Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study



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.

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  1. 1.

    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.

    Article  Google Scholar 

  2. 2.

    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.

    Article  Google Scholar 

  3. 3.

    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.

    Article  Google Scholar 

  4. 4.

    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.

    Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    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.

    Article  Google Scholar 

  11. 11.

    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.

    Article  Google Scholar 

  12. 12.

    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.

    Article  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    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.

    Article  Google Scholar 

  15. 15.

    Lyu S-Y, Su L-W, Chen Y-MA. Effects of education on harm-reduction programmes. Lancet. 2012;379(9814):e28–30.

    Article  Google Scholar 

  16. 16.

    Lin T, Chen CH, Chou P. Effects of combination approach on harm reduction programs: the Taiwan experience. Harm Reduct J. 2016;13(1):23.

    Article  Google Scholar 

  17. 17.

    Ministry of Health and Welfare 2020 Annual Drug Addiction Treatment Expenses Subsidy Program [Available from:

  18. 18.

    Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. StatPearls. Treasure Island (FL): StatPearls; 2020.

  19. 19.

    Instructions for the Application and Use of the "Taiwan Illicit Drug Issue Database" of the Ministry of Health and Welfare [Available from:

  20. 20.

    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.

    Article  Google Scholar 

  21. 21.

    Lin LY, Warren-Gash C, Smeeth L, Chen PC. Data resource profile: the National Health Insurance Research Database (NHIRD). Epidemiol Health. 2018;40:e2018062.

    Article  Google Scholar 

  22. 22.

    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.

    Article  Google Scholar 

  23. 23.

    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.

    Article  Google Scholar 

  24. 24.

    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.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    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.

    Article  Google Scholar 

  26. 26.

    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.

    Article  Google Scholar 

  27. 27.

    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.

    Article  Google Scholar 

  28. 28.

    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.

    Article  Google Scholar 

  29. 29.

    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.

    Article  Google Scholar 

  30. 30.

    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.

    Article  Google Scholar 

  31. 31.

    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.

    Article  Google Scholar 

  32. 32.

    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.

    Article  Google Scholar 

  33. 33.

    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.

    Article  Google Scholar 

  34. 34.

    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.

    Article  Google Scholar 

  35. 35.

    Cheng TM. Reflections on the 20th anniversary of Taiwan’s single-payer National Health Insurance System. Health Aff (Millwood). 2015;34(3):502–10.

    Article  Google Scholar 

  36. 36.

    Lancet. Reforming international drug policy. Lancet. 2016;387(10026):1347.

    Article  Google Scholar 

  37. 37.

    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.

    Article  Google Scholar 

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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).

Data Availability

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.

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Corresponding author

Correspondence to Cynthia Wei-Sheng Lee.

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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).

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  • Emergency department (ED)
  • Healthcare utilization
  • Methadone maintenance treatment (MMT)