Inequities in the treatment of opioid use disorder: A scoping review

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

“…50 While access to MOUD is better in New York, New York, than in much of the US, including for publicly insured populations, 51 barriers remain, including stigmatization of medication-based treatment, financial or insurance issues, program requirements, transportation, and patient dissatisfaction with treatment options. 52,53 This is reflected in national data that show low rates of MOUD treatment, particularly among the racial and ethnic minority and financially disadvantaged populations that are well represented in our study, [3][4][5]8,54 as well as suboptimal retention among those who do engage in treatment. 55 New approaches to community-based MOUD services, such as flexible, lowbarrier treatment programs 53 and robust patient navigation, 56 as well as improvements to the quality of care (eg, providing adequate medication dose), 57,58 may be needed to increase rates of MOUD following hospitalization.…”

“…The sample size after applying all eligibility criteria was smaller than anticipated in the original power calculations, which may have contributed to lack of precision in estimates of the intervention effect. Medicaid data do not capture many details of care provided in the hospital (eg, receipt of CATCH services or orders for MOUD), and administrative data sources have limited and frequently missing data about patient characteristics, including race and ethnicity, that can influence MOUD treatment . Discharge diagnosis codes may not capture all cases of OUD, although our prior analysis found that Medicaid claims had a 90% sensitivity for detecting OUD in the study hospitals .…”

“…Medicaid data do not capture many details of care provided in the hospital (eg, receipt of CATCH services or orders for MOUD), and administrative data sources have limited and frequently missing data about patient characteristics, including race and ethnicity, that can influence MOUD treatment. [3][4][5][6][7][8] Discharge diagnosis codes may not capture all cases of OUD, although our prior analysis found that Medicaid claims had a 90% sensitivity for detecting OUD in the study hospitals. 80 The study design called for analyzing outcomes at the hospital level; thus, our sample included patients in the intervention condition who may not have received CATCH services.…”

“…Opioid use disorder (OUD) can be treated with highly effective, lifesaving medications, but only an estimated 22% of people with OUD receive medication for OUD treatment (MOUD) . OUD treatment rates are low among racial and ethnic minority and socioeconomically disadvantaged populations, who are also disproportionately affected by the current overdose crisis . This treatment gap persists despite substantial federal, state, and local investments in expanding MOUD treatment access …”