There may be racial and ethnic disparities in medication-assisted treatment (MAT) initiation for opioid use disorder, according to a study published in the Journal of the American Board of Family Medicine.
In this retrospective observational study, 23,372 individuals who consulted at 2 clinics in the Pacific Northwest were enrolled. All participants visited a primary care facility at least once during the study period (September 2015 to August 2017). MAT initiation for opioid use disorder was defined as a prescription of injectable naltrexone or buprenorphine which was recorded in an electronic health record.
Patient characteristics were extracted from the electronic health record and used as independent variables in logistic regression analyses, with 1 MAT order set as the dependent variable. As there was a low number of participants reporting a race/ethnicity other than non-Hispanic white, these patients were combined into a single subgroup.
A total of 1638 participants (7%) were diagnosed with opioid use disorder, 542 of whom (33%) had ≥1 MAT order. Participants with public vs commercial insurance had lower MAT initiation (Medicaid: adjusted odds ratio [AOR], 0.38; 95% CI, 0.26-0.57); Medicare, aOR, 0.31; 95% CI, 0.18-0.53; self-pay: aOR, 0.53; 95% CI, 0.34-0.83; P <.0001).
Patients aged ≥50 years (aOR 0.54; 95% CI, 0.38-0.77; P =.003), patients with diabetes (aOR 0.56; 95% CI, 0.35-0.89; P =.0135) or asthma/chronic obstructive pulmonary disease (aOR 0.70; 95% CI, 0.53-0.94; P =.0186), and participants reporting a race/ethnicity other than non-Hispanic white (aOR 0.95; 95% CI, 0.71-1.28; P =.7528), also had lower MAT initiation. MAT initiation was higher in patients with psychiatric diagnoses (aOR 1.62; 95% CI, 1.25-2.10; P =.0003) and current tobacco users (aOR 2.46; 95% CI, 1.95-3.12; P <.0001).
Study limitations include its cross-sectional design, the inability to assess the association between previous use of behavioral health care and subsequent MAT initiation, a potential underrepresentation of those with opioid use disorder, and a majority non-Hispanic white study population.
“The persistence of these [race/ethnicity and insurance] disparities is concerning from a health equity standpoint. Future research is needed to determine the etiology of these differences to inform policies, the design of MAT treatment models, and practice-based improvements in efforts to reach historically underserved populations,” concluded the study authors.
Cantone RE, Garvey B, O’Neill A, et al. Predictors of medication-assisted treatment initiation for opioid use disorder in an interdisciplinary primary care model. J Am Board Fam Med. 2019;32(5):724-731.