OUD Treatment Inequities Identified for Medicaid Beneficiaries With Disabilities

Medicaid beneficiaries with disabilities were less likely than those without disabilities to receive and continue using medications for opioid use disorder (OUD), according to findings published in JAMA Network Open.

People with disabilities are at greater risk of developing OUD and other substance use disorders because they are more likely to experience acute and chronic pain, mental disorders, adverse social determinants of health, and other risk factors, said a team of researchers affiliated with Brandeis University. 

However, “only limited investigation regarding access to or quality of OUD treatment is specific to people with disabilities,” investigators said.

For their case-control study, researchers gathered Medicaid claims data from residential, outpatient, and inpatient care settings across the state of Washington. The data spanned 2016 through 2019 and represented beneficiaries aged 18 to 64 years who had OUD, received full benefits, were continuously eligible for 1 year, and were not dually enrolled in Medicare.

Patients were assigned disability status if their claims showed evidence of “physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities,” researchers said.

The study included 84,728 beneficiaries and represented 159,591 person-years in total. Researchers found evidence of a disability among 15.5% of the population (24,743 person-years).

Overall, people with disabilities were 40% less likely to receive medications for OUD, which included buprenorphine, methadone, or naltrexone (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58 to 0.61; P < .001). 

Disability status also impacted medication persistence, according to the findings. In the population that received medications, people with disabilities were 13% less likely than those without disabilities to continue treatment for 6 months (adjusted OR, 0.87; 95% CI, 0.82 to 0.93; P < .001).

When researchers analyzed differences by disability type, they found people with developmental disabilities were the population least likely to use any medications for OUD (AOR, 0.50; 95% CI, 0.46-0.55; P < .001).

“These differences cannot be explained clinically and highlight inequities in treatment,” researchers said. “Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among [people with disabilities]. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations.”

Reference:
Thomas CP, Stewart M, Ledingham E, Adams RS, Panas L, Reif S. Quality of opioid use disorder treatment for persons with and without disabling conditions. JAMA Netw Open. 2023;6(3):e232052. doi:10.1001/jamanetworkopen.2023.2052