There are several limitations to note. First, although the MarketScan data benefit from a large, national sample with ample longitudinal follow-up, measurement error cannot be ruled out, such that medication coverage does not always reflect actual consumption. Furthermore, patients with OUD without observed AUD claims may have a history of treated or untreated AUD not reflected in recent insurance claims. However, we observed a higher prevalence of naltrexone use in patients with AUD claims, and we also observed significant differences in OUD medication treatment outcomes between patients with OUD with recent AUD claims and peers without such claims, suggesting that the distinction between these 2 groups may be clinically meaningful and thus warrants more research. Second, unmeasured time-varying factors associated with alcohol-related admissions and OUD medication exposure can introduce confounding in case-control designs. We mitigated this, however, by including calendar time and time from event as covariates and restricting participants to 2-year observation periods surrounding the index event in order to reduce heterogeneity in observation time. We also used bidirectional sampling in order to reduce overlap bias resulting from control
