People With Disabilities Less Likely to Use Medications for Opioid Use Disorder

People with disabilities (PWD) covered by Medicaid insurance were less likely to use medication treatment for opioid use disorder (OUD) than people who did not have disabilities, according to study findings published in JAMA Network Open.

Researchers analyzed Washington State Medicaid claims data collected between 2016 and 2019 in this study. Treatments for OUD were evaluated on the basis of whether the patient had any disability.

The overall study population comprised 159,591 patients. The patients group included 53.1% women, 33.3% were aged 18 to 29 years, 72.8% were White, 61.4% had another nonopioid substance use disorder (SUD), and 15.5% had any disability. Compared with the general population, individuals with a disability were older, more were men, were White, had a mental health disorder, had another SUD, and enrolled in an urban area.

Among the disability cohort, 47.8% had a cognitive disability, 29.5% a physical disability, 26.5% a sensory disability, and 12.6% a developmental disability.

Medications for OUD (MOUD) were used by 54.7% of individuals without a disability compared with 38.1% of those with a disability. Stratified by MOUD type, those without a disability had higher usage rates of buprenorphine (27.3% vs 18.6%), methadone (21.8% vs 14.7%), and more than 1 type of MOUD (3.4% vs 2.7%), but not naltrexone (2.2% vs 2.2%) compared with the disability group, respectively.

Among PWD, MOUD use rates were highest among individuals with cognitive disabilities (42.9%) compared with sensory (34.2%), developmental (32.9%), or physical (31.1%) disabilities.

There were few differences in continued use of MOUD on the basis of disability status, in which only among individuals with 6 months or more of MOUD use, the rates were 50.0% and 46.3% among the nondisabled and disabled groups, respectively.

In the multivariate analyses, any disability was associated with a decreased likelihood of using MOUD (adjusted odds ratio [aOR], 0.60; 95% CI, 0.58-0.61; P <.001). Stratified by disability type, MOUD use was lower among individuals with developmental (aOR, 0.50; 95% CI, 0.46-0.55; P <.001), physical (aOR, 0.58; 95% CI, 0.55-0.61; P <.001), sensory (aOR, 0.61; 95% CI, 0.58-0.65; P <.001), and cognitive (aOR, 0.77; 95% CI, 0.74-0.80; P <.001) disabilities compared with individuals without that specific disability.

Continuity of MOUD use for 6 or more months was decreased among the disabled group compared with control individuals (aOR, 0.87; 95% CI, 0.82-0.93; P <.001) and for individuals with a physical (aOR, 0.85; 95% CI, 0.74-0.96; P =.009) or cognitive (aOR, 0.89; 95% CI, 0.82-0.97; P =.006) disability compared with individuals without that specific disability.

The study may have been limited as type of OUD was not included in the analysis.

Study authors concluded, “The findings of this case-control study suggest that PWD are at greater risk of OUD than persons without disability and have more risk of SUD and adverse consequences, but are less likely to use and maintain essential treatment for OUD. Addressing the MOUD initiation gap could reduce treatment inequities.”

This article originally appeared on Clinical Pain Advisor