Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States

Abstract

IMPORTANCE 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. OBJECTIVE 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. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. MAIN OUTCOMES AND MEASURES Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone).

Adults With Opioid and Methamphetamine Co-use Have Lower Odds of Completing Short-Term Residential Treatment Than Other Opioid Co-use Groups: A Retrospective Health Services Study

“…Although medications for OUD (MOUD) are effective in improving relapse and retention outcomes, individuals who co-use substances with opioids are less likely to receive these medications (12,22). Persons with OUD are less likely to receive MOUD in short-term residential compared with outpatient treatment (23), and there is also a large gap between availability of MOUD and use of MOUD in residential treatment facilities across the U.S (24). Treatment for co-occurring opioid and methamphetamine use disorders is further complicated by the lack of effective pharmacotherapy options for methamphetamine use (25)(26)(27).…”

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

“…Therefore, some treatment centers may be unable to offer buprenorphine without policy-level interventions, such as elimination of the federal X waiver requirement (Frank et al, 2018). Similarly, under federal law methadone can only be offered in opioid treatment programs, which are only integrated with 2% of residential treatment centers (Huhn et al, 2020), possibly due to heavy regulatory barriers and negative attitudes toward methadone by many in recovery communities. SUD treatment centers may be unlikely to offer methadone until federal law regarding methadone administration becomes less restrictive.…”

“…However, a typical treatment path in both outpatient and residential SUD treatment centers in the United States includes a combination of group counseling, individual counseling, and 12-step peer support groups (Fletcher, 2013;Huhn et al, 2017). Unlike in other nations where MOUD is more widely available, such as the United Kingdom and France (Fatseas & Auriacombe, 2007;Polomeni, 2014;Strang et al, 2005), in the United States fewer than half of SUD treatment centers offer MOUD (Alderks, 2017;Huhn et al, 2020), despite these medications' efficacy at preventing relapse and overdose death (National Academies of Sciences, Engineering, and Medicine, 2019).…”

Advancing emergency department–initiated buprenorphine

“…With increased funding and attention to the overdose epidemic in recent years, community access to care is improving. 46,47 However, the adoption of medications in some settings remains low, 48 there are regional differences in the distribution of medication, 49 and a large treatment gap remains. [50][51][52] Continuing efforts are needed to enhance access, and EDIB programs offer an opportunity to build connections with community clinicians and to engage people in treatment.…”