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- Title
Availability of Medications for Opioid Use Disorder in Community Mental Health Facilities.
- Authors
Cantor, Jonathan; Griffin, Beth Ann; Levitan, Barbara; Mendon-Plasek, Sapna J.; Stein, Bradley D.; Hunter, Sarah B.; Ober, Allison J.
- Abstract
Key Points: Question: What is the availability of medications for opioid use disorder (MOUD) in a representative sample of community outpatient mental health treatment facilities in high-burden states due to the opioid crisis? Findings: In this cross-sectional study of 450 community outpatient mental health treatment facilities in 20 states, 34% of clinics offered MOUD, with 51% of Certified Community Behavioral Health Clinics (CCBHCs) and 33% of non-CCBHCs offering these medications. Meaning: Despite high rates of opioid use disorder among people with co-occurring mental health disorders, only a third of community outpatient mental health treatment facilities in high-need states offer MOUD, indicating the need for improved scaling efforts. This cross-sectional study examines the availability of medications for opioid use disorder (MOUD) at community outpatient mental health treatment facilities in 20 US high-burden states. Importance: Medications for opioid use disorder (MOUD) are an effective but underutilized treatment. Opioid use disorder prevalence is high among people receiving treatment in community outpatient mental health treatment facilities (MHTFs), but MHTFs are understudied as an MOUD access point. Objective: To quantify availability of MOUD at community outpatient MHTFs in high-burden states as well as characteristics associated with offering MOUD. Design, Setting, and Participants: This cross-sectional study performed a phone survey between April and July 2023 among a representative sample of community outpatient MHTFs within 20 states most affected by the opioid crisis, including all Certified Community Behavioral Health Centers (CCBHCs). Participants were staff at 450 surveyed community outpatient MHTFs in 20 states in the US. Main Outcomes and Measures: MOUD availability. A multivariable logistic regression was fit to assess associations of facility, county, and state-level characteristics with offering MOUD. Results: Surveys with staff from 450 community outpatient MHTFs (152 CCBHCs and 298 non-CCBHCs) in 20 states were analyzed. Weighted estimates found that 34% (95% CI, 29%-39%) of MHTFs offered MOUD in these states. Facility-level factors associated with increased odds of offering MOUD were: self-reporting being a CCBHC (odds ratio [OR], 2.11 [95% CI, 1.08-4.11]), providing integrated mental and substance use disorder treatment (OR, 5.21 [95% CI, 2.44-11.14), having a specialized treatment program for clients with co-occurring mental and substance use disorders (OR, 2.25 [95% CI, 1.14-4.43), offering housing services (OR, 2.54 [95% CI, 1.43-4.51]), and laboratory testing (OR, 2.15 [95% CI, 1.12-4.12]). Facilities that accepted state-financed health insurance plans other than Medicaid as a form of payment had increased odds of offering MOUD (OR, 1.95 [95% CI, 1.01-3.76]) and facilities that accepted state mental health agency funds had reduced odds (OR, 0.43 [95% CI, 0.19-0.99]). Conclusions and Relevance: In this study of 450 community outpatient MHTFs in 20 high-burden states, approximately one-third offered MOUD. These results suggest that further study is needed to report MOUD uptake, either through increased prescribing at all clinics or through effective referral models.
- Subjects
UNITED States; MENTAL illness drug therapy; SUBSTANCE abuse; HEALTH services accessibility; CROSS-sectional method; OUTPATIENT services in hospitals; RESEARCH funding; LOGISTIC regression analysis; STATISTICAL sampling; DESCRIPTIVE statistics; ODDS ratio; NARCOTICS; TELEPHONES; DRUGS; CONFIDENCE intervals; OPIOID epidemic; DATA analysis software
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417545
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17545