three policies: expanding availability of naloxone, enacting Good Samaritan laws to protect individuals who obtain emergency services for someone undergoing an overdose, and expanding Medicaid coverage of medication-assisted treatment (MAT). States that made naloxone more available had higher odds of opioid-related hospital readmissions, which could be due to patients’ surviving the initial overdose and getting follow-up hospital care. States that expanded MAT programs had higher odds of hospital readmissions among patients insured by Medicaid. Readmission odds were lower for patients covered by Medicare and private insurance, possibly because of additional benefits for opioid treatment, such as outpatient treatment, available in Medicare and private insurance. Researchers did not find any relationships between Good Samaritan laws and opioid-related readmissions. Access the abstract.

2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8.

State variation in opioid treatment policies and opioid-related hospital readmissions.

Blanchard J1,2, Weiss AJ3, Barrett ML4, McDermott KW5, Heslin KC6.

Author information

Abstract

BACKGROUND:

State policy approaches designed to provide opioid treatment options have received significant attention in addressing the opioid epidemic in the United States. In particular, expanded availability of naloxone to reverse overdose, Good Samaritan laws intended to protect individuals who attempt to provide or obtain emergency services for someone experiencing an opioid overdose, and expanded coverage of medication-assisted treatment (MAT) for individuals with opioid abuse or dependence may help curtail hospital readmissionsfrom opioids. The objective of this retrospective cohort study was to evaluate the association between the presence of state opioid treatmentpolicies-naloxone standing orders, Good Samaritan laws, and Medicaid medication-assisted treatment (MAT) coverage-and opioid-relatedhospital readmissions.

METHODS:

We used 2013-2015 hospital inpatient discharge data from 13 states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. We examined the relationship between state opioid treatment policies and 90-day opioid-relatedreadmissions after a stay involving an opioid diagnosis.

RESULTS:

Our sample included 383,334 opioid-related index hospitalizations. Patients treated in states with naloxone standing-order policiesat the time of the index stay had higher adjusted odds of an opioid-related readmission than did those treated in states without such policies; however, this relationship was not present in states with Good Samaritan laws. Medicaid methadone coverage was associated with higher odds of readmission among all insurance groups except Medicaid. Medicaid MAT coverage generosity was associated with higher odds of readmission among the Medicaid group but lower odds of readmission among the Medicare and privately insured groups. More comprehensive Medicaid coverage of substance use disorder treatment and a greater number of opioid treatment programs were associated with lower odds of readmission.

CONCLUSIONS:

Differences in index hospitalization rates suggest that states with opioid treatment policies had a higher level of need for opioid-related intervention, which also may account for higher rates of readmission. More research is needed to understand how these policies can be most effective in influencing acute care use.