Journal of studies on alcohol and drugs · 2026
Treatment Pathways for Opioid Use Disorder in Commercially-Insured United States Adults from 2010-2019.
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Saini Jannat, Qato Danya M, Rizk John G, DiPaula Bethany, Ehret Megan, Pathan Uzma, Johnson Abree
Аннотация
INTRODUCTION: Longitudinal data on real-world treatment patterns for opioid use disorder (OUD) is limited. We aimed to identify and characterize granular pathways of OUD treatment.
METHODS: We utilized a retrospective observational cohort design using United States IBM® MarketScan® claims data from 2010-2019. The index date was the date of the first OUD diagnosis in the study period. We included commercially-insured beneficiaries, aged 18-85 years with OUD and continuous insurance eligibility for at least 6 months before (baseline period) and 3 months after (follow-up period) the index date. Independent measures were sociodemographics, clinical comorbidities, and health services utilization characteristics captured in the baseline period. Patients were categorized into one of 8 mutually exclusive categories during follow-up (dependent measures): behavioral treatment only, buprenorphine with or without behavioral treatment, methadone with or without behavioral treatment, naltrexone with or without behavioral treatment, other treatment combinations, and no treatment.
RESULTS: Of the 372,614 beneficiaries with OUD, 47% were women, with a mean age of 43 years (SD: 15.7). The predominant treatment category was behavioral treatment only (n=261,888; 70.3%), followed by buprenorphine and behavioral treatment (n=52,697; 14.1%). Nearly 10% had no evidence of treatment (n=35,322). Baseline mental health diagnosis was associated with significantly lower adjusted odds of no treatment (aOR: 0.53; 95% CI: 0.52, 0.55), behavioral treatment only (0.88; 0.86, 0.90), buprenorphine only (0.51; 0.49, 0.54), methadone with or without behavioral treatment (0.44; 0.40, 0.50), and naltrexone only (0.76; 0.67, 0.85) compared to buprenorphine and behavioral treatment. Chronic non-cancer pain was associated with significantly lower odds of all treatment categories, except behavioral treatment only, versus buprenorphine and behavioral treatment.
CONCLUSIONS: Each OUD treatment pathway demonstrated unique characteristics, underscoring the importance of addressing the totality of care needs of OUD patients to optimize treatment and outcomes.
METHODS: We utilized a retrospective observational cohort design using United States IBM® MarketScan® claims data from 2010-2019. The index date was the date of the first OUD diagnosis in the study period. We included commercially-insured beneficiaries, aged 18-85 years with OUD and continuous insurance eligibility for at least 6 months before (baseline period) and 3 months after (follow-up period) the index date. Independent measures were sociodemographics, clinical comorbidities, and health services utilization characteristics captured in the baseline period. Patients were categorized into one of 8 mutually exclusive categories during follow-up (dependent measures): behavioral treatment only, buprenorphine with or without behavioral treatment, methadone with or without behavioral treatment, naltrexone with or without behavioral treatment, other treatment combinations, and no treatment.
RESULTS: Of the 372,614 beneficiaries with OUD, 47% were women, with a mean age of 43 years (SD: 15.7). The predominant treatment category was behavioral treatment only (n=261,888; 70.3%), followed by buprenorphine and behavioral treatment (n=52,697; 14.1%). Nearly 10% had no evidence of treatment (n=35,322). Baseline mental health diagnosis was associated with significantly lower adjusted odds of no treatment (aOR: 0.53; 95% CI: 0.52, 0.55), behavioral treatment only (0.88; 0.86, 0.90), buprenorphine only (0.51; 0.49, 0.54), methadone with or without behavioral treatment (0.44; 0.40, 0.50), and naltrexone only (0.76; 0.67, 0.85) compared to buprenorphine and behavioral treatment. Chronic non-cancer pain was associated with significantly lower odds of all treatment categories, except behavioral treatment only, versus buprenorphine and behavioral treatment.
CONCLUSIONS: Each OUD treatment pathway demonstrated unique characteristics, underscoring the importance of addressing the totality of care needs of OUD patients to optimize treatment and outcomes.