Journal of general internal medicine · 2026
Racial and Ethnic Disparities in Buprenorphine and Naloxone among Medicaid Beneficiaries after Emergency Department Visits and Hospitalizations.
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Khidir Hazar, Nedelec Laurence, Sebok-Syer Stefanie S, Sabbatini Amber K, Shin Ikgyu, Melnick Edward R, Lin Michelle P
Аннотация
BACKGROUND: ED visits and hospitalizations for opioid use disorder (OUD) are key opportunities to prescribe buprenorphine and naloxone, and Medicaid is the dominant payer for individuals with OUD. Our objective was to examine racial and ethnic disparities in buprenorphine and naloxone receipt and buprenorphine retention after acute opioid-related encounters among Medicaid beneficiaries.
METHODS: Retrospective cohort study of beneficiaries aged 18-64 years in 19 states using 100% Medicaid 2016-2019 claims. Eligible encounters had a nonfatal emergency department, acute inpatient, or inpatient rehab/detox encounter for opioid overdose, withdrawal, or injection drug use-related infection. Primary outcomes were buprenorphine and naloxone prescription fills within 30 days. Secondary outcomes were fills within 3 days and buprenorphine retention (≥ 150 days' supply within 180 days). Hierarchical logistic regression adjusted for demographics, comorbidities, prior treatment, diagnosis, state, and year.
RESULTS: There were 234,944 events among 169,721 beneficiaries. Mean age was 37.48 years, 43.36% were female, 68.1% were White, 11.5% were Black, and 11.1% were Hispanic. Across all events, 14.08% filled buprenorphine and 3.78% filled naloxone within 30 days, and 4.62% were retained on buprenorphine at 180 days. Compared with non-Hispanic White patients, adjusted odds of 30-day buprenorphine fills were lower for Black (ED: aOR 0.79, 95% CI 0.71-0.88, inpatient: aOR 0.72, 0.63-0.83, rehab/detox: aOR 0.83, 0.71-0.97) and Hispanic patients (ED: aOR 0.80, 0.73-0.88, inpatient: aOR 0.83, 0.75-0.93). Buprenorphine retention was lower for Black (ED: aOR 0.64, 0.55-0.74, inpatient: aOR 0.51, 0.43-0.60, rehab/detox: OR a0.63, 0.48-0.82) and Hispanic (ED: aOR 0.70, 0.62-0.79, inpatient: aOR 0.66, 0.56-0.78) patients.
CONCLUSIONS: In this multi-state Medicaid cohort, Black and Hispanic beneficiaries had consistently lower buprenorphine receipt and retention across acute care settings. Improved transitional care and targeted Medicaid reforms may promote timely and equitable access to OUD treatment.
METHODS: Retrospective cohort study of beneficiaries aged 18-64 years in 19 states using 100% Medicaid 2016-2019 claims. Eligible encounters had a nonfatal emergency department, acute inpatient, or inpatient rehab/detox encounter for opioid overdose, withdrawal, or injection drug use-related infection. Primary outcomes were buprenorphine and naloxone prescription fills within 30 days. Secondary outcomes were fills within 3 days and buprenorphine retention (≥ 150 days' supply within 180 days). Hierarchical logistic regression adjusted for demographics, comorbidities, prior treatment, diagnosis, state, and year.
RESULTS: There were 234,944 events among 169,721 beneficiaries. Mean age was 37.48 years, 43.36% were female, 68.1% were White, 11.5% were Black, and 11.1% were Hispanic. Across all events, 14.08% filled buprenorphine and 3.78% filled naloxone within 30 days, and 4.62% were retained on buprenorphine at 180 days. Compared with non-Hispanic White patients, adjusted odds of 30-day buprenorphine fills were lower for Black (ED: aOR 0.79, 95% CI 0.71-0.88, inpatient: aOR 0.72, 0.63-0.83, rehab/detox: aOR 0.83, 0.71-0.97) and Hispanic patients (ED: aOR 0.80, 0.73-0.88, inpatient: aOR 0.83, 0.75-0.93). Buprenorphine retention was lower for Black (ED: aOR 0.64, 0.55-0.74, inpatient: aOR 0.51, 0.43-0.60, rehab/detox: OR a0.63, 0.48-0.82) and Hispanic (ED: aOR 0.70, 0.62-0.79, inpatient: aOR 0.66, 0.56-0.78) patients.
CONCLUSIONS: In this multi-state Medicaid cohort, Black and Hispanic beneficiaries had consistently lower buprenorphine receipt and retention across acute care settings. Improved transitional care and targeted Medicaid reforms may promote timely and equitable access to OUD treatment.