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Opioid Use Disorder, Pharmacotherapy, and Overdose Among Medicare Disability Beneficiaries From 2008 to 2021
Peter Treitler1, Jennifer Miles2, Elizabeth M Stone2
1Boston University School of Social Work, Boston, Massachusetts.
Introduction:
Medicare disability beneficiaries have high rates of opioid use disorder and overdose. This study aimed to examine trends in opioid-related outcomes in this population from 2008 to 2021, a period of substantial changes in the epidemiologic and opioid policy landscape.
Methods:
This repeated cross-sectional study used a 20% random sample of U.S. Medicare claims data. Joinpoint regressions estimated trends in opioid use disorder, pharmacotherapy receipt, and nonfatal opioid overdose. Analyses were stratified by race and ethnicity and comorbid substance use disorders. Analyses were completed in 2025.
Results:
Of 29,178,648 person-years of observation, opioid use disorder was observed in 4.2% of person-years, of which 21.2% received medication for opioid use disorder. Opioid use disorder prevalence increased from 2008 to 2016 (annual percentage change=16.4, 95% CI=15.0, 17.9) and remained stable thereafter. Receipt of medication for opioid use disorder was flat from 2008 to 2016 but then increased by an annual percentage change of 22.1 (95% CI=18.8, 27.7), remaining lower among Black (11.4%) and Hispanic (18.3%) than White beneficiaries (23.0%). Overdoses among beneficiaries with opioid use disorder declined starting in 2011 (annual percentage change= -6.2, 95% CI= -9.5, -5.5). Overdoses were highest among White beneficiaries from 2008 to 2015 (6.5%) but declined rapidly, with overdose rates for Black (3.7%) and Hispanic (3.7%) beneficiaries surpassing those for White beneficiaries (3.3%) by 2021.
Conclusions:
Between 2008 and 2021, opioid overdoses decreased, and pharmacotherapy receipt increased among Medicare disability beneficiaries, although trends diverged by race/ethnicity and comorbid substance use disorders. Improvements in outcomes in this population likely reflect a combination of changes in the overall opioid landscape during this period and the adoption of Medicare-specific policies aimed at preventing overdose and increasing treatment access.
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