Disability linked to treatment rates for opioid use disorder

Among Medicaid beneficiaries with opioid use disorder, those with a disability were less likely to receive medication treatment and to adhere to treatment for 6 months, according to findings published in JAMA Network Open.

“Medications to treat opioid use disorder are effective, yet underused,” Cindy Parks Thomas, PhD, a professor and associate dean for research at Brandeis University Heller Graduate School in Waltham, Massachusetts, and colleagues wrote. “Studies have revealed inequities in opioid use disorder treatment by race, ethnicity, gender and socioeconomic status, but only limited investigation regarding access to or quality of opioid use disorder treatment is specific to people with disabilities. People with disabilities account for 26% of the U.S. population, and health equity is a demonstrated concern, because people with disabilities experience barriers to health care overall.”

Thomas and colleagues analyzed outpatient, inpatient, pharmacy and residential Medicaid claims in Washington state from 2016 to 2019 to identify patients with opioid use disorder (OUD) who were eligible for full benefits for at least 12 consecutive months.

The researchers compared patients with disabilities — comprising physical, sensory, developmental and cognitive conditions — with patients who had no disabilities to evaluate differences in the use of buprenorphine, methadone or naltrexone for OUD.

Among 84,728 people with OUD across 159,591 person-years, there were 24,743 person-years (15.5%) among people with any disability. The most common disability was cognitive, accounting for 11,834 (47.8%) of the disability person-years. People with disabilities were more likely to be older and have a mental disorder compared with their counterparts.

Compared with people who did not have a disability, those who did were less likely to receive any medication for OUD (adjusted OR = 0.6; 95% CI, 0.58-0.61). Analyses by disability type revealed that people with a cognitive disability were most likely to use medication (aOR = 0.77; 95% CI, 0.74-0.8) and those with developmental disabilities were least likely to use medication (aOR = 0.5; 95% CI, 0.46-0.55) compared with patients who did not have a disability.

There was no difference in the prevalence of buprenorphine or methadone use between patients with and without disability. However, subgroup analyses revealed that those with a developmental disability were less likely to receive buprenorphine, the researchers said.

People with a disability were also less likely to use medication for more than 6 months compared with those who did not have a disability (aOR = 0.87; 95% CI, 0.82-0.93). Physical disability (aOR = 0.85; 95% CI, 0.74-0.96) and cognitive disability (aOR = 0.89; 95% CI, 0.82-0.97) were associated with lower likelihood of medication continuation compared with people without those disabilities.

“Addressing the medication for OUD initiation gap could reduce treatment inequities,” Thomas and colleagues wrote. “Several structural challenges exist that can be addressed by policy actions and practitioner and community education, including enforcement of ADA requirements, efforts to promote low-barrier care and education of practitioners and community members to mitigate the heightened stigma associated with having both a disability and OUD.”