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MOUD after ED overdose visits reduces mortality; however, recent findings revealed persistent nationwide racial and ethnic disparities in initiation.

Medications for opioid use disorder (MOUD) prescribed after emergency department (ED) visits for overdose can significantly reduce subsequent overdose mortality. However, recent findings published in Health Affairs reveal that racial and ethnic disparities in MOUD initiation persist across the US. “Although policy and clinical efforts to increase MOUD use in the Medicaid population are important, findings suggest that efforts targeting patients from racial and ethnic minority groups may be warranted,” wrote corresponding author Thuy Dieu Nguyen, PhD, MPA, of the University of Michigan, and colleagues.

MOUD Initiation Rates & Racial Disparities

Analyzing national Medicaid claims from 2016 to 2020, the researchers found that, based on unadjusted analyses, non-Hispanic White patients exhibited the highest MOUD initiation rate (7.3%), compared with Black (4.3%), Hispanic (4.9%), Asian (5.2%), American Indian/Alaska Native (5.4%), and non-Hispanic other race (7.2%) patients. In fully adjusted models, controlling for age, sex, comorbidities, insurance type, geographic factors, and year, Black patients initiated MOUD at a rate of 3.7%, which is 2.5 percentage points lower than that of White patients. This gap was predominantly driven by disparities in buprenorphine initiation (−1.7 points), with smaller differences observed for methadone (−0.4 points) and extended-release naltrexone (−0.5 points). Smaller yet notable initiation deficits were also seen among Asian (−1.5 points), American Indian/Alaska Native (−1.3 points), and Hispanic (−1.2 points) patients relative to their White counterparts.

Temporal & Regional Trends

Overall, MOUD initiation improved from 4.2% in 2016 to 7.7% in 2020, but progress was uneven, according to findings. The initiation rate among White patients rose from 4.8% to 9.0%, whereas that among Black patients increased from 2.1% to 4.9%, thereby widening the adjusted White–Black disparity from −1.9 to −3.5 percentage points over the study period. Regionally, initiation was most pronounced in the Northeast (8.6%) and Midwest (6.5%), and lowest in the South (5.5%) and West (5.0%). The White–Black initiation gap was most pronounced in the Northeast (−3.6 points) and least in the West (−2.7 points).

Policy Implications & Interventions

The authors emphasized that, during 2016–20, “rates of MOUD initiation after ED visits for opioid overdose were low among all Medicaid patients, but they were particularly low among patients from racial and ethnic minority groups.” They advocated for targeted initiatives such as expanding ED-based buprenorphine protocols, establishing bridge clinics to ensure continuity of care, and enhancing methadone access via permanent take-home flexibilities, noting that prioritizing resources for safety-net EDs and addressing systemic biases will be essential to close initiation gaps and reduce opioid-related mortality equitably.