Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population

Drug Alcohol Depend. 2021 Apr 1;221:108633. doi: 10.1016/j.drugalcdep.2021.108633. Epub 2021 Feb 16.


Background: Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses.

Objective: To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose.

Design: Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data.

Main measures: MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose.

Results: Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches.

Conclusions: Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.

Keywords: Continuity; Medications for opioid use disorder; Opioid use disorder.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care / statistics & numerical data*
  • Ambulatory Care Facilities
  • Analgesics, Opioid / therapeutic use*
  • Continuity of Patient Care / statistics & numerical data*
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Opiate Overdose / epidemiology
  • Opiate Overdose / etiology
  • Opioid-Related Disorders / drug therapy*
  • Pennsylvania / epidemiology
  • Regression Analysis
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult


  • Analgesics, Opioid