Racial and Ethnic Inequities in Buprenorphine and Methadone Utilization Among Reproductive-Age Women with Opioid Use Disorder: an Analysis of Multi-state Medicaid Claims in the USA

Kevin Y. Xu, Davida M. Schiff, Hendrée E. Jones, Caitlin E. Martin, Jeannie C. Kelly, Laura J. Bierut, Ebony B. Carter, Richard A. Grucza

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Associations between race/ethnicity and medications to treat OUD (MOUD), buprenorphine and methadone, in reproductive-age women have not been thoroughly studied in multi-state samples. Objective: To evaluate racial/ethnic variation in buprenorphine and methadone receipt and retention in a multi-state U.S. sample of Medicaid-enrolled, reproductive-age women with opioid use disorder (OUD) at the beginning of OUD treatment. Design: Retrospective cohort study. Subjects: Reproductive-age (18–45 years) women with OUD, in the Merative™ MarketScan® Multi-State Medicaid Database (2011–2016). Main Measures: Differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, “other” race/ethnicity) in the likelihood of receiving buprenorphine and methadone during the start of OUD treatment (yes/no) were estimated using multivariable logistic regression. Differences in time to medication discontinuation (days) by race/ethnicity were evaluated using multivariable Cox regression. Results: Of 66,550 reproductive-age Medicaid enrollees with OUD (84.1% non-Hispanic White, 5.9% non-Hispanic Black, 1.0% Hispanic, 5.3% “other”), 15,313 (23.0%) received buprenorphine and 6290 (9.5%) methadone. Non-Hispanic Black enrollees were less likely to receive buprenorphine (adjusted odds ratio, aOR = 0.76 [0.68–0.84]) and more likely to be referred to methadone clinics (aOR = 1.78 [1.60–2.00]) compared to non-Hispanic White participants. Across both buprenorphine and methadone in unadjusted analyses, the median discontinuation time for non-Hispanic Black enrollees was 123 days compared to 132 days and 141 days for non-Hispanic White and Hispanic enrollees respectively (χ 2 = 10.6; P =.01). In adjusted analyses, non-Hispanic Black enrollees experienced greater discontinuation for buprenorphine and methadone (adjusted hazard ratio, aHR = 1.16 [1.08–1.24] and aHR = 1.16 [1.07–1.30] respectively) compared to non-Hispanic White peers. We did not observe differences in buprenorphine or methadone receipt or retention for Hispanic enrollees compared to the non-Hispanic White enrollees. Conclusions: Our data illustrate inequities between non-Hispanic Black and non-Hispanic White Medicaid enrollees with regard to buprenorphine and methadone utilization in the USA, consistent with literature on the racialized origins of methadone and buprenorphine treatment.

Original languageEnglish
Pages (from-to)3499-3508
Number of pages10
JournalJournal of general internal medicine
Volume38
Issue number16
DOIs
StatePublished - Dec 2023

Keywords

  • addiction medicine
  • buprenorphine
  • methadone
  • opioid use disorder
  • pregnancy
  • racial disparities

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