Disparities in buprenorphine use persist years after approval
Though the 2002 approval of buprenorphine lead to an increase in the number of U.S. Medicaid enrollees receiving medication treatment for opioid use disorder, the rate at which treatment with these medications rose varied by county, race/ethnicity and income years later, researchers found.
“Increasing use of medication treatment for individuals with opioid use disorders with medications like methadone and buprenorphine is a critical piece of the nation’s response to the opioid crisis,” Bradley D. Stein, MD, PhD, from the RAND Corporation, and the department of psychiatry, University of Pittsburgh School of Medicine, told Healio Psychiatry.
“Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenorphine’s approval increased the number of Medicaid enrollees who received medication treatment in the years following FDA approval, or to what extent receipt of such treatment was equitable across communities,” he continued. “The more we know about this, the better we are able to take actions and make sure effective treatment for opioid use disorder is reaching the individuals who can benefit from it.”
Using Medicaid claims data from non-dually eligible adults with opioid use disorder enrolled in Medicaid between 2002 and2009, researchers assessed changes in methadone, buprenorphine and any other medication treatment use. The investigators also examined the link between treatment use and county-level indicators of poverty, race/ethnicity and urbanicity. They measured county-level aggregate counts of medication treatment by year (n = 7,760 county-years), then estimated count data models to determine links between treatment and county characteristics.
“The good news is that we found that from 2002 to 2009, there was a substantial increase in the number of adult Medicaid enrollees receiving medication treatment, with the bulk of the increase coming from individuals receiving buprenorphine,” Stein said. “However, we also learned that the increases in medication treatment were substantially lower in counties with populations that historically have been disadvantaged with respect to health care access and quality.”
Analysis showed that the number of Medicaid enrollees with opioid use disorders who received medication treatment rose 62% between 2002 and 2009, with the number of enrollees who received methadone increasing 20% and the remaining increase resulted from buprenorphine.
In 2002, when almost all people received methadone, urban counties had higher rates of medication therapy than rural counties (IRR = 9.54; P < .001), but there were no significant differences across counties by concentration of black race or poverty, whereas counties with higher concentrations of Hispanic residents in 2002 had higher rates of medication treatment regardless of poverty than those with a low concentration of Hispanic residents and poverty. By 2009, people in counties with a low percentage of black residents and a low poverty rate were significantly more likely to receive medication treatment than those living in all other types of counties.
Both in 2002 and 2009, urban county residents remained more likely to receive opioid use disorder treatment than residents from rural counties (IRR = 1.94; P < .01). Residents of counties with a low percentage of Hispanics and a low poverty rate were significantly more likely to receive medication treatment than residents from all other types of counties by 2009.
“It is critically important that efforts to increase access to medication treatment work to ensure that access is equitably distributed across society so that it reaches disadvantaged individuals who may be at higher risk of suffering from opioid use disorder,” Stein told Healio Psychiatry. – by Savannah Demko
Disclosure: This study was supported by The National Institute on Drug Abuse of the NIH.