Background:Early initiation and continuation of opioid use disorder (OUD) treatment, ideally for at least 6 months, are crucial for positive outcomes. However, longitudinal treatment patterns are not well understood, and whether racial/ethnic differences in treatment utilization exist is unclear. This study examines these patterns among Medicare beneficiaries.

Methods:This is a retrospective, longitudinal descriptive study of a national sample of fee-for-service Medicare beneficiaries with OUD from 2010–2019. Beneficiaries age 18–86 years with an OUD diagnosis (index date), continuously enrolled 6 months before and 3 months after the index date, were included. Beneficiaries were assigned to one of the following treatments in the 3-months post-index (i.e., treatment assignment period, marking treatment initiation): 1) Behavioral therapy (BHV) only; 2) Buprenorphine with or without BHV (BUP±BHV); 3) Naltrexone with or without BHV (NTX±BHV); and 4) No treatment. Monthly treatment pathways were then summarized for the 6- and 9-month follow-up periods following the initial treatment assignment and visualized using Sankey diagrams.

Results:Among 542,380 beneficiaries, most initiated BHV-only treatment (89.8% White, 88.6% Black, 87.4% Hispanic). No treatment initiation was more common among Black and Hispanic beneficiaries(9.5% each) than White beneficiaries(6.3%). BUP±BHV was initiated more frequently than NTX±BHV:3.5% White, 1.6% Black, and 2.6% Hispanic for BUP±BHV, versus 0.4% White, 0.3% Black, and 0.5% Hispanic for NTX±BHV. For BUP±BHV, continuation percentages were 45.2%, 37.1%, and 43.4% at 6 months, and 39.4%, 29.8%, and 32.5% at 9 months for White, Black, and Hispanic beneficiaries, respectively. NTX±BHV had lower continuation percentages across groups: 19.6%, 18.5%, and 15.1% at 6 months, and 13.7%, 11.8%, and 10.9% at 9 months. Similar trends were observed for BHV-only.

Conclusions:Use of BUP±BHV and NTX±BHV was low across all groups, with Black and Hispanic beneficiaries showing lower treatment initiation and continuation. Targeted efforts are needed to improve access to evidence-based OUD care for all racial/ethnic groups.