TY - JOUR
AU - Lance Tippit
AU - M. A. O'Connell
AU - R. C. Costantino
AU - M. Scott-Richardson
AU - S. Peters
AU - J. Pakieser
AU - L. C. Tilley
AU - K. B. Highland
A1 - 
AB - BACKGROUND: Medication for opioid use disorder (MOUD) can be critical to managing opioid use disorder (OUD). It is unknown the extent to which US Military Health System (MHS) patients diagnosed with OUD receive MOUD. METHODS: Healthcare records of MHS-enrolled active duty and retired service members (N = 13,334) with a new (index) OUD diagnosis were included between 2018 and 2021, without 90-day pre-index MOUD receipt were included. Elastic net logistic and Cox regressions evaluated care- and system-level factors associated with 1-year MOUD receipt (primary outcome) and time-to-receipt. RESULTS: Only 9% of patients received MOUD 1-year post-index; only 4% received MOUD within 14 days. Black patients (OR for receipt 0.38, 95% CI 0.30-0.49), Latinx patients (OR for receipt 0.44, 95% CI 0.33-0.59), and patients whose race and ethnicity was Other (OR for receipt 0.52, 95%CI 0.35, 0.77) experienced lower MOUD access (all p < 0.001). Retirees were more likely to receive MOUD relative to active duty service members (OR for receipt 1.81, 95%CI 1.52, 2.16, p <0.001). CONCLUSIONS: Institutional racism in MOUD prescribing, combined with the overall low rates of MOUD receipt after OUD diagnosis, highlight the need for evidence-based, multifaceted, and multilevel approaches to OUD care in the Military Health System. Without clear Defense Health Agency policy, including the designation of responsible entities, transparent and ongoing evaluation and responsiveness using standardized methodology, and resourced programming and public health campaigns, MOUD rates will likely remain poor and inequitable.
AD - School of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD, USA.; Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Enterprise Intelligence & Data Solutions Program Management Office Data Innovation Branch, Defense Health Management Systems, USA; Henry M. Jackson Foundation, Inc., 11300 Rockville Pike Suite 709, Rockville, MD 20852, USA.; Enterprise Intelligence & Data Solutions Program Management Office Data Innovation Branch, Defense Health Management Systems, USA; Department of Military & Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.; Independent Researcher, MD, USA.; Department of Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.; Department of Emergency Medicine, University of California, Davis School of Medicine, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA.; Department of Military & Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.; Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. Electronic address: krista.highland@usuhs.edu.
AN - 38006670
BT - Drug Alcohol Depend
C5 - Opioids & Substance Use; Healthcare Disparities
DA - Dec 1
DO - 10.1016/j.drugalcdep.2023.111025
DP - NLM
ET - 20231110
JF - Drug Alcohol Depend
LA - eng
N2 - BACKGROUND: Medication for opioid use disorder (MOUD) can be critical to managing opioid use disorder (OUD). It is unknown the extent to which US Military Health System (MHS) patients diagnosed with OUD receive MOUD. METHODS: Healthcare records of MHS-enrolled active duty and retired service members (N = 13,334) with a new (index) OUD diagnosis were included between 2018 and 2021, without 90-day pre-index MOUD receipt were included. Elastic net logistic and Cox regressions evaluated care- and system-level factors associated with 1-year MOUD receipt (primary outcome) and time-to-receipt. RESULTS: Only 9% of patients received MOUD 1-year post-index; only 4% received MOUD within 14 days. Black patients (OR for receipt 0.38, 95% CI 0.30-0.49), Latinx patients (OR for receipt 0.44, 95% CI 0.33-0.59), and patients whose race and ethnicity was Other (OR for receipt 0.52, 95%CI 0.35, 0.77) experienced lower MOUD access (all p < 0.001). Retirees were more likely to receive MOUD relative to active duty service members (OR for receipt 1.81, 95%CI 1.52, 2.16, p <0.001). CONCLUSIONS: Institutional racism in MOUD prescribing, combined with the overall low rates of MOUD receipt after OUD diagnosis, highlight the need for evidence-based, multifaceted, and multilevel approaches to OUD care in the Military Health System. Without clear Defense Health Agency policy, including the designation of responsible entities, transparent and ongoing evaluation and responsiveness using standardized methodology, and resourced programming and public health campaigns, MOUD rates will likely remain poor and inequitable.
PY - 2023
SN - 0376-8716
SP - 111025
ST - Racialized and beneficiary inequities in medication to treat opioid use disorder receipt within the US Military Health System
T1 - Racialized and beneficiary inequities in medication to treat opioid use disorder receipt within the US Military Health System
T2 - Drug Alcohol Depend
TI - Racialized and beneficiary inequities in medication to treat opioid use disorder receipt within the US Military Health System
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.1016/j.drugalcdep.2023.111025
VL - 253
VO - 0376-8716
Y1 - 2023
ER -