Opioid use disorder, pharmacotherapy, and overdose among Medicare disability beneficiaries from 2008-2021.

Abstract

Medicare disability beneficiaries (MDBs) have high rates of opioid use disorder (OUD) and overdose. This study aimed to examine trends in OUD diagnoses, medication for OUD (MOUD) receipt, and overdoses in the MDB population from 2008-2021, a period of substantial changes in the epidemiological and opioid policy landscape. This repeated cross-sectional study used a 20% random sample of U.S. Medicare claims data. Joinpoint regressions estimated trends in prevalent and incident OUD diagnosis, MOUD receipt, and medically-treated nonfatal opioid overdose, among MDBs. Analyses were stratified by race and ethnicity and comorbid SUDs. Analyses were completed in 2025. Of 29,178,648 person-years of observation, prevalent OUD was observed in 4.2% of person-years and 21.2% of OUD-diagnosed individuals received MOUD. OUD prevalence increased from 2008-2016 (APC=16.4, 95%CI=15.0 to 17.9) and remained stable thereafter. MOUD receipt among MDBs with OUD was flat from 2008-2016 but then increased by an APC of 22.1 (95%CI=18.8 to 27.7), remaining lower among Black (11.4%) and Hispanic (18.3%) than White (23.0%) MDBs. Overdoses among MDBs with OUD declined starting in 2011 (APC=-6.2, 95%CI=-9.5 to -5.5). Overdoses were highest among White MDBs from 2008-2015 (6.5%), but declined rapidly, with overdose rates for Black (3.7%) and Hispanic (3.7%) beneficiaries surpassing those for White beneficiaries (3.3%) by 2021. Between 2008 and 2021, opioid overdoses decreased and MOUD uptake increased among MDBs, although trends diverged based on race/ethnicity and comorbid SUD. Improvements in outcomes in this population likely reflect a combination of changes in the overall opioid landscape during this time period and adoption of Medicare-specific policies aimed at preventing overdose and increasing treatment access.