Disparities in opioid abuse treatment increased among Medicaid recipients, shows research

The number of Medicaid recipients receiving medication to treat opioid abuse increased sharply in the years after approval of a new drug, but the increase was smaller in poorer countries and areas with larger populations of black and Hispanic residents, according to a new RAND Corporation study.

While it provides evidence that more people are receiving the medication treatment recommended for opioid use disorders, the findings suggest that work is needed to address racial and ethnic disparities that developed as treatment expanded, according to researchers.

Opioid use disorders affect an estimated 9 out of every 1,000 Americans and opioid overdose-related deaths have quadrupled over the past 15 years. Medication-assisted treatment using methadone or buprenorphine can effectively treat opioid addiction, and such care is considered the best option for people with opioid use disorders.

Just recently, the U.S. House of Representatives passed the SUPPORT for Patients and Communities Act, a massive legislation package that establishes and expands programs that boost detection and monitoring of fentanyl and other synthetic opioids, and increases the maximum number of patients that healthcare practitioners may initially treat with medication-assisted treatment. The bill also makes changes to the Medicare and Medicaid programs to facilitate treatment and prevention.

While methadone only can be dispensed in special clinics and commonly requires daily visits, the approval of buprenorphine in 2002 provided an alternative drug regime that can be prescribed by any specially certified physician.

In order to determine how much medication-assisted therapy had expanded, the researchers analyzed Medicaid claims from 14 states from 2002 to 2009 to measure use of methadone and buprenorphine at the county level. Medicaid disproportionately covers people at a higher risk for opioid use disorders and is the source of payment for more than one-third of all opioid addiction treatment episodes.

The researchers found that the number of Medicaid recipients who received medication-assisted treatment for opioid use disorders jumped by 62 percent during that time. While methadone accounted for most treatment episodes, use of buprenorphine surged after its approval to account for almost one-third of treatment episodes in 2009.

Historically, there have been few sociodemographic disparities in access to treatment for substance use disorders. The study found that after accounting for whether a county was urban or rural, use of medication therapy did not vary with a county's poverty rate or ethnic/racial makeup in 2002.

But by 2009, people who lived in counties with more poverty and higher percentages of blacks and Hispanics were significantly less likely to receive medication-assisted treatment for opioid use disorders.

It was also found that people who lived in urban counties were much more likely to receive medication-assisted treatment than people who lived in rural counties, although the difference grew smaller during the period in question.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com