{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:51:55Z","timestamp":1788929515936,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["R01DE033322"],"award-info":[{"award-number":["R01DE033322"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Comparative effectiveness research studies commonly restrict cohorts to individuals who initiate a medication and do not have evidence of prior treatment. This is particularly challenging in research on medications for opioid use disorder (MOUD) because of sporadic use or intermittent adherence. We examined the impact of different lookback windows and washout criteria to identify MOUD initiator cohorts on sample size, cohort characteristics, and misclassification of treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting<\/jats:title>\n                    <jats:p>Cohort study using the Merative\u2122 MarketScan\u00ae Multi\u2010State Medicaid Database (2011\u20132022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Medicaid\u2010insured adults aged 18\u201364 with an MOUD prescription from 01\/01\/2022 to 12\/31\/2022 and a history of opioid use disorder (OUD) with at least 3\u2009months of continuous enrollment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We created treatment initiator cohorts with increasingly restrictive lookback windows for inclusion (6\u2010, 12\u2010, 24\u2010, 36\u2010months, all\u2010available). During each lookback window, we required [1] continuous enrollment; [2] continuous enrollment and OUD diagnosis; or [3] continuous enrollment, OUD diagnosis, and no prior treatment with MOUD. We defined prior treatment with MOUD as: (a)\u2009\u2265\u200930\u2009days use (less restrictive definition; allowed for some prior treatment); or (b)\u2009\u2265\u00a01\u00a0day use (more restrictive definition; did not allow prior treatment). We quantified changes in cohort sample size, demographic characteristics, and proportion of prevalent use episodes misclassified as MOUD treatment initiation (gold standard: 36\u2010month lookback window).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We identified 103\u2009794 eligible MOUD initiators (64.8% buprenorphine, 24.8% methadone, 10.4% naltrexone). Sample size of the cohorts decreased with increasingly restrictive lookback windows and washout criteria: [1] continuous enrollment (range, 96.9% for 6\u00a0months to 51.8% for 36\u2009months); [2] continuous enrollment and less restrictive washout (range, 29.7% to 8.4%); and [3] continuous enrollment and more restrictive washout (range, 22.2% to 5.8%). All\u2010available lookback performed similarly to a 12\u2010month lookback. Longer lookback windows resulted in initiator cohorts with a greater proportion of individuals who were older, female, and of a minoritized race\/ethnicity. The proportion of people with prevalent MOUD use misclassified as treatment initiation increased steadily with decreasing duration of lookback windows (24\u2010, 12\u2010, and 6\u2010month); we observed misclassification among 16.1% to 49.2% of individuals (less restrictive washout), and 16.8% to 53.2% of individuals (more restrictive washout).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The choice of lookback window duration and washout criteria in research on medications for opioid use disorder (MOUD) presents tradeoffs between cohort sample size, demographic characteristics, and misclassification of treatment initiation. This study offers practical guidance for researchers planning to perform comparative studies in MOUD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70288","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T05:25:17Z","timestamp":1765776317000},"page":"998-1007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of study design decisions on identification of treatment initiators of medications for opioid use disorder"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8177-2058","authenticated-orcid":false,"given":"Payel J.","family":"Roy","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine University of Pittsburgh  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Colvin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelin B.","family":"Nickel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2049-6918","authenticated-orcid":false,"given":"Rachael K.","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health Columbia University  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Durkin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie J.","family":"Suda","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine University of Pittsburgh  Pittsburgh PA USA"},{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis MO USA"},{"name":"Department of Surgery, Division of Public Health Sciences Washington University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Centers for Disease Control and Prevention. Drug overdose deaths. Drug Overdose.2023. Accessed December 16 2023. Available from:https:\/\/www.cdc.gov\/drugoverdose\/deaths\/index.html#:~:text=Opioids\u2014mainlysynthetic opioids (other of all drug overdose deaths)."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.8012"},{"key":"e_1_2_9_4_1","unstructured":"National Institute on Drug Abuse.Overdose death rates 2019. Accessed March 3 2019. 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Accessed December 12 2024. Available from:https:\/\/www.kff.org\/womens-health-policy\/issue-brief\/medicaid-coverage-for-women\/"},{"key":"e_1_2_9_30_1","unstructured":"HillL ArtigaS DamicoA.Health coverage by race and ethnicity 2010\u20132022. Racial Equity and Health Policy. 2024. Accessed December 12 2024. 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