Evaluating state policies to facilitate emergency department-based treatment initiation for opioid use disorder - Opioid use disorder (OUD) is a life-threatening health condition affecting 7.6 million people in the U.S. Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, decrease mortality among patients with OUD by 50%. Emergency department (ED) visits for opioid overdose are an important opportunity to initiate MOUD, but buprenorphine is only prescribed to 1 in 12 patients visiting the ED for opioid overdose. Since 2015, at least 5 states have implemented laws requiring EDs treating patients for opioid overdose to offer MOUD induction or prescriptions, provide patients with information about MOUD, and/or provide “warm hand-offs”. State ED MOUD laws could increase MOUD treatment and prevent morbidity and mortality among patients with OUD. This project will be the first to create a database of states’ ED MOUD laws, describe MOUD initiation and retention following ED visits using multiple national claims data, and examine ED MOUD law effects on patient outcomes. Knowledge from this proposal will be critical to inform development and refinement of ED MOUD laws to increase treatment initiation and retention in lifesaving OUD treatment. In Aim 1, we will create a longitudinal, publicly available database of state ED MOUD laws. Through an expert guided search of NexisUni legal software, we will identify state statutes, regulations, and executive orders effective between 2014 and 2024 that appear designed to facilitate MOUD use after ED visits for overdose. In Aim 2, we will examine MOUD initiation and retention following ED visits for opioid overdose and describe key patient, provider, and geographic factors associated with MOUD treatment after ED visits. Using 2014-2024 national Medicaid, Medicare, and commercial insurance claims data, we will describe national and state-level trends in the rates of MOUD initiation and retention after ED visits for opioid overdose. We hypothesize that rates of MOUD initiation and retention after ED visits will increase over time and across payer types, and there will be significant heterogeneity in MOUD treatment across groups based on key patient, provider, and geographic attributes. In Aim 3, we will evaluate ED MOUD laws’ effects on MOUD initiation, MOUD retention, and opioid overdose. Using difference-in-differences analyses, we will examine whether state ED MOUD laws are associated with changes in the rate of MOUD initiation, rate of retention of MOUD for at least 180 days, and opioid overdose within 30 days of ED visits. We will also assess whether the effects of state ED MOUD laws vary by specific features of the laws and by patient characteristics.
