Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States
Authors: Andrew S. Huhn, J. Gregory Hobelmann, Justin C. Strickland, George A. Oyler, Cecilia L. Bergeria, Annie Umbricht, Kelly E. Dunn
Journal: JAMA Network Open (2020)

<h3>Importance</h3> 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. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. <h3>Main Outcomes and Measures</h3> Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). <h3>Results</h3> Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (<i>P</i> &lt; .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ<sup>2</sup><sub>1</sub> = 542.09;<i>P</i> &lt; .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ<sup>2</sup><sub>1</sub> = 24.28;<i>P</i> &lt; .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ<sup>2</sup><sub>1</sub> = 180.91;<i>P</i> &lt; .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ<sup>2</sup><sub>1</sub> = 89.65;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.