OUD Treatment Disparities Persisted for Reproductive-Age Women

SAN FRANCISCO -- Black women of reproductive age received different medication for opioid use disorder (OUD) than white women and were more likely to discontinue treatment, Medicaid data showed.

Black women were less likely to start buprenorphine (adjusted OR 0.77, 95% CI 0.70-0.85) and more likely to start methadone (aOR 1.76, 95% CI 1.58-1.96) than white women, reported Kevin Young Xu, MD, MPH, of Washington University in St. Louis, Missouri, during a poster session at the American Psychiatric Association annual meeting.

Black women also were more likely to discontinue buprenorphine (aHR 1.16, 95% CI 1.08-1.25) and methadone (aHR 1.17, 95% CI 1.09-1.26) than white women, Xu reported.

In the overall sample of 65,556 reproductive-age females with OUD enrolled in Medicaid from 2006 to 2016, 23.6% had started buprenorphine treatment, 9.8% had started methadone, and 68.9% had started psychosocial treatment without medication OUD treatment.

"We're no longer concerned too much about whether buprenorphine and methadone work. I think that question has been settled," Xu told MedPage Today. "We're dealing really with more of a real-world effectiveness question than a scientific efficacy question in that people don't end up getting it."

"There are problems with access, problems with insurance coverage, problems with health care systems permitting patients to stay on it," Xu added. "And it's not helping with regards to this current polysubstance overdose crisis that is going on."

Race or ethnicity accounted for less than 3% of the total variance in treatment disparity, suggesting the problem may exist in the systems around these patients, Xu noted. Disparities are complex and may require re-examinations of several factors including individual patient care, provider bias, and reviews of community, state, and federal systems, he added.

"In essence, this data that we're looking at is trying to understand who's getting buprenorphine and who's getting methadone. We've kind of suspected for a very long time that there are racial inequities," Xu said. "This really intersects with the issue of structural racism."

The data should encourage medical educators and clinicians to reconsider the assumption that treatments work based solely on clinical trial data, because real-world data show it is more complicated, he added.

"We're actually looking at real insurance claims ... and we're not seeing such equivalence in terms of these drugs when they're used in the real world," he said. "There's actually really flagrant disparities going on."

Xu and colleagues used IBM MarketScan Medicaid databases from 2006 to 2016 to identify women with OUD, ages 18-45, who initiated OUD treatment. They defined OUD using ICD diagnosis and procedure codes.

Participants had a mean age of 31. Most (84%) were white; about 3% were pregnant when treatment started.

The study had several limitations, the researchers acknowledged. It lacked detailed geographic data to differentiate between interstate Medicaid policies and did not include data after 2016.

While the study could not identify reasons for disparities, showing OUD treatment differences is key, Xu noted. "It's really the first step in terms of advocating with government officials and policymakers that this is really inequitable," he said.

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