(208) Early Opioid Use Disorder Treatment Pathways and Determinants Among the Commercially-Insured, 2010-2019

Background: Current opioid use disorder (OUD) treatment modalities include behavioral therapy and medications for OUD (methadone, buprenorphine, naltrexone). Contemporary real-world evidence is needed to understand the landscape of OUD treatment pathways after diagnosis.

Objectives: To identify and characterize early longitudinal treatment pathways for commercially-insured US adults with OUD.

Methods: A retrospective cohort of individuals with new OUD diagnosis derived using IBM MarketScan® claims data from 2010-2019. Index date was date of first OUD diagnosis. Final cohort included adults 18-85 years at index with continuous insurance eligibility in the 6 months before (baseline) and 3 months after (follow-up) index. OUD treatment pathways were measured during follow-up and categorized as: 1) no treatment, 2) behavioral therapy only, 3) buprenorphine only, 4) buprenorphine and behavioral therapy, 5) naltrexone only, 6) naltrexone and behavioral therapy, 7) methadone with or without behavioral therapy, and 8) other. We used multinomial logistic regression to compare baseline demographics (e.g., age, sex) and clinical covariates (e.g., substance use disorder [SUD], mental health) across treatment pathways.

Results: Of the 372,614 beneficiaries with new OUD diagnosis, nearly half the sample were women (47.0%), and mean age was 43 years. Baseline prevalence of comorbid chronic non-cancer pain (CNCP) was 70.6%. Depression (29.5%), anxiety disorders (28.5%), and other SUDs (27.8%) were the most common mental health diagnoses. The predominant treatment pathway during follow-up was behavioral therapy only (n=261,888; 70.3%), followed by buprenorphine and behavioral therapy (n=52,697; 14.1%). Nearly 10% had no evidence of treatment (n=35,322). Those with co-occurring SUDs had significantly higher odds of belonging to the no treatment (OR:1.73; 95%CI: 1.68, 1.78), naltrexone (2.66; 2.35, 3.0), and naltrexone with behavioral therapy pathways (4.02; 3.80, 4.26) compared to buprenorphine and behavioral therapy (reference). Baseline mental health diagnosis was associated with significantly lower odds of belonging to the no treatment (0.53; 0.52, 0.55), behavioral therapy only (0.88; 0.86, 0.90),  buprenorphine only (0.51; 0.49, 0.54), methadone with or without behavioral therapy (0.44; 0.40, 0.50), and naltrexone only (0.76; 0.67, 0.85) pathways compared to the reference. CNCP was associated with significantly lower odds of being in all other pathways versus the reference, except for the behavioral therapy only pathway.

Conclusions: Each treatment pathway following OUD diagnosis demonstrated unique characteristics, underscoring the necessity of addressing the totality of care needs of OUD patients to optimize outcomes.