Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic

Importance Disruptions in care during the COVID-19 pandemic may have decreased access to care for patients with opioid use disorder. Objective To examine trends in opioid use disorder treatment including buprenorphine possession, urine drug testing, and opioid treatment program services during the COVID-19 public health emergency. Design, Setting, and Participants This cohort study included 6453 parent and childless adult Medicaid beneficiaries, aged 18 to 64 years, with opioid use disorder and continuous enrollment from December 1, 2018, to September 30, 2020, in Wisconsin. Logistic regression compared differences in study outcomes before, early, and later in the COVID-19 public health emergency. Analyses were conducted from January 2021 to October 2021. Exposures Early (March 16, 2020, to May 15, 2020) and later (May 16, 2020, to September 30, 2020) in the public health emergency. Main Outcomes and Measures Person-week outcomes included possession of buprenorphine, completion of outpatient urine drug testing, and receipt of opioid treatment program services. Results The final cohort of 6453 participants included 3986 (61.8%) childless adults; 5741 (89%) were younger than 50 years, 3435 (53.2%) were women, 5036 (78.0%) White, and 22.0% were racial and ethnic minority groups (American Indian, 269 [4.2%]; Asian, 26 [0.4%]; Black, 458 [7.1%]; Hispanic, 292 [4.5%]; Pacific Islander, 1 [.02%]; Multiracial, 238 [3.7%]). Overall, 2858 (44.3%), 5074 (78.6%), and 2928 (45.4%) received buprenorphine, urine drug testing, or opioid treatment program services during the study period, respectively. Probability of buprenorphine possession did not change in the early or later part of the public health emergency. Probability of urine drug testing initially decreased (marginal effect [ME], -0.04; 95% CI, -0.04 to -0.03; P < .001) and then partially recovered in the later public health emergency (ME, -0.02; 95% CI, -0.03 to -0.02; P < .001). Probability of opioid treatment program services followed a similar pattern, with an early decrease (ME, -0.05; 95% CI, -0.05 to -0.04; P < .001) followed by partial recovery (ME, -0.02; 95% CI, -0.03 to -0.02; P < .001). Conclusions and Relevance In a sample of continuously enrolled adult Medicaid beneficiaries, the COVID-19 public health emergency was not associated with decreased probability of buprenorphine possession, but was associated with decreased probability of urine drug testing and opioid treatment program services. These findings suggest patients in office-based settings retained access to buprenorphine despite decreased on-site services like urine drug tests, whereas patients at opioid treatment programs experienced greater disruption in care. Given the importance of medications for opioid use disorder in preventing overdose, policy makers should consider permanent policy changes based on lessons learned from the public health emergency to enable ongoing enhanced access to these medications. Question During the COVID-19 public health emergency, did patients with opioid use disorder experience decreased access to opioid use disorder treatment? Findings In this cohort study of 6453 Medicaid beneficiaries with opioid use disorder in Wisconsin, buprenorphine possession remained stable at the onset and for the first 6 months of the public health emergency. In contrast, completion of urine drug tests and receipt of opioid treatment program services declined with the onset of the public health emergency and recovered partially 6 months into the public health emergency. Meaning The findings of this study suggest that the COVID-19 public health emergency did not disrupt access to buprenorphine but did disrupt urine drug testing and access to opioid treatment program services. This cohort study examines whether Medicare patients in Wisconsin with opioid use disorder experienced decreased access to opioid use disorder treatment during the COVID-19 pandemic.