Co-occurring psychiatric disorders and disparities in buprenorphine utilization in opioid use disorder: An analysis of insurance claims

Kevin Y Xu; Vivien Huang; Arthur Robin Williams; Caitlin E Martin; Alexander R Bazazi; Richard A Grucza

doi:10.1016/j.dadr.2023.100195

Co-occurring psychiatric disorders and disparities in buprenorphine utilization in opioid use disorder: An analysis of insurance claims

Drug Alcohol Depend Rep. 2023 Oct 20:9:100195. doi: 10.1016/j.dadr.2023.100195. eCollection 2023 Dec.

Authors

Kevin Y Xu¹, Vivien Huang¹, Arthur Robin Williams^{2

3}, Caitlin E Martin⁴, Alexander R Bazazi⁵, Richard A Grucza^{6

7}

Affiliations

¹ Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
² Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, USA.
³ Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA.
⁴ Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
⁵ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
⁶ Department of Family and Community Medicine, St. Louis University, St. Louis, Missouri, USA.
⁷ Department of Health and Clinical Outcomes Research, St. Louis University, St Louis, Missouri, USA.

Abstract

Background: As the overdose crisis continues in the U.S. and Canada, opioid use disorder (OUD) treatment outcomes for people with co-occurring psychiatric disorders are not well characterized. Our objective was to examine the influence of co-occurring psychiatric disorders on buprenorphine initiation and discontinuation.

Methods: This retrospective cohort study used multi-state administrative claims data in the U.S. to evaluate rates of buprenorphine initiation (relative to psychosocial treatment without medication) in a cohort of 236,198 people with OUD entering treatment, both with and without co-occurring psychiatric disorders, grouping by psychiatric disorder subtype (mood, psychotic, and anxiety-and-related disorders). Among people initiating buprenorphine, we assessed the influence of co-occurring psychiatric disorders on buprenorphine retention. We used multivariable Poisson regression to estimate buprenorphine initiation and Cox regression to estimate time to discontinuation, adjusting for all 3 classes of co-occurring disorders simultaneously and adjusting for baseline demographic and clinical characteristics.

Results: Buprenorphine initiation occurred in 29.3 % of those with co-occurring anxiety-and-related disorders, compared to 25.9 % and 17.5 % in people with mood and psychotic disorders. Mood (adjusted-risk-ratio[aRR] = 0.82[95 % CI = 0.82-0.83]) and psychotic disorders (aRR = 0.95[0.94-0.96]) were associated with decreased initiation (versus psychosocial treatment), in contrast to greater initiation in the anxiety disorders cohort (aRR = 1.06[1.05-1.06]). We observed an increase in buprenorphine discontinuation associated with mood (adjusted-hazard-ratio[aHR] = 1.20[1.17-1.24]) and anxiety disorders (aHR = 1.12[1.09-1.14]), in contrast to no association between psychotic disorders and buprenorphine discontinuation.

Conclusions: We observed underutilization of buprenorphine among people with co-occurring mood and psychotic disorders, as well as high buprenorphine discontinuation across anxiety, mood, and psychotic disorders.

Keywords: Buprenorphine; Co-occurring disorders; Insurance claims; Opioid use disorders; Psychiatric disorders; Psychosis; Treatment retention.

Abstract

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