Lock-in programs for individuals at risk for opioid misuse appear to have little effect on overdoses — a finding that points to a need for improved program design.
Dr. Becky Naumann, assistant professor of epidemiology at the University of North Carolina Gillings School of Global Public Health, is lead author of “Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk,” which was published in Medical Care.
Lock-in programs, also called patient review and restriction programs, identify individuals at risk for overusing opioids and other controlled substances. They then restrict access to these medications by requiring patients to use a single prescriber and/or pharmacy to obtain such drugs.
Through enrollment in lock-in programs, providers can identify individuals who could benefit from opioid use disorder treatment, such as medication-assisted treatment (MAT).
To examine the effects of a Medicaid lock-in program, Dr. Naumann and her team analyzed North Carolina Medicaid claims from July 2009 to June 2013. They found that while the lock-in programs may have been useful for increasing connections to MAT, there did not appear to be an impact on average overdose risk across this population.
“In previous studies, we found that the average amount of opioids dispensed to individuals increased during program enrollment,” says Dr. Naumann. “And we know that it’s also a possibility that program restrictions may lead some people to use substances outside of the health care system.”
According to Dr. Naumann, lock-in programs are too often a one-size approach for a complex problem.
“We need to address the many needs of the patient, including comorbidities and factors like housing and transportation,” she says.Friday Letter Submission, Publish on September 20