George Pro1, Jeff Utter2, Shane Haberstroh3, Julie A Baldwin4. 1. Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: george.pro@nau.edu. 2. University of Colorado, Department of Family Medicine, Colorado University Anschutz, 12631 East 17th Avenue, Aurora, CO, 80045, USA. Electronic address: jeffrey.utter@ucdenver.edu. 3. Northern Arizona University, Department of Educational Psychology, 801 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: shane.haberstroh@nau.edu. 4. Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: julie.baldwin@nau.edu.
Abstract
BACKGROUND: Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. METHODS: MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders. RESULTS: Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001). CONCLUSION: Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients. Published by Elsevier B.V.
BACKGROUND: Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. METHODS:MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders. RESULTS: Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001). CONCLUSION: Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients. Published by Elsevier B.V.
Entities:
Keywords:
Health disparities; Health policy; Medication-assisted treatment; Mental health; Opioid use disorder
Authors: Cynthia I Campbell; Amber L Bahorik; Paul VanVeldhuisen; Constance Weisner; Andrea L Rubinstein; G Thomas Ray Journal: Prev Med Date: 2018-02-02 Impact factor: 4.018