Semester

Spring

Date of Graduation

2020

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Gordon Smith

Committee Member

Marie Abate

Committee Member

Sijin Wen

Committee Member

Kim Innes

Committee Member

Usha Sambamoorthi

Abstract

Background

With increasing number of opioid overdoses in West Virginia (WV) in recent years and limited number of people receiving treatment, the dissertation study aims to better understand fatal overdose problems in WV and the impact of medication for opioid use disorder (MOUD) in preventing overdose deaths.

Method

WV drug-related deaths from 2005 to 2018 was used to describe the involvement of fentanyl and FAs. WV Medicaid claim data was analyzed to describe the recurrent opioid overdose and the changes in receipt of MOUD. Further, a Medicaid opioid overdose cohort was created to evaluate the effect of occurrence of recurrent overdose and receipt of MOUD on survival outcomes following a non-fatal overdose after 12 months.

Results

Fentanyl and FAs were drastically increasingly involved in WV fatal overdoses. Overall, only about 5-10% of people who experienced an opioid overdose received MOUD at any time. Compared with no MOUD, those who received MOUD were associated with non-significant increase of all-cause mortality (adjusted hazard ratio 1.14), and occurrence of recurrent overdose was associated with non-significant increase of all-cause mortality (adjusted hazard ratio 1.54).

Conclusion

Starting 2015, drug involvement in the deaths changed from predominantly prescription opioids to fentanyl and new identified FAs. MOUD is likely to be effective in lowering mortality risk in WV. However, small sample size and limited follow up period prevented us from reaching sufficient statistical power. Future research with more recent years’ Medicaid data are needed to guide the timely receipt of MOUD for the patients in urgent need.

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