Impact of the COVID-19 pandemic on health care utilization for commercial and Medicaid beneficiaries with opioid use disorder

Introduction: We sought to examine how COVID-19 affected opioid use disorder (OUD)-specific health care utilization for insured individuals with preexisting OUD during the first year of the pandemic. Methods: In this retrospective cohort study, using data from the Merative (TM) MarketScan (R) Commercial and Medicaid data, we examined pre- and post-pandemic changes receipt of therapy, medication for opioid use disorder (MOUD), and emergency department (ED) and inpatient admissions. Results: The pandemic-exposed cohort was more likely to receive therapy; however, the commercial sample did not evidence change in the number of sessions received while Medicaid beneficiaries evidenced a significant decrease of 3.87 sessions per year, p < 0.001. We observed increases in the likelihood of receiving any MOUD among Medicaid beneficiaries, but significant decreases in months of MOUD for both commercial (2.16 months, p < 0.001) and Medicaid pandemic cohorts (1.94 months, p < 0.001) compared with their respective pre-pandemic cohorts. There were significant decreases in the likelihood of any and the count of emergency department visits across samples during the pandemic, all p < 0.001. For the Medicaid sample, there was a significant decrease in the likelihood of having an inpatient admission, p < 0.001, and there was a greater decrease in the number of inpatient days per year among commercially insured, p = 0.011 during the pandemic. Conclusions: Adults diagnosed with OUD before the pandemic experienced significant disruptions to care, particularly continuity of care and access to emergency services, despite efforts by policymakers to counter pandemic-related access barriers.