# Identifying Disparities in the Cascade of Care for Medicaid-Enrolled Youth with Opioid Use Disorder

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2022 · $597,957

## Abstract

PROJECT SUMMARY/ABSTRACT:
Two-thirds of individuals with opioid use disorder (OUD) first misuse opioids before age 25. Intervention early
in the life course is critical, and requires that adolescents and young adults (hereafter, “youth”) receive high-
quality care in a continuum of care. Optimizing clinical care at every stage in this continuum is critical, and
cannot be achieved alongside persistent racial and ethnic disparities. To lay the groundwork for quality
improvement nationwide in Medicaid programs—the primary insurers for youth of color in the US—this project
will apply the Cascade of Care framework to OUD identification and treatment in youth. The Cascade
describes a series of 5 stages, i.e., how many youth with OUD (i) are identified (“diagnosis”), (ii) begin
treatment (“initiation”), (iii) start medications for opioid use disorder (“MOUD”), (iv) stay in treatment in the
short-term (“engagement”), and (v) stay in treatment in the long term (“retention”). Analyses will use newly
released Medicaid data from across US states linked to numerous national databases to provide key county-
and state-level information. The central objective is to provide a comprehensive picture of the Cascade for
youth aged 13-25 with OUD, throughout focusing on disparities. Specific Aims are to: (1) Apply the Cascade of
Care framework to youth with OUD and estimate racial and ethnic disparities at each stage, using a systematic
approach to uncover underlying, potentially intervenable mechanisms contributing to disparities; (2) Determine
whether MOUD receipt is associated with subsequent treatment engagement and retention, and with smaller
racial and ethnic disparities, thus informing whether MOUD might be a strategy to reduce inequities in OUD
treatment; and (3) Determine whether the Cascade is associated with emergency department use and
hospitalizations, thus identifying whether real-world clinical outcomes worsen when youth leave the Cascade,
and whether such outcomes are disproportionately experienced by youth of color. Throughout, race is
conceptualized as a social (not biological) construct, and the project seeks to identify ways that the operation
of healthcare systems and legal and regulatory climates contribute to health disparities, in order to ultimately
guide policy change. The research team brings together expertise in youth, OUD treatment, health disparities,
community engagement, health services research, and relevant statistical approaches. The project will be
guided by a diverse Youth and Family Advisory Board to inform protocol development, analysis, interpretation,
and dissemination of findings, with a goal of maximizing relevance and delivery of results to youth and families,
as well as key stakeholders nationally.

## Key facts

- **NIH application ID:** 10584158
- **Project number:** 1R01DA057566-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Scott Evan Hadland
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $597,957
- **Award type:** 1
- **Project period:** 2022-09-15 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10584158

## Citation

> US National Institutes of Health, RePORTER application 10584158, Identifying Disparities in the Cascade of Care for Medicaid-Enrolled Youth with Opioid Use Disorder (1R01DA057566-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10584158. Licensed CC0.

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