Substance Abuse Programs Research Articles

North Carolina, UNC partner on MH hospital for young people

The N.C. Department of Health and Human Services is partnering with UNC Health to open a 54‐bed hospital for children and teens experiencing mental health crises, WUNC 91.5, North Carolina Public Radio, reported Dec. 13. Across the state's hospitals, an average of more than 250 people wait for behavioral health services in emergency departments every day. That includes more than 50 children and adolescents, according to state data. The average waiting time to get out of the ER is 57 hours. “A busy emergency room is no place for anyone, let alone a child or adolescent who is having a behavioral health crisis,” said Dr. Wesley Burks, CEO of UNC Health. Leading research shows that community‐based care is generally better, but the state says it needs these high level services as well. It can take up to three months for a patient to be seen in an outpatient setting, a time lag that may worsen a mental health crisis. “If you were to walk through the psych emergency department at UNC or anywhere else, you would see massive suffering and families literally living in the emergency department,” said Dr. Samantha Meltzer‐Brody, chair of the UNC department of psychiatry. “This is a very critical step forward.” North Carolina Department of Health and Human Services secretary Kody Kinsley said the state is investing in more community‐based care. “But we also have kids today sitting in emergency departments and other places that have nowhere to go, where more at‐home services and more prevention services are not going to make a difference for them today,” he said. “We have got to address the crisis at hand, and we also are committed to investing in resources in the community.” The hospital will be developed at the R.J. Blackley Alcohol and Drug Abuse Treatment Center in Butner. That facility is one of three state operated North Carolina Alcohol and Drug Abuse Treatment Centers specifically designed to provide medically‐monitored detoxification/crisis stabilization. Kinsley says there's enough capacity throughout the system that these treatment and stabilization and services will still be provided to those in need.

How 42 CFR Part 2 changes affect OTPs – methadone and PDMPs

H. Westley Clark, M.D., J.D., is the former director of the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that has proposed to amend 42 CFR Part 2, the regulation protecting the confidentiality of alcohol and drug abuse treatment patient records. In a massive notice of proposed rulemaking (NPRM) published in 2019, SAMHSA proposed to remove the ban against giving opioid treatment program (OTP) patient data — methadone being the key medication — to prescription drug monitoring programs (PDMPs). That ban was instituted by Clark himself when, as CSAT director, he issued a “Dear Colleague Letter” to OTPs telling them they should not give patient medication data to the PDMP, but rather should check the PDMP to see what medications their patients are on. The rationale for the letter was the same as the rationale for opposition to SAMHSA's NPRM: Patients would not want to go to treatment if they knew their methadone information could be shared without their consent.

The Effect of Peer Support on Treatment Engagement for Opioid Use Disorder.

Opioid misuse has been a growing problem in the United States that has escalated into a national public health emergency. Despite substance abuse programs that offer assistance in the treatment of opioid use disorder (OUD), keeping clients engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety. This research compares two different approaches to treatment of OUD to assess relative treatment adherence. The purpose of this research is to establish whether a peer support-based treatment methodology, combined with increased medication-assisted treatment, provided by an outpatient facility is more effective than treatment-as-usual in improving client engagement in recovery treatment. The research analyzed data collected over a 6-month period by a facility. The retrospective review of data compared a total of 1,570 clients enrolled in a certified recovery services (CRSs) program versus individuals engaged in treatment-as-usual program. Inclusion criteria consisted of clients with at least one diagnoses of OUD who met level of care requirements. Statistical t-test analysis revealed greater engagement in recovery services among those enrolled in the CRS program. The findings support the benefits of a peer support program as a treatment methodology for clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines.

Psychoactive Substance Effect on Mental Health and Well-Being Focusing on Student-Aged Lithuanian Cohort of Sexual Minorities

Mental health refers to cognitive, behavioral, and emotional well-being. However, significant research gaps are still found in disclosing the disparities in mental health outcomes between heterosexual and sexual minority (SM) individuals during the period of 20–24 years of age. Therefore, the aim of this study was to assess the association between the prevalence of psychoactive substance use and the severity of anxiety or depressive symptoms, and well-being across SM and non-SM student-aged populations (N = 1330). This cross-sectional study was conducted in Lithuania over the period of fifteen months following the beginning of the COVID-19 pandemic. This study concentrated on the mental health symptomatology, well-being status, and the prevalence of the psychoactive substance use, which were measured by three screening instruments. In terms of negative well-being, mental health problems, and health-risk behaviors, it was found that the SMs were potentially more exposed than the non-SMs. The current study also revealed a significant impact of substance use (alcohol consumption, cigarette smoking) on the symptoms of anxiety (adjusted odds ratios (AOR) 1.6 (95% confidence interval (CI): 1.0–2.6), AOR 1.5 (95% CI: 1.0–2.2)), and negative well-being (AOR 1.7 (95% CI: 1.0–2.8), AOR 1.7 (95% CI: 1.1–2.5)) across the SM student-aged group. The association between the increased self-administration of cannabis and positive mental health outcomes appertained to milder anxiety symptoms amid SMs has been identified (AOR 0.5 (95% CI: 0.2–0.9)). Given that minority stressors could play an important part in mediating between the sexual orientation and negative outcomes of mental and behavioral health in student-aged populations, health strategies should focus on the development of effective substance abuse and drug prevention programs, both student-centered and SMs-centered, aimed to reduce health-risk behaviors in emerging adulthood.

Comparison of neonatal outcomes in pregnant women undergoing medication-assisted treatment of opioid use disorder with methadone or buprenorphine/naloxone

Introduction The number of pregnant women with opioid use disorder (OUD) has quadrupled from 1999 to 2014. Current first line treatment for OUD in pregnancy is methadone with increasing support for buprenorphine. Limited data exist on use of buprenorphine/naloxone for OUD in pregnancy despite it being standard therapy in the non-pregnant individuals. The aim of this study was to compare neonatal opioid withdrawal syndrome (NOWS) prevalence and characteristics among neonates born to women prescribed methadone and buprenorphine/naloxone. Methods This is a retrospective cohort analysis of mother–neonate dyads treated with either methadone or buprenorphine/naloxone for OUD in pregnancy who received prenatal care in the substance abuse, treatment, education, and prevention program (STEPP) clinic and delivered at OSU. Primary neonatal outcomes included: neonates diagnosed and treated for NOWS, peak scores on Modified Finnegan Neonatal Abstinence Score (FNAS), number of scores ≥9 on FNAS, and duration of treatment for NOWS. Secondary outcomes included: fetal growth restriction, preterm birth (<37 weeks), neonatal head circumference, birth weight, NICU admission, five-minute Apgar score, and length of hospitalization. Results From 2013 to 2017, we identified 588 mother–neonate dyads: 149 treated with methadone and 439 treated with buprenorphine/naloxone. Ninety-eight neonates (65.8%) in the methadone group were diagnosed with NOWS requiring pharmacological interventions compared with 170 (38.7%) in the buprenorphine/naloxone group (aOR 3.46, 95% confidence interval (CI) 2.31–5.20, p < .01). Methadone-exposed neonates were six times more likely to be treated with >1 medication for NOWS (aOR 6.32, 95% CI 2.20–18.13, p < .01). Fetal growth restriction was diagnosed more often in the methadone group compared to the buprenorphine/naloxone group (aOR 1.73, 95% CI 1.02–2.93, p < .01). Significant maternal findings were that women using methadone for OUD started PNC earlier (15w vs. 17w, p = .04) and were less likely to be taking selective serotonin-reuptake inhibitors (SSRIs) (15% vs. 25%, p = .02) compared to the buprenorphine/naloxone group. Conclusions Buprenorphine/naloxone treatment for OUD in pregnancy appears safe and has decreased NOWS and pharmacologic intervention for the neonate.

Hurricane season and addiction: SAMHSA guidance to OTPs

The Substance Abuse and Mental Health Services Administration (SAMHSA) has said that patient safety comes first, which means that Opioid Treatment Program (OTP) patients may get increased methadone take‐homes even without permission. Preemptive guidance to obtain approval from the OTP's State Opioid Treatment Authority (SOTA) — an office within the state alcohol and drug agency — already has been issued by SAMHSA's Center for Substance Abuse Treatment (CSAT), which regulates OTPs. The SOTA approval to close the OTP can come either via the OTP extranet (an internet that can only be accessed by authorized users), or verbally to the OTP sponsor (owner), said Christopher Garrett, SAMHSA spokesperson. In addition, requests to close may be submitted to SAMHSA retroactively, he told ADAW last week, as Hurricane Ian was bearing down on Florida.

The implications of borderline personality features for jail inmates' institutional misconduct and treatment-seeking.

Borderline personality disorder (BPD) is common in jails and prisons. In a sample of 506 jail inmates (30% female), we examined whether BPD symptoms assessed upon incarceration predict subsequent institutional misconduct and treatment-seeking. BPD features modestly predicted occurrence (vs. nonoccurrence) of institutional misconduct. Importantly, BPD did not predict the number of institutional misconduct incidents. That is, BPD was not associated with frequent, repeated difficulties in institutional adjustment. Consistent with previous research showing a relationship between BPD and past treatment-seeking in clinical and community samples, jail inmates' BPD features significantly predicted subsequent requests for treatment. Regarding specific types of treatment, the relationship held for substance abuse programs and forensic mental health services but not for psychoeducational services or support groups. There were very few moderators of the link between BPD and subsequent institutional misconduct and treatment-seeking. Most of the observed relationships held across sex, race, and age. Findings of the study indicate that jail staff and clinicians must learn to distinguish between initial adjustment problems and frequent misconduct among inmates high in BPD to facilitate their adjustment. The study further highlights the need for BPD-relevant treatments and services in jails. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Angela's psych squad": Black psychology against the American carceral state in the 1970s.

This article examines the duality of the Black psychology movement in the United States as both a distinctly American and a postcolonial approach to mental health. The Westside Community Mental Health Center in San Francisco served as the organizational hub for the Association for Black Psychologists (ABPsi) in the 1970s. The Westside clinicians understood forensic psychology as a kind of preventative care as California, more so than any other state, was seduced by the eugenic dream of human improvement through therapeutic interventions in schools and prisons intended to correct the wayward deviant. Their community's mental wellbeing required dismantling the interlinked disciplinary apparatus which disproportionately surveyed, tracked, and confined young Black men. These psychologists mounted a legal challenge to the use of intelligence testing to sort Black children in schools, seeking to replace standardized tests with "dynamic assessments" inspired by Israeli psychologist Reuven Feuerstein's work with refugee children. They consulted on the voir dire process in the highly politicized Angela Davis trial to minimize the presence of racially prejudiced jurors. They offered expert testimony on the psychological damage of solitary confinement on behalf of prison activists. The Westside team artfully developed and deployed the psychological concept of "bias" in their confrontations with local manifestations of the American carceral state. In their theoretical writings, these psychologists reflected upon their historical positionality, understanding themselves as products of the decolonial moment. Bay Area encounters with Third World internationalism, the Black Panther Party (BPP), the Nation of Islam, and community-led substance abuse programs shaped clinical care at Westside and inspired the Afrocentric consciousness many came to espouse. ABPsi initially had a significant impact on the historically white American Psychological Association's training practices. However, the two organizations split over the IQ controversy at a moment when psychologists became increasingly enmeshed in the criminal justice system.

Much more in store before, and if, H.R. 7666 becomes a reality

Last month, the House of Representatives passed H.R. 7666, which would alter much treatment for opioid use disorder and revamp many Substance Abuse and Mental Health Services Administration (SAMHSA) programs (see House passes H.R. 7666, setting stage for revamping SAMHSA, ADAW June 27, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33477). However, there's a lot to be done before, and if, this package passes the Senate.

Evaluating the Effectiveness of Short-term Clinical Guideline to Treat Sexual Addiction Disorder in People With Sexual Addiction: A Clinical Trial

Objectives Sex addiction is one type of behavioral addiction that is characterized by extreme fantasies and hard-to-control sexual behaviors. This disorder causes problems in the lives of affected people and their victims. The treatment is non-pharmacological and psychological, which are time-consuming and expensive. Short-term interventions are one of the ways to help these people. This study aims to evaluate the effectiveness of short-term clinical guidelines to treat sexual addiction disorder in affected individuals. Methods This was a randomized clinical trial study with pre-test-post-test and follow-up. The studied population in this research included all people with sexual addiction disorder who live in Isfahan City, Iran. The statistical population was those who had the chance to be included in the study. These were individuals who were referred to outpatient and residential drug abuse treatment centers, psychiatric treatment centers, and sexual disorders treatment clinics. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into 2 intervention and comparison groups. The intervention group received ten 120-min therapy sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed the HBI three times. The first time was immediately before the treatment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed via repeated measures analysis of variance (RM-ANOVA) in the SPSS software, v. 22. Results In the present study, there were 30 patients with a sexual addiction disorder, of which 15 were in the intervention group and 15 were in the comparison group (the Mean age of the participants was 26.4 years). The Mean scores of HBI in the intervention group in the pretest, post-test, and follow-up stages were 67, 49, and 57, respectively, while the mean scores of HBI in the comparison group were 64, 60, and 59 for the pretest, post-test, and the follow-up, respectively. Repeated measurement findings showed that this clinical guideline is effective in reducing participants’ sexual addiction symptoms (P‌&lt;‌0.01). Conclusion Clinical guideline for short-term treatment of sexual addiction disorder is effective in reducing the symptoms of sexual addiction disorder. Using this method, which can be held online, and considering its short time and reduced cost of treatment, allows more people to benefit from it.

Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States

IntroductionLesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). MethodsWe contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and “special programs/groups” for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; and the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). ResultsOf the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. ConclusionsThe lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.

SAMHSA announces almost $1.5 billion in new SOR grants

On May 19, the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), announced that it is accepting applications for the fiscal year (FY) 2022 cohort of the State Opioid Response (SOR). Only single state agencies (NASADAD members) and territories can apply. From the funding opportunity announcement: “The purpose of this program is to address the opioid overdose crisis by providing resources to states and territories for increasing access to FDA‐approved medications for the treatment of opioid use disorder (MOUD), and for supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder (OUD) and other concurrent substance use disorders. The SOR program also supports the continuum of care for stimulant misuse and use disorders, including for cocaine and methamphetamine. The SOR program aims to help reduce unmet treatment needs and opioid‐related overdose deaths across America.” There will be 59 awards for the grants, which are for up to 2 years. No cost sharing is required. Applications are due July 18. For more on the grant, go to https://www.samhsa.gov/grants/grant‐announcements/ti‐22‐005.

Lawmakers call for increased funding for SAMHSA

Last month a group of representatives called on the U.S. House Committee on Appropriations to increase funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), in particular, for the Center for Substance Abuse Treatment (CSAT), the Center for Substance Abuse Prevention (CSAP), and the Substance Abuse Prevention and Treatment (SAPT) Block Grant.

How access to addictive drugs affects the supply of substance abuse treatment: Evidence from Medicare Part D.

This paper documents how substance abuse treatment (SAT) providers and services respond to increases in population-level opioid addiction. I do this by exploiting the implementation of Medicare Part D as an exogenous increase in the availability of prescription opioids. Starting in 2006, states with higher shares of the population eligible for Medicare Part D experienced increases in residential and hospital inpatient SAT facilities, beds dedicated to SAT, and SAT facilities offering medication-assisted treatment, relative to states with lower shares. These results suggest that the supply of SAT in the United States is capable of responding significantly to changes in demand.

Urinalysis based assessment of compliance and drug use patterns in patients prescribed tramadol: A cross-sectional study from a tertiary care centre.

Strict adherence to pharmacological dosage regimens is a prerequisite to the success of most treatments, particularly for patients in drug abuse programs. The compliance of tramadol, an atypical non-scheduled narcotic analgesic, using objective method has not been adequately studied in an Indian setting. To evaluate the compliance and pattern of drug use among opioid-dependent subjects prescribed tramadol based on urinalysis. Fifty male opioid-dependent patients (ICD 10), seeking treatment at a tertiary de-addiction treatment centre of North India on tramadol prescription for atleastpast four weeks were included. Self-reported substance use was recorded using semi-structured proforma. Ten ml of urine was collected for the assessment of compliance of tramadol of other substance use (morphine, buprenorphine, dextropropoxyphene, pentazocine, cannabis, benzodiazepines, pheniramine). All these drugs were analyzed using the immunoassay-based Cassette test and Gas Chromatography in human urine. Mean age of the participants was 42.8 years and the mean duration of opioid use was 15.9years. The urine specimen of all subjects tested positive for tramadol. Urinalysis revealed benzodiazepines, cannabis, and pheniramine to be the most common substances of use in this population. It was seen that agreement of self-reporting and urine test results was good for morphine (κ=0.558) and cannabis (κ=0.312) and was poor for buprenorphine, pentazocine, and pheniramine. The study demonstrates the continued use of several illicit or non-prescribed medications in a medication-assisted opioid treatment population. The results affirm the reliability of urinalysis as an adjunct for testing compliance in such a population.

The Effectiveness of Interpersonal Psychotherapy on Alexithymia, Emotion Regulation, and Psychological Capital of Male Substance Abusers Treated by Addiction Treatment Centers in Kerman.

Addiction is a psychiatric disorder with biological, psychological, and social aspects. Literatures indicated that alexithymia, emotional dysregulation, and low psychological capital affect substance abuse. This study investigated the effectiveness of interpersonal psychotherapy on alexithymia, emotional regulation, and psychological capital of male substance abusers. This quasi-experimental study was conducted in 2021 in Kerman, Iran using a pretest, post-test design with a control group. A single therapy center was randomly selected via the multi-stage cluster method from several substance abuse treatment centers. 50 people were randomly selected and allocated to experimental and control groups. The research instruments were questionnaires for alexithymia, emotional regulation, and psychological capital. After the pretest phase, the experimental group underwent 12 sessions of interpersonal psychotherapy. In the next step, the post-test was conducted and after 6 weeks the follow-up test was performed on the groups. The control group did not receive the treatment. Finally, the data obtained from 40 participants were analyzed using the MANCOVA test by SPSS25 statistical software. Our findings indicated significant MANCOVA results for alexithymia (F=65.14 and P<0.05), emotion regulation (F=44.72 and P<0.05) and psychological capital (F=12.05 and P<0.05) showing a significant difference between the scores of dependent variables in the experimental group and control group. The results showed that interpersonal psychotherapy improves the state of alexithymia, emotional regulation, and psychological capital in substance abusers. It can also be used as an effective intervention in addiction treatment centers.

The profile of amphetamine users in a substance abuse treatment center in Mexico

Introduction: in Mexico, amphetamine use is a public health problem. Objective: to describe the profile of consumers of amphetamines. Method: it was retrospective and cross-sectional study. The medical records of those admitted to the state Cúspide substance abuse treatment center, during the period 2016-2018, were reviewed. Results: 112 patients (89 men, 23 women) were analyzed. The profile included a patient with high school (40.2%), coming from an unstructured (67.9%) and dysfunctional family (93.8%) with poor parental affective relationship, alcoholism in the family nucleus (55.3%), early onset of sexual activity, alcohol and tobacco consumption; impulsive personality, suicide attempts (35.7%), and injuries to third parties and theft (73.2%). Discussion and conclusions: amphetamine use and rising prevalence behavior are a reality; the problem goes beyond the field of health and becomes a social problem that potentially involves the entire population to a greater or lesser extent. Knowing the epidemiological profile of the amphetamine consumer is a reference for implementing health policies and establishing preventive and therapeutic measures in order to solve the problem.

A service evaluation of the Behavioural Treatment for Substance Abuse (BTSA) programme for forensic dual diagnosis populations

ABSTRACT Literature links mental health problems comorbid with substance abuse with increased recovery time. There is limited research evaluating the effectiveness of substance abuse treatments for dual-diagnosis patients. This project aimed to evaluate the effectiveness of the BTSA group with this population. Questionnaires measuring motivation, locus of control, confidence to abstain and self-efficacy were administered to six different cohorts of BTSA participants (N = 38) at baseline, post, and follow-up stages. In addition, participants from the most recent BTSA cohort (N = 4) attended a post-program focus group, to provide information about their experiences of the intervention. Statistical analyses revealed that participants’ confidence in their ability to manage substance abuse was significantly higher post group, but the hypotheses that there would also be significant improvements in participants’ self-efficacy, motivation, and locus of control following completion of the program were not supported. Thematic analysis identified three key themes relevant to participants, namely validation, psychoeducation and identifying progress. This project provided valuable insights into participants’ experiences of the group, highlighting what they had gained form the intervention, and the impact on them from having Recovery Champions working in conjunction with NHS staff to facilitate the intervention. Limitations are discussed, alongside recommendations for improving the program.

The Small Body Outline Drawing and Art Therapy With a Female Substance Use Disorder Patient to Facilitate Mindful Processing of Trauma: A Case Report (Le petit dessin de contour du corps et l’art-thérapie avec une patiente souffrant d’un trouble d’abus de substances pour faciliter le traitement conscient du traumatisme : un rapport de cas)

This case report provides detail with which to gain a further understanding of the small body outline drawing as an art therapy innovation and tool of art therapy practice used for the treatment of substance use disorder. This report focuses on the experience of an adult female patient who has been diagnosed with alcohol and stimulant use disorder and who had experienced sexual abuse and related trauma. The patient participated in a weekly art therapy group at a women’s 90-day residential substance abuse program, where she created a small body outline drawing. The patient made significant progress throughout the course of her treatment and maintained sobriety for at least one year following this treatment. The small body outline drawing, within the context of art therapy and in combination with a 12-step group and individual therapy, was observed to have assisted the patient in maintaining sobriety through the facilitation of verbal and mindful expression of past trauma.

Identifying barriers to emergency department-initiated buprenorphine: A spatial analysis of treatment facility access in Michigan.

Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers. Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5miles, and 66 (50.4%) had a facility within 10miles. EDs within 10miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p<0.0001) and annual patient volumes (58,616 vs. 17,484; p<0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p=0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress. Only half of Michigan EDs are within 10miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.