Association between peer support services, treatment engagement and overdose risk among Kentucky Medicaid beneficiaries with opioid use disorder.

Abstract

Peer-support specialists leverage experience to assist individuals with opioid use disorder (OUD) in their recovery, leading to better patient health outcomes. However, the longitudinal impact of peer support on treatment and health outcomes is understudied. We identified the universe of patients with OUD beneficiaries in Kentucky's Medicaid managed care program from 2020 to 2021. Among this population, we utilized mixed-effect logistic regression models to study the association between peer-support engagement duration and buprenorphine receipt and opioid overdose risk. We also used descriptive analysis to compare beneficiaries who received one or more peer-support service claims with OUD-treated beneficiaries who did not receive any peer support, and the evolution of peer-support receiving beneficiary characteristics across the duration of peer-engagement. Peer-support receipt was associated with higher rates of mental health comorbidities, greater social vulnerability, and more intense service delivery across a broader array of settings. Following peer-support initiation, beneficiary use of services in more intensive settings declined. Relative to the period before receipt of peer services, peer-support retention was associated with a 19.7 percentage point increase in buprenorphine receipt and a 0.4 percentage point reduction in overdose risk. Engagement with peers declined drastically over time, with fewer than 20 % of beneficiaries remaining in peer support after two years. Given the associated benefits of peer support, declining participation underscores the need for strategies to enhance retention. Addressing reimbursement policies, clinical integration barriers, and follow-up protocols may strengthen the impact of peer support in OUD treatment.