State Medicaid Policies Governing Access to Medications for Opioid Use Disorder (MOUD) and MOUD Treatment Use in a Large Sample of People Who Inject Drugs in 20 U.S. States

Background: People who inject drugs (PWID) are especially vulnerable to harms from opioid use disorder (OUD). Medications for OUD (MOUD) effectively reduce overdose and infectious disease transmission risks. Objective: We investigate whether state Medicaid coverage for methadone and buprenorphine is related to past-year MOUD use among PWID using cross-sectional, multilevel analyses with individual-level data on PWID from the Centers for Disease Control and Prevention’s 2018 National HIV Behavioral Surveillance. The sample included 8,142 PWID aged 18-64 who reported daily opioid use from 22 U.S. metropolitan areas. Our outcome was any self-reported MOUD use in the past 12 months. Exposures were state Medicaid coverage and prior authorization requirements for methadone and buprenorphine. We interacted these exposures with PWID race/ethnicity, insurance status, and spatial access to treatment and harm reduction resources. Results: Compared with PWID in states without Medicaid methadone coverage, odds of past-year MOUD use were 73% (pp背景：注射毒品者（People who inject drugs, PWID）尤其易受阿片类药物使用障碍（Opioid Use Disorder, OUD）带来的健康损害。阿片类药物使用障碍治疗药物（Medications for OUD, MOUD）可有效降低过量中毒及传染病传播风险。研究目的：本研究依托美国疾病控制与预防中心（Centers for Disease Control and Prevention）2018年全国HIV行为监测系统中注射毒品者的个体水平数据，采用横断面多水平分析方法，探讨各州针对美沙酮与丁丙诺啡的医疗补助计划（Medicaid）覆盖情况，与注射毒品者过去一年的阿片类药物使用障碍治疗药物使用行为是否存在关联。本研究的分析样本涵盖来自美国22个大都市区的8142名18至64岁、自述每日使用阿片类药物的注射毒品者。本研究的结局指标为过去12个月内自述是否使用过阿片类药物使用障碍治疗药物。暴露因素包括各州针对美沙酮与丁丙诺啡的医疗补助计划覆盖情况，以及相关事先授权要求。本研究进一步分析了上述暴露因素与注射毒品者种族/族裔、保险参保状态，以及治疗与减害资源空间可及性之间的交互效应。研究结果：与未将美沙酮纳入医疗补助计划覆盖范围的州的注射毒品者相比，过去一年使用阿片类药物使用障碍治疗药物的比值比提升了73%（pp