Impact of State Policies on the Treatment of OUD in Adolescents Covered by Medicaid

• In Event: Policies related to Opioid Use and Health Outcomes

Abstract

The United States remains in the midst of a crisis of opioid mortality. Adolescents and young adults are uniquely impacted by opioid-related harms. Drug-related deaths among 12- to 17-year-olds, largely driven by opioids, rapidly increased between 2015 and 2019, doubled between 2019 and 2021, and continue to increase despite the adult overdose rate plateauing. Although it’s more common for adults to be diagnosed with opioid use disorder (OUD) than teens, there is evidence that symptom onset begins before age 18 for up to 50% of individuals with substance use disorders, including OUD. There is substantial clinical evidence indicating that medication for OUD (MOUD) introduces very low risk to adolescents and often leads to better long-term outcomes in adolescents than in adults. However, fewer than 5% of adolescents with OUD (compared with roughly 25% of adults with OUD) receive MOUD despite recommendations from the American Academy of Pediatrics (AAP) and others.

 

Following the sharp increase in adolescent overdoses, a number of states enacted policies aimed at increasing diagnosis and treatment of OUD among adolescents. These types of policies can be grouped into six categories: increased medication for OUD (MOUD) access, increased access to treatment services designed for adolescents, waived parental consent and confidentiality for treatment, introduction of school-based treatment programs, funding and grants for adolescent treatment, and expansion of telemedicine for adolescent OUD. Policies such as these could have a significant impact on different aspects of diagnosis and treatment of OUD for adolescents. 

 

This study uses Medicaid TAF data, years 2016-2021, to evaluate the impact of these policies on adolescent OUD care among Medicaid beneficiaries. This analysis is done in two parts. The first part estimates a separate model to evaluate the effect of each policy on its target area, using dynamic difference-in-difference (DID) models that are robust to heterogeneous policy adoption dates. For example, states that enacted policies to increase MOUD access will be compared to states that did not enact these policies, using DID, in order to evaluate the relationship between these policies and the proportion of adolescents receiving MOUD in Medicaid. Because many states implement several of these policies, the second part of the analysis uses a generalized difference-in-differences model, which accounts for varying levels of exposure to state adolescent OUD policies, to evaluate if states with more policies see overall increases in OUD diagnosis and treatment and decreases in opioid poisonings and mortality.

 

Adolescent OUD is a growing problem made more complex by state variation in diagnosis rates, treatment rates, and overdose rates, as well as variation in funding and state policy. Due to the complexity, more localized approaches by states, targeting adolescent age groups, are needed to increase diagnosis and appropriate treatment. Therefore, state policy may play a pivotal role in addressing adolescent OUD. 

Author

• Shelby Jan Steuart, University of Maryland, College Park
  Presenting Author