Evaluating the Effectiveness of Medications for Opioid Use Disorder Among Critically Ill Medicaid Beneficiaries Using Target Trial Emulation

Medicaid is the single largest payer of medications for opioid use disorder (MOUD) in the U.S. and plays a major role in caring for the critically ill Medicaid patient population with OUD. Nearly 1 in 6 Medicaid beneficiaries with an intensive care unit (ICU) stay have OUD or have experienced an opioid overdose. MOUD is the standard treatment for OUD, yet existing research suggests gaps in continuity of care for Medicaid ICU patients with OUD--35% of this population receive MOUD within 30 days of a discharge compared to over 60% of all Medicaid beneficiaries with OUD.

Led by Sarah Marks, this pilot study aims to shape clinical guidelines and healthcare policy for the care of ICU patients with OUD by generating evidence on the initiation, continuation, and comparative effectiveness of different types of medications for OUD and evaluating their impact on healthcare utilization and mortality rates post-discharge. Marks and colleagues will apply a target trial emulation strategy, using the 2024 Transformed Medicaid Statistical Information System Analytics Files, to assess causality and examine if the initiation or continuation of MOUD among patients after hospitalization improves health outcomes.

Sarah Marks is pursuing dual MD/PhD degrees in health policy and medicine at Virginia Commonwealth University (VCU). As a physician-scientist in training, her research focuses on reducing health disparities and addressing the health needs of patients admitted into intensive care units, particularly those with substance use disorders. She has extensive experience working with Medicaid claims as a lead analyst with the VCU-Department of Medical Assistance Services evaluation team and as an active participant in the multi-state Medicaid Outcomes Distributed Research Network. Marks has published studies in Health Affairs Scholar and the Journal of Addiction Medicine examining the role of Medicaid in critical care and the prevalence of substance use disorders among critically ill Medicaid beneficiaries in Virginia.