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Abstract: Background/Objectives: With disproportionately high rates of opioid overdose mortality and opioid use disorder (OUD), Medicare beneficiaries with disabilities are an important population to engage in treatment. This study examined racial/ethnic disparities in buprenorphine initiation after a new OUD diagnosis in this priority population. Methods: This longitudinal, retrospective cohort study used national data from a 20% random sample of Medicare beneficiaries from 2016-2018. The sample included individuals with eligibility due to disability and 12 months of continuous enrollment in Parts A, B, and D who had a new OUD diagnosis (i.e., no diagnosis in the prior 180 days) and a known race/ethnicity (N= 181,796). Buprenorphine initiation was measured as a filled prescription within 30 and 180 days of the index diagnosis. Claims data were linked with the Area Health Resources File and the Medicare Part D Prescriber Public Use Files to measure county-level Medicare buprenorphine prescriber availability, proportion of White residents, and median household income. Outcomes were estimated using multilevel logistic regression accounting for county-level clustering and adjusting for individual and county-level covariates. Results: Black (aOR=0.37; p<0.01), Asian/Pacific Islander (aOR=0.41; p<0.01), Hispanic/Latinx (aOR=0.58; p<0.01), and American Indian/Alaskan Native (aOR=0.68; p<0.01) beneficiaries had significantly lower odds of receiving buprenorphine within 30 days of an index diagnosis compared with their White counterparts. Similar patterns were observed for the 180-day outcome, and estimates remained significant after adjusting for county-level measures. Buprenorphine initiation within 30 days of an index diagnosis was significantly associated with higher county-level rates of Medicare buprenorphine prescribers (aOR=1.13; p<0.01), and a higher proportion of White residents (aOR=5.15; p<0.01). Conclusions: Racial/ethnic disparities in timely receipt of buprenorphine after a new OUD diagnosis highlight the need to increase access to care for disadvantaged groups. Interventions that increase buprenorphine prescribing and Medicare participation with a focus minority-majority counties may improve treatment equity.
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