Differential Changes in Use of Medications for Opioid Use Disorder by Race-Ethnicity: Effects of a Hub-and-Spoke Model.

Abstract

Objective: The authors examined, separately for different racial-ethnic groups, whether use of medications for opioid use disorder (MOUD) increased more among people treated in a hub-and-spoke care model than among people treated in a non-hub-and-spoke model.

Methods: Comparative time-series analyses were performed with Washington State Medicaid claims (2017-2019) data for 115,911 enrollees to investigate MOUD use, stratified by care model and enrollee race-ethnicity.

Results: Following implementation of the hub-and-spoke model, the proportions of enrollees with opioid use disorder receiving MOUD increased in all racial-ethnic groups. Buprenorphine use increased more among Black, Hispanic, and White enrollees treated in the hub-and-spoke model than among people of the same race-ethnicities treated in a non-hub-and-spoke model (beta range 0.56-0.93, p<0.05). However, within the hub-and-spoke model, rates of buprenorphine use increased more among White enrollees than among American Indian or Alaska Native (AI/AN) enrollees (β=0.84, p<0.001). Methadone use increased more among AI/AN enrollees treated in the hub-and-spoke model compared with AI/AN enrollees treated in a non-hub-and-spoke model (β=0.39, p<0.001).

Conclusions: Following implementation of the hub-and-spoke model, MOUD use increased for Medicaid enrollees of all race-ethnicities. The increase in MOUD use for Black, Hispanic, and White enrollees who received treatment in the hub-and-spoke model was greater than that for people of the same race-ethnicities treated in a non-hub-and-spoke model. Thus, the hub-and-spoke model may be a useful strategy to increase use of MOUD treatment.