Comorbid Health Conditions and Treatment Utilization among Individuals with Opioid Use Disorder Experiencing Homelessness

Abstract

Abstract Background People experiencing homelessness have been particularly hard hit by the opioid crisis. This epidemic has also impacted individuals experiencing homelessness in ways that are distinct from how it has impacted individuals with stable housing. However, not much is known about comorbid health conditions and health services utilization among adults with opioid use disorder (OUD) who are experiencing homelessness. Method A retrospective observational cohort study was conducted utilizing a large national all-payer electronic health record database. The sample for the analysis is comprised of 2,080 individuals with OUD who had an ICD-10 Z code of homelessness (Z59.0), and the comparison group includes 980 individuals with OUD covered under Medicaid who were matched on age and gender to the homeless population. Results Higher rates of mental health conditions such as bipolar disorder (48%) and schizophrenia (22%) were present among individuals with OUD experiencing homelessness compared to individuals with OUD covered under Medicaid not experiencing homelessness (26% and 8%, respectively). In addition, higher rates of alcohol (44%) and stimulant abuse (30%) were also present among the patients compared to the comparison group (29% and 9%, respectively). Utilization of buprenorphine for OUD and treatment for mental health conditions were low among the patients experiencing homelessness. Conclusion Underlying mental health conditions and polysubstance use contribute toward making individuals experiencing homelessness more susceptible to adverse health outcomes associated with OUD. Health policy initiatives directed toward treatment engagement might benefit from an emphasis on addressing housing instability that many individuals with OUD might be experiencing.