Lowering Cardiovascular Disease Among People with Opioid Use Disorder

ABSTRACT Cardiovascular disease (CVD) is the leading cause of non-overdose death among people with opioid use dis- order (OUD). Hypertension (HTN) is a modifiable individual risk factor for CVD, with HTN medications reducing major adverse cardiovascular events (MACE) up to 25% compared to no treatment. Despite the high preva- lence (50%) of HTN, people with OUD are less likely to receive HTN treatment than those without OUD. This population is further susceptible to CVD due to high rates of tobacco use (90%). Thus, there is a public health imperative to reduce CVD risk among this population. People with OUD may face barriers accessing diagnosis and treatment of CVD risk factors like HTN. Primary care providers commonly manage CVD risk factors but may hold stigmatizing attitudes towards patients with OUD. Co-located CVD prevention is rare in addiction treatment settings. Therefore, perspectives from people with OUD and providers who manage CVD risk factors and OUD are needed to fill the gap in our understanding of the barriers and facilitators to preventing CVD among this population. State Medicaid programs, which cover 40% of people with OUD, use payment and health system delivery strategies such as Medicaid Health Homes to improve OUD treatment through care coordination and management for high-risk populations. Yet little is known how these strategies impact CVD among people with OUD. This proposal’s objective is to determine the extent to which CVD affects people with OUD and how patients, providers, and payers can prevent CVD. This project will utilize 2016-2024 Trans- formed Medicaid Statistical Information System Analytic Files data from 50 states to examine the relationship between CVD and OUD and to assess the impact of Health Homes on CVD risk reduction among people with OUD. To attain the proposal’s overall objective, the candidate will pursue the following aims: Aim 1 will examine the relationship between OUD and time to MACE. Aim 2 will determine barriers and facilitators to CVD preven- tion among people with OUD using qualitative methods. Aim 3 will examine HTN medication use among people with OUD across states with compared to without Health Home models. The research plan will be augmented with mentoring from an experienced team of health services researchers as well as coursework and experiential learning in advanced quasi-experimental methods, qualitative methods, and state-level addiction policy. To- gether, these research and career development plans will support the candidate’s long-term career goal of becoming an independent investigator and leader in addiction health services research to improve access to quality healthcare for people with SUDs through generating evidence that informs local and national policy reform.