Therapies Offered at Residential Addiction Treatment Programs in the United States

Beetham, Tamara; Saloner, Brendan; Gaye, Marema; Wakeman, Sarah E.; Frank, Richard G.; Barnett, Michael L.

doi:10.1001/jama.2020.8969

Cited by 49 publications

(25 citation statements)

References 3 publications

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“…The publicly funded OUD treatment system in Los Angeles (LA), California (CA) is one of the largest and most diverse systems of care in the United States. This system has significantly expanded since publicly funded health insurance started covering treatment considering three program service types [ 36 – 38 ]: (1) specialty outpatient treatment programs offering MOUD, exclusively dispensing methadone; (2) outpatient services from treatment programs that mainly offer non-medication counseling services; and (3) office-based physician services offering MOUD and dispensing exclusively buprenorphine and or naltrexone. This publicly funded system mainly relies on (1) methadone, which may include limited counseling and (2) counseling-only [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

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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“…After this re-contact attempt, we classified the facility as a nonrespondent. We used a secret shopper approach, which other studies have used successfully in the past related to the provision of mental health treatment ( Cantor, McBain, et al, 2020 ), and the treatment of OUD ( Beetham et al, 2020 , Beetham et al, 2019 ; Patrick et al, 2020 ). The study used the secret shopper to understand the real-life barriers that patients may encounter during the COVID-19 pandemic, and the Department of Health and Human Services has recommended this approach as a field experiment ( US Department of Health and Human Services, 2014 ).…”

Section: Methodsmentioning

confidence: 99%

The new services that opioid treatment programs have adopted in response to COVID-19

Cantor

Laurito

2021

Journal of Substance Abuse Treatment

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COVID-19 has exacerbated the opioid epidemic and transformed how programs treat opioid use disorder. In response to the pandemic, the federal government modified guidelines to allow opioid treatment programs (OTPs) greater flexibility in the provision of medication for opioid use disorder. We conducted a telephone survey of 31.10% of OTPs in the contiguous United States between June and July 2020. We contacted a random sample of 477 facilities and obtained responses from 373. The survey asked questions about new patient intake, screening for COVID-19, social distancing measures, as well as new treatments offered due to changes in federal government policy. We calculated percentages of positive and nonpositive responses to each survey question. We estimated logistic regressions of facility-, county- and state-level predictors of each treatment approach. Most OTPs are taking new patients (91%). Roughly 83% of them screen for COVID-19 symptoms for in-person visits and about 92% use social distancing measures. More than half of OTPs provide curbside treatment (83%) or telehealth (81%). Less than a quarter of OTPs offer medication drop off (21%) or pick up by a trusted person (32%) when patients need to quarantine due to COVID-19. Results from multivariable logistic regressions show that OTPs in states that had a shelter-in-place policy are more likely to socially distance for in-person visits than those in states without such a policy.

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“…Too often, the regulation and financing of SUD care provide weak accountability that allows treatment providers to supply services that actively discourage use of evidence-based treatment-promoting services that in some cases increase overdose and mortality risk upon discharge. Recent "secret shopper" studies show that 39% of residential SUD programs do not offer MOUD with an opioid agonist; 21% actively discourage admission of patients being treated with MOUD using an opioid agonist (Beetham et al 2020). There is also continued reliance on inpatient detoxification programs that are not closely connected to communitybased continuing care.…”

Section: Create a High-level Dol-hhs-treasury Fusion Center Dedicatedmentioning

confidence: 99%

Policy Responses to the Addiction Crisis

Frank

Humphreys

Pollack

2021

Journal of Health Politics, Policy and Law

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The COVID-19 pandemic is just one of two public health crises the new Biden administration will confront. The addiction crisis is the other. The opioid epidemic has already killed more Americans than World Wars I and II combined. And it is but the most visible sign of a broader population health challenge that includes methamphetamine, cocaine, benzodiazepines, and alcohol. This essay presents practical legislative and executive actions required to address these challenges. We focus on two broad policy challenges: (1) improving financing and delivery of treatment for substance use disorders (SUDs) and (2) reducing population exposure to addictive and lethal substances. Through both of these channels, a portfolio of well-implemented, evidence-informed policies can save many thousands of lives every year.

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Therapies Offered at Residential Addiction Treatment Programs in the United States

Cited by 49 publications

References 3 publications

Gender disparities in opioid treatment progress in methadone versus counseling

Gender disparities in opioid treatment progress in methadone versus counseling

The new services that opioid treatment programs have adopted in response to COVID-19

Policy Responses to the Addiction Crisis

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