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[Submitted on 19 Aug 2026] Title:Toward Fairness in Machine Learning Models for Predicting Treatment Retention and Premature Discontinuation in Medication for Opioid Use Disorder View a PDF of the paper titled Toward Fairness in Machine Learning Models for Predicting Treatment Retention and Premature Discontinuation in Medication for Opioid Use Disorder, by Tongnian Wang and 5 other authors View PDF HTML (experimental) Abstract:Persistent low retention and completion rates in medications for opioid use disorder (MOUD) have driven the use of machine learning (ML) models to predict retention and identify patients at risk of premature discontinuation. However, the fairness of these models across patient populations remains largely unexplored, raising concerns about their application in treatment decision support. This study systematically assesses algorithmic fairness in ML models for predicting MOUD retention and premature discontinuation and investigates the effectiveness of bias mitigation techniques. Using the cross-sectional Treatment Episode Data Set-Discharges (TEDS-D), which includes treatment episodes for individuals in the U.S. discharged between 2015 and 2019, we trained four ML models to predict premature treatment discontinuation and retention beyond 180 days among individuals receiving outpatient MOUD. We evaluated overall performance and subgroup-level error rates across patient subgroups defined by race, ethnicity, age, and sex, complemented by model explanation analyses. We further assessed bias mitigation techniques and their effects on both fairness and predictive performance. Our findings demonstrate that ML models for MOUD outcome prediction can exhibit subgroup-level performance gaps even when overall predictive performance appears acceptable and that bias mitigation can reduce, but not fully eliminate, these gaps without trade-offs. By demonstrating the importance of fairness-aware evaluation and transparent reporting of subgroup performance, this study provides practical insights for the responsible and context-sensitive use of ML models for risk stratification and care prioritization in MOUD treatment settings. Subjects: Machine Learning (cs.LG); Computers and Society (cs.CY) Cite as: arXiv:2609.22113 [cs.LG] (or arXiv:2609.22113v1 [cs.LG] for this version) https://doi.org/10.48550/arXiv.2609.22113 arXiv-issued DOI via DataCite Submission history From: Tongnian Wang [view email] [v1] Wed, 19 Aug 2026 03:27:43 UTC (1,937 KB) Full-text links: Access Paper: View a PDF of the paper titled Toward Fairness in Machine Learning Models for Predicting Treatment Retention and Premature Discontinuation in Medication for Opioid Use Disorder, by Tongnian Wang and 5 other authors View PDF HTML (experimental) TeX Source view license Current browse context: cs.LG new | recent | 2026-09 Change to browse by: cs cs.CY References & Citations NASA ADS Google Scholar Semantic Scholar Loading... Data provided by: Bibliographic Tools Bibliographic and Citation Tools Bibliographic Explorer Toggle Bibliographic Explorer (What is the Explorer?) Connected Papers Toggle Connected Papers (What is Connected Papers?) Litmaps Toggle Litmaps (What is Litmaps?) scite.ai Toggle scite Smart Citations (What are Smart Citations?) Code, Data, Media Code, Data and Media Associated with this Article alphaXiv Toggle alphaXiv (What is alphaXiv?) Links to Code Toggle CatalyzeX Code Finder for Papers (What is CatalyzeX?) DagsHub Toggle DagsHub (What is DagsHub?) GotitPub Toggle Gotit.pub (What is GotitPub?) Huggingface Toggle Hugging Face (What is Huggingface?) ScienceCast Toggle ScienceCast (What is ScienceCast?) Demos Demos Replicate Toggle Replicate (What is Replicate?) Spaces Toggle Hugging Face Spaces (What is Spaces?) Spaces Toggle TXYZ.AI (What is TXYZ.AI?) Related Papers Recommenders and Search Tools Link to Influence Flower Influence Flower (What are Influence Flowers?) Core recommender toggle CORE Recommender (What is CORE?) IArxiv recommender toggle IArxiv Recommender (What is IArxiv?) Author Venue Institution Topic About arXivLabs arXivLabs: experimental projects with community collaborators arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website. Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them. Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs. Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)