PMID- 34218991
OWN - NLM
STAT- MEDLINE
DCOM- 20220321
LR  - 20230202
IS  - 1873-6483 (Electronic)
IS  - 0740-5472 (Print)
IS  - 0740-5472 (Linking)
VI  - 133
DP  - 2022 Feb
TI  - Black clients in expansion states who used opioids were more likely to access 
      medication for opioid use disorder after ACA implementation.
PG  - 108533
LID - S0740-5472(21)00259-2 [pii]
LID - 10.1016/j.jsat.2021.108533 [doi]
AB  - INTRODUCTION: Black people in the United States who use opioids receive less 
      treatment and die from overdoses at higher rates than White people. Medication 
      for opioid use disorder (MOUD) decreases overdose risk. Implementation of the 
      Affordable Care Act (ACA) in the United States was associated with an increase in 
      MOUD. To what extent racial disparity exists in MOUD following ACA implementation 
      remains unclear. Using a national sample of people seeking treatment for opioids 
      (clients), we compared changes in MOUD after the ACA to determine whether 
      implementation was associated with increased MOUD for Black clients relative to 
      White clients. METHODS: We identified 878,110 first episodes for clients with 
      opioids as primary concern from SAMHDA's Treatment Episodes Dataset-Admissions 
      (TEDS-A; 2007-2018). We performed descriptive and logistic regression analyses to 
      estimate odds of MOUD for Black and White clients by Medicaid expansion status. 
      We interacted ACA implementation with racial group and performed subpopulation 
      analyses for Medicaid enrollees and criminal justice-referred clients. RESULTS: 
      In expansion states post-ACA, MOUD increased from 33.6% to 51.3% for White 
      clients and from 36.2% to 61.7% for Black clients. Pre-ACA, Black clients were 
      less likely than White clients to use MOUD (adjusted odds ratio (aOR) = 0.88, 
      99th Confidence Interval (CI) = [0.85, 0.91]), and post-ACA, the change in odds 
      of MOUD did not differ. Criminal justice-referred clients experienced less of a 
      change in odds of MOUD among Black clients than among White clients (aOR = 0.74, 
      CI = [0.62, 0.89]). Among Medicaid-insured clients, the change in odds of MOUD 
      among Black clients was larger (aOR = 1.16, CI = [1.03, 1.30]). In the 
      non-expansion states before 2014, Black clients were less likely to receive MOUD 
      (aOR = 0.86, CI = [0.77, 0.95]) than White clients. After 2014, the change in 
      odds of MOUD increased more for Black clients relative to White clients 
      (aOR = 1.24, CI = [1.07, 1.44]). We did not find significant changes in MOUD for 
      clients referred through the criminal justice system or with Medicaid. 
      CONCLUSION: The ACA was associated with increased use of MOUD among Black clients 
      and reduction in treatment disparity between Black and White clients. For 
      criminal justice-referred Black clients, disparities in MOUD persist. Black 
      clients with Medicaid in expansion states had the greatest reduction in 
      disparities.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Johnson, Natrina L
AU  - Johnson NL
AD  - Boston University School of Public Health, 715 Albany Street, Suite 116W, Boston, 
      MA 02118, United States of America. Electronic address: natrina@bu.edu.
FAU - Choi, Sugy
AU  - Choi S
AD  - Boston University School of Public Health, 715 Albany Street, Suite 116W, Boston, 
      MA 02118, United States of America. Electronic address: sugychoi@bu.edu.
FAU - Herrera, Carolina-Nicole
AU  - Herrera CN
AD  - Boston University School of Public Health, 715 Albany Street, Suite 116W, Boston, 
      MA 02118, United States of America. Electronic address: herrera1@bu.edu.
LA  - eng
GR  - T32 DA041898/DA/NIDA NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210611
PL  - United States
TA  - J Subst Abuse Treat
JT  - Journal of substance abuse treatment
JID - 8500909
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - *Analgesics, Opioid/therapeutic use
MH  - Criminal Law
MH  - Humans
MH  - Medicaid
MH  - *Opioid-Related Disorders/drug therapy
MH  - Patient Protection and Affordable Care Act
MH  - United States
PMC - PMC8664894
MID - NIHMS1720935
OTO - NOTNLM
OT  - Medicaid expansion
OT  - Medication for addiction treatment (MAT)
OT  - Policy evaluation
OT  - Race
OT  - Substance use disorder (SUD)
EDAT- 2021/07/06 06:00
MHDA- 2022/03/22 06:00
PMCR- 2023/02/01
CRDT- 2021/07/05 05:28
PHST- 2020/11/25 00:00 [received]
PHST- 2021/04/20 00:00 [revised]
PHST- 2021/06/08 00:00 [accepted]
PHST- 2021/07/06 06:00 [pubmed]
PHST- 2022/03/22 06:00 [medline]
PHST- 2021/07/05 05:28 [entrez]
PHST- 2023/02/01 00:00 [pmc-release]
AID - S0740-5472(21)00259-2 [pii]
AID - 10.1016/j.jsat.2021.108533 [doi]
PST - ppublish
SO  - J Subst Abuse Treat. 2022 Feb;133:108533. doi: 10.1016/j.jsat.2021.108533. Epub 
      2021 Jun 11.