Outcomes of State Targeted/Opioid Response grants and the Medication First approach: evidence of racial inequities in improved treatment access and retention

Since 2017, Missouri has used federal funds to increase access to medication for opioid use disorder (OUD) within the State’s publicly-funded substance use specialty treatment system through a ‘Medication First’ approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention in the first year of funding. The current manuscript, which focuses on the St. Louis region, the epicenter of Missouri’s overdose crisis, examines whether improvements were experienced equally among Black and White clients. Results from negative binomial regressions indicate that White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients. In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.