Abstract
While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.
Highlights
The opioid crisis has affected US individuals from all walks of life
medication for opioid use disorder (MOUD) Availability in Residential Treatment Facilities Of the 13 585 facilities reporting to the National Survey of Substance Abuse Treatment Services (N-SSATS) in 2017, only residential treatment facilities within the 50 states and District of Columbia were included (2863 [21.1%])
Association of State-Level Medicaid Policy With MOUD Use Among Residential Facility Admissions Of 2 005 395 admissions reported to Treatment Episode Data Set–Admissions (TEDS-A) in 2017, only admissions that identified opioids as the patient’s primary drug of choice and took place at residential treatment facilities within the 50 states or District of Columbia were included in these analyses (232 414 [11.9%])
Summary
The opioid crisis has affected US individuals from all walks of life. To address this public health emergency, it is crucial to transition individuals with active opioid use disorder (OUD) into long-term, meaningful recovery.[1,2] Residential treatment facilities are frequently viewed as the highest level of care across substance use disorders, providing an expensive[3,4] yet effective means of addressing the challenges that occur in early recovery,[5,6] often through comprehensive behavioral interventions that provide a foundation for long-term recovery.[7]. Several medications for OUD (MOUDs) are considered by the medical community to be the criterion standard in initiating and sustaining long-term OUD recovery.[2] Despite current public health efforts to bridge paraprofessional and medical care,[10,11] most individuals with OUD still do not have access to or receive any form of MOUD.[12,13] Broadly speaking, US Food and Drug Administration– approved MOUDs act on the μ-opioid receptor and include the full agonist methadone,[14] the partial agonist buprenorphine (sublingual,[15] subdermal implants,[16] and extended-release depot injections17), and the antagonist naltrexone (oral and extended-release depot injections [XR-NTX]18) These MOUDs are frontline treatments for moderate to severe OUD, potential patients continue to face challenges with insurance coverage and treatment accessibility,[19] and clinicians continue to face legal and practical barriers to prescribing MOUDs.[20,21,22,23,24]
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