Racial and ethnic disparities in buprenorphine retention and treatment outcome in a longitudinal cohort of U.S. veterans with opioid use disorder

Background: Despite the availability of efficacious opioid use disorder (OUD) medications (MOUD), there are racial and ethnic disparities in their use in the general population. Here, we examine the use of MOUD in a racially and ethnically diverse veteran sample. Objectives: To examine racial and ethnic differences in veterans’ 1) likelihood of receiving MOUD and 2) treatment retention, dosage, and abstinence outcomes among veterans receiving buprenorphine treatment. Methods: Among 29,502 veterans with OUD, we examined the effects of race and ethnicity on 1) whether methadone or buprenorphine was prescribed as MOUD, and 2) among those prescribed buprenorphine, using multivariable logistic regression to adjust for potential confounders, the likelihood of receiving ≥180 days of treatment and achieving opioid abstinence. Results: Thirty percent of veterans with OUD received MOUD, with race being a significant predictor (p <.01): White veterans were most likely to receive buprenorphine (12%) or both medications (11%), while Black veterans were most likely to receive only methadone (16%). Among 5,768 veterans prescribed buprenorphine, retention was highest among American Indian/Alaska Native (59%), White (59%), and Other race (62%) veterans and lowest among multiracial (47%) and Black veterans (49%). In an adjusted analysis (n = 3,273, 92% male, 8% female), Black veterans had significantly lower odds of opioid abstinence than White veterans (aOR = 0.53, 95% CI = 0.43, 0.67). Conclusion: There are racial disparities in MOUD prescribing and rates of retention, particularly in the rate of abstinence among buprenorphine-treated veterans. Standardized criteria for MOUD selection may help guide clinical decisions and reduce racial disparities in treatment outcomes.