Predictors of incident anxiety and stress-related diagnoses following buprenorphine initiation among commercially insured patients with opioid use disorder.

Abstract

Anxiety and stress-related disorders (ASRD) are common among people with opioid use disorder (OUD), yet many initiate buprenorphine treatment without a documented psychiatric diagnosis. How often these disorders become identifiable after initiation, and which patient characteristics are associated with diagnosis, remains unclear. We conducted a retrospective cohort study using Merative MarketScan® Commercial Claims data (2018-2023). People with OUD initiating buprenorphine after ≥ 180 days without treatment and without an ASRD (ICD-10: F40-F43) during the baseline period were included. The primary outcome was time to newly documented ASRD diagnosis. Inverse probability of censoring weighted Cox proportional hazards regression was used to identify clinical and demographic features associated with receipt of a new ASRD diagnosis. A total of 1069 of 3054 patients (35.0%) received a new ASRD after initiation. Median time to diagnosis was 199 days (IQR: 54-342). Female sex at birth, younger age, baseline benzodiazepine exposure, sedative use disorder, major depression, and other mood or personality disorders were associated with higher hazard of incident diagnosis. Patients initiated via telehealth were less likely to receive an anxiety diagnosis than those initiated in other settings (aHR 0.78; 95% CI: 0.62-0.98). Sensitivity analyses excluding benzodiazepine-exposed patients yielded similar results. More than one-in-three initiating buprenorphine received an ASRD diagnosis in the first year of treatment. These findings support routine mental health screening at treatment onset, particularly for patients with sedative use or mood disorders, and highlight the need to examine diagnostic practices in telehealth settings.