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

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 < .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 chi(2)(1) = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald chi(2)(1) = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald chi(2)(1) = 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 chi(2)(1) = 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. This cross-sectional study examines differences in availability and use of medications for opioid use disorder in residential treatment facilities in the United States as a function of Medicaid policy, facility-level factors, and admissions-level factors. 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 232414 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.