Typology of laws restricting access to methadone treatment in the United States: A latent class analysis.

Abstract

In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership. A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated. States (n=50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n=13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n=14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n=23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1vs Class 3, aRRR:3.92; 95%CI:1.25-12.22). States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.