Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention

Background: Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State’s publicly-funded substance use specialty treatment system through a “Medication First” approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri’s overdose crisis, examines whether improvements were experienced equally among Black and White clients. Methods: This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions. Results: White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients. Conclusion: In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.