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Background: The COVID-19 pandemic's impact on utilization of medications for opioid use disorder (MOUD) among patients with opioid use disorder (OUD) and chronic pain is unclear., Methods: We analyzed New York State (NYS) Medicaid claims from pre-pandemic (August 2019-February 2020) and pandemic (March 2020-December 2020) periods for beneficiaries with and without chronic pain. We calculated monthly proportions of patients with OUD diagnoses in 6-month-lookback windows utilizing MOUD and proportions of treatment-naïve patients initiating MOUD. We used interrupted time series to assess changes in MOUD utilization and initiation rates by medication type and by race/ethnicity., Results: Among 20,785 patients with OUD and chronic pain, 49.3% utilized MOUD (versus 60.3% without chronic pain). The pandemic did not affect utilization in either group but briefly disrupted initiation among patients with chronic pain (β=-0.009; 95% CI [-0.015, -0.002]). Overall MOUD utilization was not affected by the pandemic for any race/ethnicity but opioid treatment program (OTP) utilization was briefly disrupted for non-Hispanic Black individuals (β=-0.007 [-0.013, -0.001]). The pandemic disrupted overall MOUD initiation in non-Hispanic Black (β=-0.007 [-0.012, -0.002]) and Hispanic individuals (β=-0.010 [-0.019, -0.001])., Conclusions: Adults with chronic pain who were enrolled in NYS Medicaid before the COVID-19 pandemic had lower MOUD utilization than those without chronic pain. MOUD initiation was briefly disrupted, with disparities especially in racial/ethnic minority groups. Flexible MOUD policy initiatives may have maintained overall treatment utilization, but disparities in initiation and care continuity remain for patients with chronic pain, and particularly for racial/ethnic minoritized subgroups., Competing Interests: Declaration of Competing Interest The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the New York State Department of Health. Examples of analysis performed within this article are only examples. They should not be utilized in real-world analytic products. AP reports no conflicts of interest. KWM reports no conflicts of interest. DSH reports payments made to their institution for unrelated project work for Syneos Health on measurement of addiction in patients with chronic pain. KT reports no conflicts of interest. ZLM reports no conflicts of interest. VJ reports no conflicts of interest. TNT reports no conflicts of interest. JRP reports no conflicts of interest. SC reports no conflicts of interest. SSM reports no conflicts of interest. MC reports no conflicts of interest. NK receives compensation for expert testimony in ongoing opioid litigation., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The United States overdose crisis continues unabated. Despite efforts to increase capacity for treating opioid use disorder (OUD) in the U.S., how actual treatment receipt compares to need remains unclear. In this cross-sectional study, we estimate progress in addressing the gap between OUD prevalence and OUD treatment receipt at the national and state levels from 2010 to 2019., Methods: We estimated past-year OUD prevalence rates based on the U.S. National Survey on Drug Use and Health (NSDUH), using adjustment methods that attempt to account for OUD underestimation in national household surveys. We used data from specialty substance use treatment records and outpatient pharmacy claims to estimate the gap between OUD prevalence and number of persons receiving medications for opioid use disorder (MOUD) during the past decade., Results: Adjusted estimates suggest past-year OUD affected 7,631,804 individuals in the U.S. in (2,773 per 100,000 adults 12+), relative to only 1,023,959 individuals who received MOUD (365 per 100,000 adults 12+). This implies approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it. MOUD receipt increased across states over the past decade, but most regions still experience wide gaps between OUD prevalence and MOUD receipt., Conclusions: Despite some progress in expanding access to MOUD, a substantial gap between OUD prevalence and treatment receipt highlights the critical need to increase access to evidence-based services., Competing Interests: Declaration of interests The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Keyes reports personal fees for consultation and testimony in litigation., (Copyright © 2022. Published by Elsevier B.V.)

Objective: Availability of medications for opioid use disorder (MOUD) remains sparse. To date, there has been no national, state-by-state comparison of patient MOUD utilization relative to treatment availability and burden of overdose deaths. We aimed to quantify, for each state, the number of MOUD patients relative to (1) office-based buprenorphine providers and opioid treatment programs (OTPs) and (2) overdose deaths., Methods: We conducted a spatial analysis of patients receiving MOUD from OTPs or buprenorphine providers in March 2017 across all 50 states and Washington, DC. For each state, we calculated the number of patients receiving MOUD from OTPs and buprenorphine prescriptions, relative to available OTPs and buprenorphine providers; as well as ratios of number of patients receiving MOUD relative to overdose deaths., Results: In March 2017, 942,368 patients attended an OTP (410,288) or received a buprenorphine prescription (486,318). Patient to OTP ratio was highest in West Virginia, Delaware, Washington, DC, New Jersey, New Hampshire, Connecticut and Ohio, ranging from 91 to 193 patients per OTP in the first quintile to 430 to 648 in the fifth. Patient to buprenorphine provider ratio was highest in Kentucky and West Virginia, ranging from 3 to 7 patients per provider in the first quintile to 19 to 28 in the fifth. Median MOUD patients per overdose death was 21 (IQR:14.9-28.2). Of high overdose states, Washington, DC, New Jersey, and Ohio had the smallest number of patients on MOUD relative to deaths., Conclusions: High patient volume relative to treatment availability in overdose-burdened areas may indicate strain on MOUD providers and OTPs. Promoting greater utilization while expanding MOUD providers and programs is critical., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 American Society of Addiction Medicine.)