Medication for opioid use disorder treatment and specialty outpatient substance use treatment outcomes: Differences in retention and completion among opioid-related discharges in 2016

Askari, Masomeh; Martins, Sílvia S.; Mauro, Pia M.

doi:10.1016/j.jsat.2020.108028

Cited by 20 publications

(19 citation statements)

References 40 publications

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“…Rural and disadvantaged individuals may not seek healthcare not only because of limited availability and accessibility of providers, but also owing to concerns about stigma, confidentiality, and being disproportionately uninsured or underinsured. [50][51][52][53] Buprenorphine treatment is covered by Medicaid programs in all states, 54 while methadone as medication-assisted treatment is reimbursed by 42 states only. 55 According to the 2017 National Survey of Substance Abuse Treatment Services, only 35% of OTPs accepted Medicare, 56 and it was not until January 2020 that Medicare started covering the cost of medication-assisted treatment at OTPs.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

et al. 2021

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Objectives: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States.Methods: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis.Results: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. Conclusions:The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.

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Section: Discussionmentioning

confidence: 99%

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

et al. 2021

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“…These findings were consistent with other studies showing disparities in treatment engagement among female clients identified as Latinas [ 9 , 10 ]. The most recent national study also shows that clients on methadone treatment were associated with decrease treatment completion of their treatment plan [ 28 ]. But other studies that consider methadone and buprenorphine have showed improved recovery outcomes compared to non-opioid replacement therapies, including drug-free counseling [ 57 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…Third, the percentages of completion of treatment plan for clients with OUD in our LA County sample (18.4%) are below rates reported using the TEDS national data (27.8) [ 1 ]. Most completion studies using TEDS data use slightly different codes to develop the completion measure [ 16 , 17 , 28 , 43 , 54 – 56 ]. For instance, we included only outpatient clients whose primary or secondary drug of choice was opioids, who may have had previous treatment episodes and who were transferred to another program.…”

Section: Discussionmentioning

confidence: 99%

“…For the second outcome, we coded 1 if the clinician reported the client completed the treatment/recovery plan for that episode, and 0 if not. These are measures that have been used to evaluate treatment completion in regional [ 54 – 56 ] and national studies [ 1 , 16 , 17 , 28 , 43 ]. They do not include information on the number, type or description of the treatment plan or its goals.…”

Section: Methodsmentioning

confidence: 99%

“…Although the literature on methadone treatment indicates its effectiveness in decreasing drug abuse, criminal behavior, and HIV risk [ 4 , 13 ], and in increasing treatment retention [ 28 ] and counseling utilization [ 29 – 33 ], there has been limited evidence related to the impact of methadone on treatment progress and completion. Recent studies that examined all MOUD -not just methadone - found that these opioid medications were related to an increase in retention [ 28 ], but a decrease in treatment completion [ 1 , 28 ]. Emerging work shows that methadone is associated with gender/race/ethnic disparities in retention in publicly funded OUD treatment [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Gender disparities in opioid treatment progress in methadone versus counseling

Guerrero¹,

Amaro

Kong

et al. 2021

Subst Abuse Treat Prev Policy

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Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. Methods Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. Results We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. Conclusions Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.

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Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019

et al. 2022

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Medication for opioid use disorder treatment and specialty outpatient substance use treatment outcomes: Differences in retention and completion among opioid-related discharges in 2016

Cited by 20 publications

References 40 publications

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

Gender disparities in opioid treatment progress in methadone versus counseling

Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019

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