Health Insurance Instability and Mortality among Patients Receiving Buprenorphine Treatment for Opioid Use Disorder: Linkage of the Prescription Opioid Registry with the National Death Index

The prevalence of opioid use disorder (OUD) has increased amid the opioid overdose public health crisis. Yet, retention in medication-based treatment for OUD remains suboptimal. Health insurance instability poses a significant barrier to treatment continuity and can induce high-risk care transitions. Research in this area is lacking due to limited capture of patient data after disenrollment from health systems. To address this gap, the proposed multi-site cohort study of patients across four health systems in the Health Systems Node seeks to link electronic health records (EHR) with novel data sources to examine instability insurance and its association with all-cause and overdose mortality. These sources will include the National Death Index, all-payer claims data, and criminal justice data. As EHR data are increasingly important for pragmatic trials, this study will advance research by identifying data sources and methods to address bias from loss to follow-up, a common concern across studies.