June 8, 2021
Alex Gertner, PhD, an alumnus of the UNC Gillings School of Global Health, received an Annual Award from AcademyHealth for research into the use of effective treatments for opioid use disorder (OUD) in Medicaid beneficiaries. His research provides evidence for increasing access to and improving the quality of treatment of OUD with buprenorphine under Medicaid.
“Deaths from opioid overdoses continue to devastate communities across the country, but it doesn’t have to be this way,” said Gertner. “Medication treatment for opioid addiction is safe and effective although it remains underused. My dissertation examined access and quality of medication treatment in Medicaid, the country’s largest payer of addiction treatment.”
Drug overdose in the USA is a public health issue of epidemic proportions, and treatment of OUD, which underlies much of this harm, lags far behind. This is especially true for Medicaid enrollees, who die from overdose at a rate several times higher than the general population. Gertner’s research responds to and reinforces the need for further investigation of access to and quality of treatments for OUD in Medicaid.
Treatment with such medications as buprenorphine and methadone, or opioid agonist treatment (OAT), has the strongest evidence of reducing mortality from overdose related to OUD. However, these medications are used at a rate far lower than this evidence would suggest.
Gertner won the Outstanding Dissertation Award for “Quality and Access of Buprenorphine Treatment for Opioid Use Disorder in Medicaid,” which examines three issues related to buprenorphine treatment for OAT in Medicaid: access, quality of care and treatment retention.
In the first chapter, Gertner presents an analysis of national data to determine whether the expansion of Medicaid under the Affordable Care Act led to an increase in the use of OAT and whether the number of providers offering OAT played a role. Next, he used data from North Carolina Medicaid to explore the effects of increased access to buprenorphine treatment on quality of care. In the final chapter, he sought to understand factors related to treatment retention through an analysis of Medicaid claims in N.C. and interviews with prescribers of buprenorphine.
His findings suggest that increasing health coverage alone is not sufficient to increase use of OAT for OUD, and a lack of provider capacity likely plays a role. These results also call into question the effectiveness of requirements for a special waiver from the US Drug Enforcement Agency to dispense buprenorphine.
Marisa Domino, PhD, professor and director of the Doctor of Philosophy degree program for the School’s Department of Health Policy and Management (HPM), was Gertner’s dissertation advisor, and Pam Silberman, JD, DrPH ‘97, professor and director of the executive doctoral program in health leadership in HPM, who served on his dissertation committee, nominated him for the award.
Gertner received a Doctor of Philosophy degree from the School’s Department of Health Policy and Management (HPM) in 2020 and is a fourth-year medical student at UNC. His dissertation research, which was also published in Health Services Research and Health Affairs, was recognized by UNC’s Graduate School, which awarded Gertner the 2021 Dean’s Distinguished Dissertation Award in social sciences. This award recognizes exceptional dissertations from doctoral candidates or recent doctoral graduates. In his current research, he’s using multiple methods to evaluate policies and practices that affect mental health and addiction outcomes.
AcademyHealth — which is a professional organization for health services researchers, health policy analysts and health practitioners — issues Annual Awards to recognize people and projects that have made “significant contributions to the fields of health services research and health policy.” Gertner is one of four awardees, and the organization also bestows awards for distinguished career, emerging leader and publication of the year. The awardees will be honored at AcademyHealth’s 2021 virtual Annual Research Meeting on June 15.
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