Treatment Pathways for Opioid Use Disorder in Commercially-Insured United States Adults from 2010-2019

Longitudinal data on real-world treatment patterns for opioid use disorder (OUD) is limited. We aimed to identify and characterize granular pathways of OUD treatment.

We utilized a retrospective observational cohort design using United States IBM® MarketScan® claims data from 2010-2019. The index date was the date of the first OUD diagnosis in the study period. We included commercially-insured beneficiaries, aged 18-85 years with OUD and continuous insurance eligibility for at least 6 months before (baseline period) and 3 months after (follow-up period) the index date. Independent measures were sociodemographics, clinical comorbidities, and health services utilization characteristics captured in the baseline period. Patients were categorized into one of 8 mutually exclusive categories during follow-up (dependent measures): behavioral treatment only, buprenorphine with or without behavioral treatment, methadone with or without behavioral treatment, naltrexone with or without behavioral treatment, other treatment combinations, and no treatment.

Of the 372,614 beneficiaries with OUD, 47% were women, with a mean age of 43 years (SD: 15.7). The predominant treatment category was behavioral treatment only (n=261,888; 70.3%), followed by buprenorphine and behavioral treatment (n=52,697; 14.1%). Nearly 10% had no evidence of treatment (n=35,322). Baseline mental health diagnosis was associated with significantly lower adjusted odds of no treatment (aOR: 0.53; 95% CI: 0.52, 0.55), behavioral treatment only (0.88; 0.86, 0.90), buprenorphine only (0.51; 0.49, 0.54), methadone with or without behavioral treatment (0.44; 0.40, 0.50), and naltrexone only (0.76; 0.67, 0.85) compared to buprenorphine and behavioral treatment. Chronic non-cancer pain was associated with significantly lower odds of all treatment categories, except behavioral treatment only, versus buprenorphine and behavioral treatment.

Each OUD treatment pathway demonstrated unique characteristics, underscoring the importance of addressing the totality of care needs of OUD patients to optimize treatment and outcomes.