Focusing on the state with the highest overdose rate, we find that use of buprenorphine significantly increased after a non-fatal overdose, but remained very low. Less than 10% of people every month post-overdose received MOUD or mental health counseling, which is below rates reported in other states.2, 3 In our analysis, MOUD only includes buprenorphine and naltrexone because West Virginia Medicaid did not cover methadone. Despite high rates of mental health comorbidities, people saw little to no change in receipt of counseling or medications for OUD or mental health conditions post-overdose.

With less than 10% of people receiving MOUD post-overdose among West Virginia Medicaid enrollees, a non-fatal overdose presents a major, under-utilized opportunity to increase treatment for opioid use disorder. Given the high burden of psychiatric comorbidities and the role of counseling in medication-assisted treatment for opioid use disorder, low rates of and declines in mental health counseling post-overdose also presents an important opportunity to improve treatment for people who experience an opioid overdose. Our study is the first to investigate changes in treatment for psychiatric comorbidities following a non-fatal overdose. Limitations of the study include restriction to those meeting continuous Medicaid eligibility requirements and inability of claims data to capture care not billed. Efforts to reduce risk of complications post-overdose should strive for adequate use of both MOUD and treatments for psychiatric conditions that are highly comorbid with OUD.