Medication‐Assisted Opioid Treatment Prescribers in Federally Qualified Health Centers: Capacity Lags in Rural Areas

Abstract

Purpose This study explores correlates of on‐site availability of substance use disorder treatment services in federally qualified health centers, including buprenorphine treatment that is critical to addressing the opioid epidemic. Methods We employed descriptive and multivariable analyses with weighted 2010 Assessment of Behavioral Health Services survey data and the 2010 Uniform Data System. Findings In 2010, 47.6% of health centers provided on‐site substance use disorder treatment, 12.3% provided buprenorphine treatment for opioids, and 38.8% were interested in expanding buprenorphine availability. Urban health centers, those in the West, and health centers with electronic health records had higher odds of offering on‐site substance use disorder treatment. Compared with on‐site mental health treatment, substance use disorder treatment was available in fewer clinic sites within each organization. Health centers in rural areas had lower odds of providing on‐site buprenorphine treatment (OR = 0.49, 95% CI: 0.26‐0.94), and those in the South had lower odds of providing on‐site buprenorphine treatment compared with health centers in other regions. Rural health centers had lower odds of expressing interest in expanding the availability of buprenorphine treatment (OR = 0.58, 95% CI: 0.35‐0.97). Conclusions Improving access to substance use disorder treatment in primary care is a critical part of the strategy to combat the opioid use disorder epidemic. These findings highlight the important role of health centers as portals of access to substance use disorder treatment services in underserved communities. Recent investments to expand treatment capacity in health centers will expand the availability of substance use disorder services, but urban/rural and regional disparities should be monitored.

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

“…Access to treatment for substance use disorders is a significant issue in non metropolitan areas as travel distances may pose a barrier . We focused on the impact of travel time on continuity after discharge from detoxification or residential treatment for substance use disorders because continuity is associated with better outcomes, but rates are relatively low .…”

“…Third, closer integration between specialty agencies and primary care could open greater options for continuity, particularly in terms of medication‐assisted treatment. However, there is some evidence that there is a reluctance to expand buprenorphine treatment in rural areas and in the South . However, with federal funding in 2018 Washington State began implementing a hub‐and‐spoke model to provide integrated care for clients with opioid use disorders and to increase the number of providers who can prescribe buprenorphine and provide other pharmacotherapy.…”

“…[1][2][3] Continuity into follow-up treatment for a substance use disorder (SUD) within the 1 or 2 weeks after discharge from detoxification [4][5][6][7] or residential treatment 8,9 is associated with improved outcomes, yet the majority of clients do not even begin this continuing treatment. [10][11][12] Access to continuing care is especially limited in rural and non metropolitan areas, [13][14][15][16][17][18] an issue of particular importance since failure to receive adequate treatment can contribute to the burden of SUDs in rural America.…”

“…Access to treatment for substance use disorders is a significant issue in non metropolitan areas as travel distances may pose a barrier. 13,[15][16][17] We focused on the impact of travel time on continuity after discharge from detoxification or residential treatment for substance use disorders because continuity is associated with better outcomes, but rates are relatively low. [10][11][12] In our study, travel times to the original agency providing treatment are sometimes, but not always, significant in predicting continuity within 14 days.…”

Portraying a More Complete Picture of Illicit Drug Use Epidemiology and Policy for Rural America: A Competing Viewpoint to the CDC's MMWR Report

“…Federally qualified health centers in rural areas have potential to expand treatment access for drug abuse, but the paper by Jones shows that the majority of federally qualified health centers nationally do not offer any substance use treatment services . The paper also shows that federally qualified health centers have much lower odds of offering or considering offering medication‐assisted treatment for opioid use disorder.…”