Each year, hundreds of thousands of Medicare recipients with opioid use disorder (OUD) are eligible for safe, effective medication but don’t receive it—with patients of color having significantly less access than white patients.
More than 1 million Medicare recipients were diagnosed with OUD in 2020, according to a recent report from the Department of Health and Human Services. But less than 16 percent of them received medication (MOUD).
US residents are eligible for Medicare after age 65, and younger people can be eligible if they also receive federal disability insurance. About half of Medicare recipients with OUD are under 65. The report found these younger recipients were far likelier to receive MOUD than those over 65. Opioid-involved deaths for elderly Americans (over 55) have increased significantly since 1999.
The FDA has approved three different MOUD—buprenorphine, methadone and naltrexone. Methadone is the most strictly controlled of the three and is dispensed through clinics, often in daily doses. Buprenorphine can be generally prescribed and picked up from a pharmacy like any other medication, though it has been the subject of recent crackdowns by the Drug Enforcement Administration (DEA).
Naltrexone is not a DEA-controlled substance, but patients must be fully detoxified from opioids before starting treatment. It also carries a higher risk of fatal overdose. It is often the only MOUD offered by prisons and jails.
Of the 167,700 eligible Medicare recipients who received MOUD in 2020, the vast majority (130,000) were prescribed through a doctor’s office—primarily buprenorphine, with a small portion receiving naltrexone. A much smaller proportion (39,000) were prescribed through a methadone clinic—primarily methadone, though a fraction received buprenorphine or naltrexone via these clinics as well.
The report noted very poor MOUD access in predominantly rural states throughout the South, Midwest and Rocky Mountains. Florida, Texas and Nevada have the fewest doctors waivered to prescribe buprenorphine.
Those waiver restrictions were relaxed in April 2021, though the report only includes data from 2020. Another barrier to methadone access has been that compared to buprenorphine providers, fewer methadone providers are enrolled in Medicare, especially in states with the least MOUD access. Medicare only started covering methadone clinics in January 2020.
The report found Black, Hispanic and Asian/Pacific Islander recipients were less likely than white recipients to receive MOUD, especially buprenorphine. During the pandemic, opioid-involved US deaths have surged for Black people. Racist barriers continue to drive this disturbing trend.
Photograph by Mike Mozart via Flickr/Creative Commons 2.0