TY - JOUR
KW - Adolescent
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Continental Population Groups
KW - Diagnosis, Dual (Psychiatry)/trends
KW - Ethnic Groups
KW - Female
KW - Forecasting
KW - Humans
KW - Male
KW - Medicaid/trends
KW - Mental Disorders/diagnosis/drug therapy/ethnology
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Opiate Substitution Treatment/methods/trends
KW - Opioid-Related Disorders/diagnosis/drug therapy/ethnology
KW - Sex Factors
KW - United States/epidemiology
KW - Young Adult
KW - Health Disparities
KW - Health Policy
KW - medication-assisted treatment
KW - Mental Health
KW - opioid use disorder
AU - G. Pro
AU - J. Utter
AU - S. Haberstroh
AU - J. A. Baldwin
A1 - 
AB - 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.
AD - Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: george.pro@nau.edu.; University of Colorado, Department of Family Medicine, Colorado University Anschutz, 12631 East 17th Avenue, Aurora, CO, 80045, USA. Electronic address: jeffrey.utter@ucdenver.edu.; Northern Arizona University, Department of Educational Psychology, 801 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: shane.haberstroh@nau.edu.; Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA. Electronic address: julie.baldwin@nau.edu.
BT - Drug and alcohol dependence
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Healthcare Policy; Opioids & Substance Use
DO - 10.1016/j.drugalcdep.2020.107952
JF - Drug and alcohol dependence
LA - eng
M1 - Journal Article
N2 - 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.
PY - 2020
SN - 1879-0046; 0376-8716; 0376-8716
SP - 107952
T1 - Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year
T2 - Drug and alcohol dependence
TI - Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Healthcare Policy; Opioids & Substance Use
U2 - 32172130
U3 - 10.1016/j.drugalcdep.2020.107952
VL - 209
VO - 1879-0046; 0376-8716; 0376-8716
Y1 - 2020
Y2 - Apr 1
ER -