The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT.
A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups.
During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable.
MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2018;391(10117):241–50.
Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry. 2019;76(2):208–16.
Lewer D, Tweed EJ, Aldridge RW, Morley KI. Causes of hospital admission and mortality among 6683 people who use heroin: A cohort study comparing relative and absolute risks. Drug Alcohol Depend. 2019;204:107525.
Choi SKY, Boyle E, Cairney J, Grootendorst P, Gardner S, Collins EJ, et al. Impact of depression and recreational drug use on emergency department encounters and hospital admissions among people living with HIV in Ontario: A secondary analysis using the OHTN cohort study. PLoS ONE. 2018;13(4):e0195185-e.
Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, et al. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction. 2020;115(6):1011–23.
Chen IM, Huang CL-C, Yeh B-J, Chien Y-L. Health service utilization of heroin abusers: a retrospective cohort study. Addict Behav. 2015;45:281–6.
Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J. 2017;14(1):16.
Onyeka IN, Beynon CM, Ronkainen K, Tiihonen J, Föhr J, Kuikanmäki O, et al. Hospitalization in a cohort seeking treatment for illicit drug use in Finland. J Subst Abuse Treat. 2015;53:64–70.
Chen Y-C, Chen C-K, Lin S-K, Chiang S-C, Su L-W, Wang L-J. Health care service utilization and associated factors among heroin users in northern Taiwan. Addict Behav. 2013;38(11):2635–8.
Gourevitch MN, Chatterji P, Deb N, Schoenbaum EE, Turner BJ. On-site medical care in methadone maintenance: associations with health care use and expenditures. J Subst Abuse Treat. 2007;32(2):143–51.
Schwarz R, Zelenev A, Bruce RD, Altice FL. Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat. 2012;43(4):451–7.
Chen C-Y, Wang IA, Fang S-Y, Huang N, Tsay J-H, Chang S-H. Inadequate prenatal care utilization among women with and without methadone-treated opioid use disorders in Taiwan. Int J Drug Policy. 2019;67:1–8.
Lan CW, Lin C, Thanh DC, Li L. Drug-related stigma and access to care among people who inject drugs in Vietnam. Drug Alcohol Rev. 2018;37(3):333–9.
McCarty D, Perrin NA, Green CA, Polen MR, Leo MC, Lynch F. Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan. Drug Alcohol Depend. 2010;111(3):235–40.
Lyu S-Y, Su L-W, Chen Y-MA. Effects of education on harm-reduction programmes. Lancet. 2012;379(9814):e28–30.
Lin T, Chen CH, Chou P. Effects of combination approach on harm reduction programs: the Taiwan experience. Harm Reduct J. 2016;13(1):23.
Ministry of Health and Welfare 2020 Annual Drug Addiction Treatment Expenses Subsidy Program [Available from: https://dep.mohw.gov.tw/domhaoh/cp-4097-50627-107.html.
Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. StatPearls. Treasure Island (FL): StatPearls; 2020.
Instructions for the Application and Use of the "Taiwan Illicit Drug Issue Database" of the Ministry of Health and Welfare [Available from: https://antidrug.moj.gov.tw/cp-91-6186-2.html.
Hsieh CY, Su CC, Shao SC, Sung SF, Lin SJ, Kao Yang YH, et al. Taiwan’s National Health Insurance Research Database: past and future. Clin Epidemiol. 2019;11:349–58.
Lin LY, Warren-Gash C, Smeeth L, Chen PC. Data resource profile: the National Health Insurance Research Database (NHIRD). Epidemiol Health. 2018;40:e2018062.
Chien LC, Chou YJ, Huang YC, Shen YJ, Huang N. Reducing low value services in surgical inpatients in Taiwan: Does diagnosis-related group payment work? Health Policy. 2020;124(1):89–96.
Cheng S-H, Chen C-C, Tsai S-L. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study. Health Policy. 2012;107(2–3):202–8.
Chiu SL, Chu CL, Muo CH, Chen CL, Lan SJ. Trends in glaucoma medication expenditures under universal health coverage: a national population-based longitudinal survey in Taiwan. J Ophthalmol. 2015;2015:243401.
Tsou Y-A, Lin C-C, Lai C-H, Wang C-Y, Lin C-D, Chen P-C, et al. Does Adenotonsillectomy really reduced clinic visits for pediatric upper respiratory tract infections? A national database study in Taiwan. Int J Pediatr Otorhinolaryngol. 2013;77(5):677–81.
Ko YL, Wang JW, Hsu HM, Kao CH, Lin CY. What happened to health service utilization, health care expenditures, and quality of care in patients with acute pancreatitis after implementation of global budgeting in Taiwan? Medicine (Baltimore). 2018;97(41):e12620.
Troberg K, Håkansson A, Dahlman D. Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment. J Addict. 2019;2019:7942145.
O’Toole J, Hambly R, Cox A-M, O’Shea B, Darker C. Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls. Eur J Gen Pract. 2014;20(4):275–80.
Fang S-Y, Huang N, Lin T, Ho I-K, Chen C-Y. Health insurance coverage and healthcare utilization among infants of mothers in the national methadone maintenance treatment program in Taiwan. Drug Alcohol Depend. 2015;153:86–93.
Papi M, Pontecorvi L, Setola R. A new model for the length of stay of hospital patients. Health Care Manag Sci. 2016;19(1):58–65.
Tran BX, Nguyen LT. Impact of methadone maintenance on health utility, health care utilization and expenditure in drug users with HIV/AIDS. Int J Drug Policy. 2013;24(6):e105–10.
Yin W, Pang L, Cao X, McGoogan JM, Liu M, Zhang C, et al. Factors associated with depression and anxiety among patients attending community-based methadone maintenance treatment in China. Addiction. 2015;110(Suppl 1):51–60.
Hallinan R, Elsayed M, Espinoza D, Veillard A-S, Morley KC, Lintzeris N, et al. Insomnia and excessive daytime sleepiness in women and men receiving methadone and buprenorphine maintenance treatment. Subst Use Misuse. 2019;54(10):1589–98.
Cho HE, Wang L, Chen JS, Liu M, Kuo CF, Chung KC. Investigating the causal effect of socioeconomic status on quality of care under a universal health insurance system - a marginal structural model approach. BMC Health Serv Res. 2019;19(1):987.
Cheng TM. Reflections on the 20th anniversary of Taiwan’s single-payer National Health Insurance System. Health Aff (Millwood). 2015;34(3):502–10.
Lancet. Reforming international drug policy. Lancet. 2016;387(10026):1347.
Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, et al. Public health and international drug policy. Lancet. 2016;387(10026):1427–80.
We thank Department of Mental and Oral Health (DMOH), Ministry of Health and Welfare, Taipei, Taiwan for the use of their Database of Substitution Therapy. Parts of this material are based on data and information compiled and provided by DMOH. However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of DMOH.
This study was supported in part by Ministry of Science and Technology (MOST 104-3011-F-039-001), Ministry of Health and Welfare (M05B4352), National Health Research Institutes (NP-108-GP-05), Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004), China Medical University Hospital, and China Medical University under the Higher Education Sprout Project of the Ministry of Education, Taiwan. The journal’s Rapid Service Fee was funded by the China Medical University Hospital.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Chieh-Liang Huang, I-Ju Tsai, Wen-Chi Lin, Ing-Kang Ho, Ruey-Yun Wang and Cynthia Wei-Sheng Lee declare that they have no conflict of interest.
Compliance with Ethics Guidelines
The Ethics Review Board of National Health Research Institutes in Taiwan approved this study (EC1060510-E-R1).
Due to constraints on the data sharing permissions of the data in Health and Welfare Data Science Center (HWDC) in Taiwan, we are not allowed to share the data for public use.
About this article
Cite this article
Huang, CL., Tsai, IJ., Lin, WC. et al. Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study. Adv Ther (2021). https://doi.org/10.1007/s12325-021-01633-w
- Emergency department (ED)
- Healthcare utilization
- Methadone maintenance treatment (MMT)