MOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location

• Published in: Drug and alcohol dependence 2025-01, Vol.266, p.112509, Article 112509
• Main Authors: Herrera, Carolina-Nicole, Choi, Sugy, Johnson, Natrina L.
• Format: Article
• Language: English
• Subjects: ACA; Adolescent; Adult; Ambulatory care; Analgesics, Opioid - therapeutic use; Drug Overdose - ethnology; Female; Hispanic; Hispanic or Latino; Humans; Male; Medicaid; Middle Aged; MOUD; Opioid-Related Disorders - ethnology; Patient Protection and Affordable Care Act; Substance use treatment; United States - epidemiology; White; Young Adult
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2024.112509

Overdose death rates for Hispanic people rose 2010–2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people (“White”). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act (“ACA”) should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids (“clients”). We analyzed first annual ambulatory care episodes (TEDS-A, 2009–2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients. Among Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA. MOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states. •MOUD use differed among Hispanic ambulatory clients by state/heritage (2009–2019).•Post-ACA, Hispanic and White ambulatory clients had similar increases in MOUD use nationally.•Post-ACA >72 % of Hispanic and White ambulatory clients in California used MOUD.•MOUD use was lowest in states that did not expand Medicaid.