Do residential addiction treatment facilities in the U.S. use medications for opioid use disorder (MOUDs) ? A study published February 7, 2020 in the Journal of the American Medical Association (JAMA) found the answer was that not enough do.
Researchers used 2017 data from 2,863 residential treatment facilities and 232,414 admissions. They found that 1,717, or 60 percent of residential treatment facilities, offered no medications approved by the Food and Drug Administration for treatment of opioid use disorder. Those facilities located in states that either resisted Medicaid expansion and/or had prescriber restrictions for Medicaid reimbursement were associated with particularly low use of MOUDs, according to the study.
“These findings have clear implications for public health officials regarding the association of state-level Medicaid policy with the use of MOUDs in residential facilities,” researchers noted.
The study found that in 2017, 854 residential treatment facilities (29.8%) offered extended-release naltrexone, while 953 (33.3%) offered buprenorphine, and just 60 (2.1%) offered methadone.
“While trends in access to MOUDs across the United States are generally improving, state-level disparities, which might reflect regional differences in stigma, especially toward buprenorphine and methadone are still evident,” according to the study’s researchers.
The use of these medications, along with counseling is considered to be the gold standard for addiction treatment.
On average, 130 Americans die every day from an opioid overdose, according to the Centers for Disease Control.
Another JAMA study published February 5, 2020 of more than 40,000 people diagnosed with opioid use disorder found that those who used buprenorphine or methadone had less of a risk of overdose and opioid-related hospitalizations when compared to other treatment options such as inpatient detoxification or residential services, intensive behavioral health, naltrexone, and non-intensive behavioral health, as well as no treatment at all.
The study found that even though it was not as effective as buprenorphine or methadone, non-intensive (outpatient) behavioral health (59.3%) was the most common type of treatment, followed by inpatient detoxification or residential services (15.8%). Surprisingly, not receiving any treatment was more common (5.2%) than naltrexone (2.4%] or intensive behavioral health (4.8%).
Researchers in the first study concluded that “Medicaid expansion and the relaxation of MOUD prescribing restrictions for Medicaid reimbursement could improve MOUD availability and use in residential facilities.” Researchers from the second study came to a similar conclusion that “opportunities exist for health plans to reduce restrictions on use for MOUD and the need for treatment models that prioritize access to and retention of MOUD treatment.”
Many factors go into treatment decisions including the type of insurance a patient has and the restrictions they impose on treatment types, stigmas associated with various MOUDs, the type of treatment facility a patient uses.