Racial Disparities in Payment Source of Opioid Use Disorder Treatment among Non-Incarcerated Justice Involved Adults in the United States

Background: Research has documented low rate of opioid use disorder (OUD) treatment utilization among individuals involved in the criminal justice system. However, racial and ethnic differences in sources of payment for OUD treatment have not been examined in the literature.

Aim of the study: Although substance use disorder (SUD) treatment is relatively rare for all criminal justice system involved racial-ethnic groups, previous research has indicated that, among individuals with SUD, those from racial-ethnic minority groups receive treatment at lower rate compared to their non-Hispanic White counterparts. Given the alarming rise of OUD in the US and association between source of payment and utilization of health care services, this study seeks to quantify racial and ethnic differences in sources of payment for OUD treatment among individuals with a criminal justice involvement.

Method: Using data from the 2008 - 2016 National Survey of Drug Use and Health (NSDUH), this study analyzes data on non-incarcerated individuals with OUD who had any criminal justice involvement in the previous 12 months. An extension of the Blinder-Oaxaca decomposition
method for non-linear models is implemented to determine the extent at which differences in OUD treatment utilization across non-Hispanic Blacks and non-Hispanic Whites are explained by observed and measurable characteristics or unobserved factors.

Results: Results indicate that non-Hispanic Whites are more likely to have their OUD treatment paid through a court (10%) relative to non-Hispanic Blacks (4.0%). Black-White differences in measurable factors explain 87% of the disparity, while the rest is attributed to unobserved factors.
Non-Hispanic blacks are more likely to have their OUD treatment paid by public insurance (77% vs 36%) than non-Hispanic Whites and only 72% of this disparity can be explained by observed characteristics.

Implications for Health Policy: Our findings indicate race/ethnicity disparities in utilization of OUD treatment among the criminal justice involved population. Expansion of health insurance coverage and more equitable treatment options in the justice system that incentivize more OUD treatment availability may help address the racial/ethnic disparities in sources of payment among the criminal justice system involved population with OUD.