Source: National Institute of Drug Abuse.

Use of medication for opioid use disorder increased among Medicaid enrollees between 2014-2018, according to a new study published in JAMA.

The Medicaid Outcomes Distributed Research Network (MODRN) conducted this new research. MODRN authors include Dr. Anna Austin, Core Faculty at the UNC Injury Prevention Research Center (IPRC) and Assistant Professor in the Department of Maternal and Child Health at UNC Gillings School of Global Public Health, and Dr. Paul Lanier, Core Faculty at UNC IRPC and Associate Professor in the UNC School of Social Work.

The authors used an exploratory serial cross-sectional design to study Medicaid enrollee data from 11 states. For each person-year of data for enrollees with opioid use disorder (OUD), they constructed an indicator of receipt of any medications for OUD. The authors used generalized estimating equations to estimate associations between enrollee characteristics and the outcome variables for each state. They then conducted random effects meta-analyses to pool the 11 state-specific estimates of individual parameters into global estimates.

In terms of demographics, they found that 41.7% of Medicaid enrollees with OUD were aged 21-34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders.

Prevalence of OUD increased in the 11 states from 3.3% in 2014 to 5.0% in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 to 57.1% in 2018. Use of buprenorphine and naltrexone led to the overall increase in medications for OUD; the share of enrollees diagnosed with OUD receiving methadone decreased during this time. Many factors may have led to these results, including states broadening Medicaid coverage for OUD treatment and loosening restrictions on medications for OUD. In addition, the increase of Medicaid enrollees with OUD may have been due to Medicaid expansion in eight of the 11 states.

Still, 43% of Medicaid enrollees diagnosed with OUD did not receive medication treatment. In addition, non-Hispanic Black enrollees had substantially lower rates of any medications for OUD compared with White enrollees. These inequities found in medication treatment for Medicaid enrollees with OUD warrant future research.

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