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    Original Investigation
    Psychiatry
    February 7, 2020

    Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States

    Author Affiliations
    • 1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 2Ashley Addiction Treatment, Havre de Grace, Maryland
    • 3Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland
    JAMA Netw Open. 2020;3(2):e1920843. doi:10.1001/jamanetworkopen.2019.20843
    Key Points español 中文 (chinese)

    Question  Do residential addiction treatment facilities in the United States use medications for opioid use disorder (MOUDs)?

    Findings  This cross-sectional study, using data on 2863 residential treatment facilities and 232 414 admissions, found that the availability and use of MOUDs was relatively low in residential addiction treatment facilities. Residential facilities in states that resisted Medicaid expansion and/or had prescriber restrictions for Medicaid reimbursement were associated with particularly low use of MOUDs.

    Meaning  While residential treatment facilities may offer a high level of behavioral treatment in a structured environment, this study indicates that access to MOUDs for patients in these facilities is lacking.

    Abstract

    Importance  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.

    Objective  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.

    Design, Setting, and Participants  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.

    Exposures  Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient’s primary drug of choice.

    Main Outcomes and Measures  Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone).

    Results  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 (P < .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 χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .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 χ21 = 89.65; P < .001).

    Conclusions and Relevance  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.

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