Inequities in Opioid Addiction Treatment Persist for Women of Childbearing Age

According to Medicaid data, Black women of reproductive age were more likely to stop receiving treatment for opioid use disorder (OUD) than white women.

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

According to Xu, black women were also more likely than white women to stop taking methadone (aHR 1.17, 95% CI 1.09-1.26) and buprenorphine (aHR 1.16, 95% CI 1.08-1.25).

From 2006 to 2016, a total of 65,556 females of reproductive age with OUD who were enrolled in Medicaid had begun buprenorphine treatment, methadone treatment, or psychosocial treatment without medication.

“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 represented under 3% of the complete fluctuation in treatment disparity, recommending the issue might exist in the systems around these patients, Xu noted. He added that disparities are complicated and may necessitate reexamining a number of factors, such as individual patient care, provider bias, and reviews of community, state, and federal systems.

“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.”

He added that the data should encourage medical educators and clinicians to reevaluate the assumption that treatments work solely on the basis of data from clinical trials because real-world data demonstrate that it is more complex.

“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 associates utilized IBM MarketScan Medicaid databases from 2006 to 2016 to recognize women with OUD, ages 18-45, who started OUD treatment. They defined OUD using ICD diagnosis and procedure codes.

The mean age of the participants was 31. The majority, or 84 percent, were white; When treatment began, approximately 3% were pregnant.

The review had a few limitations, the specialists recognized. It did not include data after 2016 and lacked detailed geographic data to distinguish between interstate Medicaid policies.

Despite the fact that the study was unable to pinpoint the causes of disparities, Xu noted that demonstrating differences in OUD treatment is crucial. He stated, “It’s really the first step in terms of advocating with government officials and policymakers that this is really inequitable.”