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

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 232414 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 232414 admissions, 205612 (88.5%) contained complete demographic data (166213 [80.8%] aged 25-54 years; 136854 [66.6%] men; 151867 [73.9%] white). Among all admissions, MOUDs were used in only 34058 of 192336 (17.7%) in states that expanded Medicaid and 775 of 40078 (1.9%) in states that did not expand Medicaid (P