OBJECTIVES : Three medication-assisted treatments (MATs) are FDA-approved to treat opioid use disorder (OUD): buprenorphine, naltrexone, methadone. Differences among MAT-treated patients are not well established. This study compares demographic and clinical characteristics and MAT-related healthcare resource utilization (HCRU) among patients initiating MAT.

METHODS : In IBM MarketScan® Commercial Claims and Encounters Database, patients aged 12-64, enrolled for 12 months prior to, and 6 months following, initial OUD diagnosis between January 1, 2012 and December 31, 2017, with at least one prescription for MAT following diagnosis were selected. Patient characteristics and MAT-related HCRU were compared between MAT-treated groups.

RESULTS : Among 96,380 OUD patients, 30% initiated on buprenorphine, 8% naltrexone, and 1% methadone. Patients prescribed naltrexone were, on average, younger (31.86) than those on buprenorphine (34.33) and methadone (36.62). Time from OUD diagnosis to treatment was longest for naltrexone patients (210.96 days), compared to methadone (147.87) and buprenorphine (114.53).

Naltrexone patients had higher proportions of mental health-related comorbidities than those on buprenorphine and methadone, including ADHD (20%, 14%, 8%, respectively), anxiety (38%, 27%, 21%), depression (28%, 15%, 10%), and alcohol dependence (22%, 3%, 1%). Patients on buprenorphine had higher proportions with chronic pain (43%) than those on methadone (34%) and naltrexone (33%).

Within six months of diagnosis, 43% of MAT patients received psychotherapy, of which naltrexone patients had higher proportions (57%) and more encounters (mean=7.34, SD=14.11) for psychotherapy than buprenorphine (40%; mean=3.96, SD=9.71) and methadone (23%; mean=1.81, SD=6.31). Naltrexone patients also had higher proportions (86%) and more encounters (mean=21.19, SD=24.87) for intensive outpatient/partial hospitalizations than buprenorphine (81%; mean=8.27, SD=15.40) and methadone (40%, mean=3.50; SD=13.57).

CONCLUSIONS : Using real-world evidence, this study highlights distinct differences in demographics, clinical conditions, and HCRU among OUD patients initiating one of three MATs. Research is warranted to assess factors contributing to initial MAT type and access to other OUD-related treatments.