(C-070) Racial and Ethnic Differences in Initiation and Continuation of Treatment Among Medicare Beneficiaries with Opioid Use Disorder from 2010-2019

Background: Early initiation and continuation of opioid use disorder (OUD) treatment are crucial for successful health outcomes, with duration of treatment generally recommended to last at least 6 months. Evidence on OUD treatment patterns among different racial and ethnic groups is limited in the Medicare population.

Objectives: To describe and compare real-world treatment trajectories of Medicare beneficiaries with OUD following first OUD diagnosis (index date) for the 6- and 9-month period after initial treatment assignment period, stratified by race/ethnicity.

Methods: This is a retrospective, longitudinal descriptive study of a national sample of fee-for-service Medicare beneficiaries with OUD from 2010–2019. Beneficiaries ages 18–86 years with an OUD diagnosis, continuously enrolled 6 months before and 3 months after the index date, were included. Beneficiaries were assigned to one of the following treatments in the 3-months post-index (i.e., treatment assignment period, marking initiation of treatment): 1) Behavioral therapy (BHV) only, 2) Buprenorphine with or without BHV (BUP±BHV), and 3) Naltrexone with or without BHV (NTX±BHV). Monthly treatment pathways, including disenrollment, were then summarized for the 6- and 9-month follow-up periods following the initial treatment assignment and visualized using Sankey diagrams.

Results: 542,380 beneficiaries initiating BHV and/or MOUD were included in this study. The majority of beneficiaries of all racial/ethnic groups initiated BHV only (89.8% White, 88.6% Black, 87.4% Hispanic). The proportion of the sample initiating MOUD was low, overall and across all racial/ethnic subgroups. Of the MOUDs, BUP+BHV initiation was the most frequent but differed by race/ethnicity: 3.5% White, 1.6% Black, and 2.6% Hispanic beneficiaries. Even fewer initiated NTX±BHV: 0.4% White, 0.3% Black, and 0.5% Hispanic. During both follow-up periods, the majority of beneficiaries continued on the same treatment they were assigned. Specifically, 45.2% White, 37.1% Black, and 43.4% Hispanic beneficiaries continued BUP±BHV treatment for 6 months, whereas only 39.4% White, 29.8% Black, and 32.5% Hispanic beneficiaries remained in treatment for at least 9 months. Among those initiating NTX±BHV, 19.6% White, 18.5% Black, and 15.1% Hispanic beneficiaries continued treatment for 6 months, while only 13.7%, 11.8%, and 10.9%, respectively, continued for 9 months. Similar trends were observed for BHV-only treatment without MOUD.

Conclusions: Disparities in the initiation and continuation of OUD treatments among Medicare beneficiaries highlight the need for targeted efforts to improve equitable access and continuity in evidence-based care for all, especially Black and Hispanic subgroups.