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theses

The ongoing U.S. overdose epidemic has resulted in the deaths of more than 1 million Americans since 1999, the majority of which involved opioids. The Substance Abuse and Mental Health Administration conservatively estimates that 2.7 million Americans have opioid use disorder, yet many of them do not receive treatment and even fewer receive evidence-based medications for opioid use disorder. Increasing addiction treatment engagement is critical for addressing the opioid crisis and requires a coordinated strategy that involves all sectors of the health care system. Hospitals, where individuals with opioid use disorder are likely to present for overdose and other opioid-related consequences, are central to this effort. However, opioid use disorder is inadequately addressed in hospitals, and practices that increase treatment initiation are not widely implemented. Further research is needed to build evidence of effectiveness, improve care quality, and develop best practices for program implementation. The focus of this three-paper dissertation is on drug treatment initiation and outcomes following opioid-related acute care hospital visits. Using New Jersey Medicaid data, the first paper examines rates of 7-day addiction treatment initiation following emergency department or inpatient hospital encounters and investigates variation among acute care hospitals. This analysis found that treatment initiation rates among hospitals ranged from 3.3% to 22%, suggesting that hospital practices can have a large impact on whether patients engage in services after discharge. The second and third papers examine outcomes associated with two hospital-based interventions designed to facilitate post-discharge treatment initiation. Paper 2 investigates the impact of a peer navigation intervention on treatment initiation and outcomes following medically treated overdose. The analysis found that patients treated in hospitals that implemented the program had higher rates of treatment utilization and lower rates of overdose than patients treated in comparison group hospitals, but effects were highly heterogeneous across implementation sites. Paper 3 examines the association of emergency department buprenorphine receipt with post-discharge outcomes, finding that patients who received buprenorphine had higher rates of treatment engagement during follow-up. Findings from this dissertation provide critical information to practitioners and policymakers as they continue to respond to the opioid crisis.

http://dissertations.umi.com/gsnb.rutgers:12391

Ph.D.

Includes bibliographical references

doi:10.7282/t3-qjbf-ss63

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