title: Opioid use disorder in the United States: insurance status and treatment access.
abstract: BACKGROUND
  In the United States, insurance status and rates of treatment for individuals with opioid use disorder are unknown.
  
  
  METHODS
  Cross-sectional survey: 2002-2004 National Survey on Drug Use and Health (NSDUH). Bivariate and multivariate associations between demographics, treatment and insurance status and presence or absence of opioid use disorder were investigated.
  
  
  RESULTS
  On unadjusted analysis, young respondents, respondents of Hispanic ethnicity (OR 1.5; 95% CI 1.1-2.2), unemployed respondents (OR 2.6; 95% CI 1.8-3.8) and respondents with Medicaid (OR 4.5; 95% CI 2.5-8.3) or lack of insurance (OR 3.2; 95% CI 1.8-5.9) were more likely to have opioid use disorder. On unadjusted analysis among those with any substance use disorder, 12-16 year olds were more likely to have opioid use disorder (OR 3.4; 95% CI 2.0-5.8) than a non-opioid substance use disorder, as were women (OR for men 0.6; 95% CI 0.5-0.7) and unemployed respondents (OR 1.5; 95% CI 1.02-2.1). Only 15.2% of those with past-year opioid use disorder received treatment in the past year. Respondents treated for opioid use had higher rates of Medicaid (p<0.01), Medicare (p<0.01) and other public assistance (p=0.01) compared with those treated for other substances. Treatments for opioid use were more likely to be hospital (p=0.04) and inpatient rehabilitation (p=0.02) settings compared to treatment for other substance use. Among those with opioid use disorder, not being employed was independently associated with receiving treatment (AOR 3.5; 95% CI 1.4-8.5).
  
  
  CONCLUSIONS
  In the U.S., high rates of unemployment, Medicaid and uninsurance among those with opioid use disorder and low rates of treatment suggest that efforts to expand treatment must include policy strategies to help reach a population with significant barriers to treatment access.
authors.affiliation: Department of Internal Medicine, Philadelphia VAMC, Philadelphia, PA 19104, United States. william.becker4@va.gov
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Beryl
authors.initials: B
authors.lastname: Schulman
authors.forename: Ruth
authors.initials: R
authors.lastname: Finkelstein
authors.forename: Yngvild
authors.initials: Y
authors.lastname: Olsen
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology