Sociodemographic Factors Associated with Opioid Agonist Treatment Receipt and Retention at an Integrated Safety-Net Health System

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Abstract
Sociodemographic differences in opioid use disorder (OUD) treatment engagement have implications for population health. Continuum of care models can guide the opioid epidemic response by identifying differences in treatment patterns. We evaluated one such model at an integrated, safety-net health system in Denver, Colorado and examined the association of patient characteristics with opioid agonist treatment (OAT) receipt and retention. We identified a cohort of patients with OUD from 2023 to 2024 from electronic health records. We used multivariable regression to estimate the association of sociodemographic and health factors with OAT receipt and 90-day retention. Of 8,954 patients with OUD, 40% received OAT and 40% of those were retained on OAT at 90 days. Non-Hispanic Black patients and those with co-occurring alcohol use disorder had a lower likelihood of OAT receipt (Risk Ratio [RR] vs non-Hispanic White 0.68, 95% CI: 0.62-0.76; RR vs no alcohol use disorder: 0.88, 95% CI: 0.83-0.32). Patients without insurance and young adults aged 18-24 years had a lower likelihood of OAT receipt and retention. Those with co-occurring mental health conditions had a higher likelihood of OAT receipt and retention. Co-occurring stimulant use disorder, age 55+, and medical comorbidities had differential associations between OAT receipt and retention. Associations between patient characteristics and OAT receipt and retention suggest three patterns: cumulative disadvantage with factors associated with both lower treatment and retention; uneven disadvantage for factors associated with either decreased treatment or retention; and inverse associations wherein factors showed benefit in one stage but disadvantage in the other.

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