Clinical Scorecard: Prompt Administration of New Opioid Treatment Following Acute Care Visits for Overdose in the Medicaid Population of the U.S.
At a Glance
Category
Detail
Condition
Opioid Use Disorder (OUD) and opioid overdose
Key Mechanisms
Medication for OUD (MOUD) including buprenorphine, methadone, and naltrexone reduce risk of repeat overdose and death
Target Population
Medicaid beneficiaries aged 18–64 with acute care visits for opioid overdose
Care Setting
Emergency department (ED) and inpatient acute care settings
Key Highlights
Over 105,000 drug poisoning deaths in the U.S. in 2023, with nearly 80,000 involving opioids.
Acute care settings are critical intervention points to connect overdose survivors to MOUD.
Post-overdose MOUD initiation remains low, especially new treatment uptake among previously untreated individuals.
Guideline-Based Recommendations
Diagnosis
Identify opioid overdose events using ICD-9-CM and ICD-10-CM codes excluding intentional self-poisoning.
Assess for involvement of heroin, synthetic opioids, stimulants, and benzodiazepines.
Evaluate medical severity including hospitalization and mechanical ventilation.
Management
Initiate MOUD promptly after overdose using buprenorphine, methadone, or naltrexone.
Exclude buprenorphine formulations indicated for pain management when prescribing for OUD.
Consider supervised dispensing and long-acting formulations as appropriate.
Monitoring & Follow-up
Track MOUD adherence using proportion of days covered (PDC) metrics.
Monitor for behavioral health and medical comorbidities including SUDs and serious mental illness.
Assess health service utilization including inpatient, ED visits, and psychosocial services.
Risks
High risk of repeat overdose and death shortly after initial overdose event.
Low rates of MOUD initiation post-overdose increase risk of adverse outcomes.
Comorbid conditions such as chronic pain, respiratory diseases, and injection-related infections may increase overdose risk.
Patient & Prescribing Data
Medicaid enrollees aged 18–64 with opioid overdose treated in ED or inpatient settings
Most post-overdose MOUD recipients had prior treatment; new treatment initiation remains low, highlighting gaps in engagement for previously untreated individuals.
Clinical Best Practices
Use national Medicaid claims data to identify and track MOUD initiation patterns.
Focus on increasing new MOUD uptake post-overdose, especially among patients without prior treatment.
Incorporate sociodemographic, clinical, and community-level factors to tailor interventions.
Ensure continuous Medicaid enrollment to facilitate longitudinal care and monitoring.
Leverage acute care encounters as critical opportunities for initiating MOUD.
In a target-trial emulation of more than 600,000 veterans, GLP-1 RA initiators saw fewer new substance use disorders—and patients with existing SUDs had fewer overdoses, hospitalizations, and deaths.
