Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

Yang, Justin; Román-Urrestarazu, Andrés; Brayne, Carol

doi:10.1371/journal.pone.0226349

Cited by 14 publications

(9 citation statements)

References 38 publications

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“…Consistent with existing literature examining MOUD access in the general population, this systematic review found younger age to be negatively associated with MOUD access. In addition, the findings suggest that younger age was positively associated with accessing opioid antagonists and partial opioid agonists, such as naltrexone and buprenorphine-naloxone, respectively.…”

Section: Discussionsupporting

confidence: 85%

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

2022

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IMPORTANCEThe ongoing overdose crisis continues to adversely affect adolescents and young adults (AYAs) and has led to numerous preventable deaths. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, have the potential to reduce opioid use and associated harms; however, there are concerns that AYAs lack access to these potentially life-saving medications.OBJECTIVE To systematically review peer-reviewed literature on MOUD access and associated factors to synthesize strategies that can improve MOUD access for AYAs who use opioids. EVIDENCE REVIEWThe MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Web of Science, and Global Dissertations & Theses databases were searched from database inception until May 3, 2021. English, French, Russian, or Spanish peer-reviewed studies that evaluated the availability, prescription receipt, or initiation of MOUD were eligible for inclusion.FINDINGS This systematic review identified 37 cohort (n = 17), cross-sectional (n = 15), and qualitative (n = 5) studies that accounted for 179 785 AYAs (mean [SD] age, 24.4 [3.9] years; 148 779 [85%] were female; 67 771 [84%] were White) and examined access to methadone (30 studies), buprenorphine (26 studies), and naltrexone (10 studies). Findings reinforce concerns that AYAs were less likely to access MOUD and suggest that adolescents were more likely to receive naltrexone or buprenorphine-naloxone, which have a lower potential for abuse, in comparison with young adults. This review also identified other factors that were associated with MOUD access, including criminal justice involvement, residing in the US South, living in a limited-income area, Black race, and Hispanic or Latino ethnicity, suggesting ways in which treatment services may be improved to increase MOUD access and meet the treatment goals of AYAs.CONCLUSION AND RELEVANCE This systematic review found gaps in MOUD access between AYAs and non-AYA populations in addition to differences in MOUD access between adolescents and young adults. Considering that existing clinical guidelines recommend the use of MOUD among AYAs, and in light of the increasing number of opioid toxicity deaths, there is a need to improve MOUD access among AYAs by reducing barriers to MOUD and providing AYAs with a continuum of health and social supports alongside MOUD. Future research into ways to encourage MOUD uptake among AYAs may improve the treatment and health outcomes for this population.

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Section: Discussionsupporting

confidence: 85%

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

2022

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“…58 Another study investigating socioeconomic determinants of planned methadone treatment noted that those who were not experiencing homelessness were more likely to receive methadone as part of their treatment 59 and a later study found that experiencing homelessness was associated with decreased odds of receiving MOUD and also lower odds of waiting greater than 1 week to enter treatment. 16 Similarly a study of the use of methadone within “detoxification” settings found those experiencing homelessness were less likely to have methadone planned for their treatment. 15 The present study’s results build off these studies by demonstrating that, in addition to the disparities that may limit treatment entry into MOUD, those individuals experiencing homelessness that are able to enroll into MOUD have reduced retention length and decreased odds of treatment completion.…”

Section: Discussionmentioning

confidence: 99%

“…14 While many people with OUD receive non-MOUD treatments, 15 PEH with OUD who enter SUD treatment are less likely than their housed counterparts to receive MOUD. [16][17][18] Expanding engagement in evidence-based OUD treatment is even more important in the face of the aforementioned worsening overdose crisis, which disproportionately impacts PEH.…”

Section: Introductionmentioning

confidence: 99%

A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States

et al. 2023

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Background: Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement. Methods: Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates. Results: There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables ( P’s < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = −0.0853, P < 0.001, 95% CI = [−0.114, −0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = −0.3435, P < 0.001, 95% CI = [−0.371, −0.316], OR = 0.709) after accounting for covariates. Conclusions: Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.

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“…5 Although recent data suggest that the prevalence of OUD and its negative consequences may be increasing among women, a recent study using national data on SUD treatment admissions found that women had slightly higher odds of receiving medication for OUD than men. 24 Historically, services tailored to women (eg, women’s recovery groups, child care) have generally been considered beneficial but not necessary, leading to their underuse in OUD treatment settings. 25 The higher proportion of OUD among women compared with men with a need for SUD treatment further supports previous evidence, 6,13 endorsing the need for universal adoption of gender-informed treatment for people with OUD.…”

Section: Discussionmentioning

confidence: 99%

“…OUD than men. 24 Historically, services tailored to women (eg, women's recovery groups, child care) have generally been considered beneficial but not necessary, leading to their underuse in OUD treatment settings. 25 The higher proportion of OUD among women compared with men with a need for SUD treatment further supports previous evidence, 6,13 endorsing the need for universal adoption of gender-informed treatment for people with OUD.…”

Section: Discussionmentioning

confidence: 99%

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

et al. 2021

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Objectives Disparities in substance use disorder (SUD) treatment use persist across groups, including gender. Using a gender-informed approach to expand treatment capacity and reduce barriers to treatment engagement is vital. We examined SUD treatment need and receipt among people with SUD in the United States, by gender, and assessed gender-specific sociodemographic factors associated with unmet need for SUD treatment and reported treatment barriers. Methods We conducted an analysis of data among adults aged ≥18 with a past-year SUD from the National Survey on Drug Use and Health (2015-2018). We computed population-adjusted frequencies and proportions for SUD treatment need and receipt and assessed gender differences. Multivariate logistic regression assessed gender-specific sociodemographic variables associated with SUD treatment receipt. Results Among adults with a past-year SUD, 63.4% were men and 36.6% were women ( P < .001), only 10.6% received SUD treatment, and a greater percentage of women than men needed treatment for opioid use disorder (11.9% vs 9.9%; P = .002). Receipt of SUD treatment was lowest among women with alcohol use disorder followed by men with alcohol use disorder (7.5% vs 8.9%; P = .052). Non-Latinx Black men had fewer than half the adjusted odds of receiving SUD treatment than non-Latinx White men (adjusted odds ratio [aOR] = 0.44; 95% CI, 0.27-0.71). Latinx women (aOR = 0.37; 95% CI, 0.18-0.73) and non-Latinx Black women (aOR = 0.51; 95% CI, 0.27-0.94) had significantly lower odds of receiving SUD treatment than non-Latinx White women. Conclusions As public health efforts target expanding SUD treatment capacity and addressing disparities in use of SUD treatment, interventions informed by gender and culture should be prioritized.

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Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

Cited by 14 publications

References 38 publications

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

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