Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Abstract

Medicaid presently insures about one-fourth of the US population and disproportionately insures about thirty eight percent of non-elderly adults with an opioid use disorder (OUD). Owing to Medicaid’s prominent role insuring persons with an OUD and that Medicaid coverage includes pharmaceutical benefits, there has been considerable interest in studying potential prescription opioid misuse among Medicaid beneficiaries and identifying subpopulations at higher risk for misuse and possible progression to an OUD. Study goals were to explore the associations among prescription opioid misuse, OUD, and co-occurring mental health and other substance use disorders (SUD). We analyzed Illinois Medicaid 2018 claims data for 1,102,479 adult beneficiaries 18 to 64 years of age. Using algorithms based on previous studies, we first determined the presence or absence of nine SUDS (including OUD) as well as nine mental health disorders and likely prescription opioid misuse. We then subdivided the beneficiary sample into five groups: those who were prescribed opioids and evidenced either no, possible, or probable misuse; those evidencing an OUD; and those evidencing no opioid use or misuse. Bivariate analyses, upset plots, and multinomial logistic regressions were used to compare the five subgroups on the prevalence of co-occurring SUDS and mental health disorders. Those with an OUD or with probable prescription opioid misuse had the highest prevalences of most co-occurring conditions with beneficiaries with an OUD the most likely to evidence co-occurring SUDS, particularly tobacco use disorder, whereas those with probable misuse had elevated prevalence rates of co-occurring mental health disorders comparable to those with an OUD. The medical complexity of persons with an OUD or misusing prescription opioids are considered in light of recent attempts to expand buprenorphine provision as medication assisted treatment among Medicaid beneficiaries. We also consider the possibility co-occurring mental health disorders and tobacco use disorder as important risk factors for progressing to prescription opioid misuse and an OUD