Abstract / Summary
Opioid use disorder (OUD) is a chronic condition with low rates of treatment success; use of medication for OUD (MOUD) is inconsistent across treatment settings. The purpose of this study was to examine the independent and interactive associations of MOUD and health insurance status with successful treatment completion across residential and outpatient treatment settings. We conducted multilevel random-effects logistic regression analyses of the 2022 Treatment Episode Dataset–Discharge (TEDS-D) to estimate associations among MOUD receipt, insurance status (Medicaid, Medicare, private insurance, uninsured), and treatment completion. Models adjusted for demographic and clinical characteristics and stratified by treatment setting. The sample included 175,942 treatment episodes among adults aged 18 years and older whose primary substance at admission was heroin, non-prescription methadone, or other opiates and synthetics. Associations between MOUD, insurance status, and treatment completion varied by treatment setting; insurance moderated the association between MOUD and completion in both outpatient settings. All data were compared to no insurance, no MOUD. In short-term residential treatment, MOUD was associated with higher odds of completion among privately insured (OR: 1.94; 95% CI: 1.10–3.43) but not among the uninsured (OR: 0.79; 95% CI: 0.57–1.10; ROR: 2.45; 95% CI: 1.28–4.67), although the omnibus test of moderation was not significant. In intensive outpatient treatment, MOUD was associated with lower odds of completion among Medicaid recipients (OR: 0.79; 95% CI: 0.65–0.97) but not among the uninsured (OR: 1.15; 95% CI: 0.86–1.54; ROR: 0.69; 95% CI: 0.51–0.92). In non-intensive outpatient treatment, MOUD was associated with lower odds of completion in every insurance group, with the association attenuated among Medicaid (ROR: 1.29; 95% CI: 1.12–1.48) and Medicare (ROR: 1.35; 95% CI: 1.09–1.69) beneficiaries relative to the uninsured. Insurance status and MOUD receipt are differentially associated with successful treatment completion across care settings. MOUD was associated with higher completion among privately insured clients in short-term residential treatment, with lower completion among Medicaid recipients in intensive outpatient care, and across all insurance groups in non-intensive outpatient care. Insurance expansion alone may be insufficient to improve treatment completion, underscoring the need for Medicaid-focused policies and supports that address barriers to OUD treatment. Not applicable.