More Americans are in addiction treatment, but there are gaps

July 27, 2021

Substantially more people in the U.S. with opioid use disorder are receiving evidence-based treatment for the disease, but there are still considerable gaps in care along racial lines, according a large analysis t of opioid use disorder among Medicaid recipients, as reported in a news release from UPMC.

The results, published in JAMA, provide insights that policymakers and medical providers can act on to improve access to quality care for opioid use disorder, one of the leading causes of death in the U.S.

The Medicaid Outcomes Distributed Research Network (MODRN) obtained de-identified, standardized data from 11 states, including six states that rank among the highest for opioid overdose deaths, accounting for 16.3 million people aged 12 through 64, or 22% of Medicaid’s enrollees. 

The prevalence of opioid use disorder increased from 3.3% of enrollees in 2014 to 5% in 2018. Notably, the share of enrollees with opioid use disorder enrolled in Medicaid due to the Affordable Care Act (ACA) expansion grew from 27.3% to 50.7% in the same time period.

“Medicaid plays an incredibly important role in our health system, and the population it serves overlaps with those most likely to have opioid use disorder. But Medicaid is 50-plus separate programs that can’t easily share data,” said co-author Julie Donohue, PhD, Chair and Professor of the University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management. “For the first time, we’ve pooled a large part of that data, enabling us to draw powerful conclusions that could better enable our country to address the opioid epidemic, which has only grown more intense during the COVID-19 pandemic.”

There are several medications — buprenorphine, methadone and naltrexone — to treat opioid use disorder. These medications work best when taken continuously, so the MODRN team looked at several indicators of quality of care, including at least one period of 180 days of continuous medication, at least one order for a urine drug test and at least one claim for behavioral health counseling. They also looked into whether people with opioid use disorder were being prescribed other controlled substances associated with increased risk of overdose, such as benzodiazepines, which would indicate a clinician hadn’t adequately reviewed their medical history.

The team found that Black enrollees were considerably less likely than White enrollees to be treated with medications for their opioid use disorder and were less likely to have continuity of such treatment. In contrast, pregnant women with opioid use disorder were far more likely than the average person with opioid use disorder to receive continuous medication-assisted treatment. This is likely because the women were actively engaged in care due to their pregnancy and motivated to continue treatment.

There was great variability across states in the quality measures of behavioral health counseling, urine testing and controlled substance prescribing. The MODRN team shared information with each state’s Medicaid managers.

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