Trends in receipt of methadone vs. buprenorphine by race/ethnicity before and after COVID-19 (2018–2022): a Veterans Health Administration study

Background Using Veterans Health Administration (VHA) data, this descriptive study examines inequities by race and ethnicity in receipt of medications for opioid use disorder (MOUD) before and during the COVID-19 pandemic, when more flexible prescribing policies were introduced. Methods We extracted 48 monthly cohorts (3/1/2018-2/28/2022) from national VHA electronic health records (EHR) for outpatients ≥ 18 years with a past-year OUD diagnosis. The primary outcome was receipt of any MOUD (methadone, buprenorphine, and/or naltrexone); secondary analyses examined methadone and buprenorphine individually. Outcomes were compared between non-Hispanic White, non-Hispanic Black, Hispanic Black, Hispanic White, and Hispanic neither Black nor White patients. Results Among 110,136 patients with OUD, non-Hispanic Black and non-Hispanic White patients had similar MOUD receipt in March 2018 (27.3% and 27.8%), but by February 2022, receipt was lower for non-Hispanic Black (29.3%) than non-Hispanic White patients (35.0%). Similarly, Hispanic Black patients had similar MOUD receipt in March 2018 compared with Hispanic White and Hispanic neither Black nor White patients (28.0% vs. 28.4% and 27.0%) but had lower MOUD receipt by February 2022 (26.2% vs. 33.2% and 33.7%). Buprenorphine receipt increased post-pandemic but remained lower for non-Hispanic Black (13.9% to 15.5%) and Hispanic Black (11.6% to 15.1%) patients than non-Hispanic White patients (27.9% to 29.8%). Methadone receipt declined post-pandemic but remained higher for non-Hispanic Black (17.4% to 14.4%) and Hispanic Black (17.1% to 11.9%) patients than non-Hispanic White patients (6.6% to 5.5%). Conclusions Although pandemic-related policy changes were intended to expand access to MOUD, findings suggest that their benefits may not have been equitably distributed across racial and ethnic groups. Improving equity may require targeted approaches to reduce barriers to buprenorphine and methadone.