Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data

Authors

Kenneth A. Feder, Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America. Electronic address: Kfeder1@jh.edu.
Yuzhong Li, New York University Global School of Public Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
Kathryn N. Burke, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
Lauren Byrne, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
Isha K. Desai, George Washington University Milken Institute School of Public Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
Brendan Saloner, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
Noa Krawczyk, Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.

Document Type

Journal Article

Publication Date

10-21-2024

Journal

Journal of substance use and addiction treatment

Volume

168

DOI

10.1016/j.josat.2024.209545

Keywords

Medication for opioid use disorder; Multi-level models; Specialty substance use treatment

Abstract

BACKGROUND: Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD). METHODS: We linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021-June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix. RESULTS: Of 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30-49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary "drug of abuse," stimulant use, and not working but actively looking for work. CONCLUSION: Findings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication.

APA Citation

Feder, Kenneth A.; Li, Yuzhong; Burke, Kathryn N.; Byrne, Lauren; Desai, Isha K.; Saloner, Brendan; and Krawczyk, Noa, "Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data" (2024). GW Authored Works. Paper 5797.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5797

Department

School of Medicine and Health Sciences Student Works