The Influence of Vulnerability on the Treatment and Outcomes for Opioid Use Disorder Among People Who Present to the Emergency Department with an Opioid-Related Diagnosis

Objectives: Evaluate the relationship between vulnerability and opioid overdoses, along with access to treatment, in people who present to the emergency department (ED) with an opioid-related diagnosis.

Methods: We use administrative claims data from commercial and Medicare Advantage enrollees (OptumLabs® DataWarehouse) to evaluate the: a) differences in opioid overdose ED visits by race/ethnicity during the early, mid, and late COVID-19 pandemic compared to those predicted from pre-pandemic using Poisson models and a graphical analysis; b) associations between race and ethnicity and access to Medication for Opioid Use Disorder (MOUD) and behavioral health services using a multinomial logistic regression model; c) association between social vulnerability and MOUD retention using a logistic regression model with generalized estimating equations. We adjusted for pertinent covariates.

Results: During the early pandemic, non-Hispanic White and non-Hispanic Black enrollees had above-predicted opioid overdose ED visits. Post-early pandemic, non-Hispanic Black enrollees continued to have above-predicted or as-predicted visits and Hispanic enrollees had as-predicted visits, whereas non-Hispanic White enrollees had at or below-predicted visits, signaling disparities after access disruptions subsided. We also found that, non-Hispanic Black (vs non-Hispanic White) enrollees were 4.9, 0.5, and 0.4 percentage points less likely to receive MOUD with behavioral health services, MOUD without behavioral health services, and behavioral health services without MOUD, respectively, and that Hispanic (vs non-Hispanic White) enrollees were 0.3 less likely to receive MOUD without behavioral health services. Finally, we found that social vulnerability was significantly associated with 30-day buprenorphine treatment retention wherein people residing in more socially vulnerable ZIP code areas (vs less socially vulnerable ZIP code areas) were 6.6 percentage points less likely to have 30-day buprenorphine treatment retention.

Conclusion: Point-of-care, community, and policy interventions that support expanded access to treatment are needed to reduce opioid overdose disparities and save lives. Such interventions should be equity-centered, drawing on the lived experiences of people who use drugs.