State-level regulations and opioid-related health outcomes

Introduction: Due to the ongoing opioid use disorder crisis, improved access to opioid treatment programs (OTPs) is needed. However, OTPs operate in a complex regulatory environment which may limit their ability to positively affect health outcomes. The objective of this study was to examine how the number and type of state OTP regulations are associated with opioid-related deaths, hospitalizations, and emergency department visits. Methods: Cross-sectional data capturing information about OTP state-level regulations collected by Jackson et al. was combined with other secondary sources. OTP regulations were categorized based on the nature of their focus. Analyses include bivariate and multivariable regressions that controlled for region and other state laws that can affect opioid outcomes. Results: In bivariate analysis, a greater number of OTP regulations was positively correlated with both deaths and emergency visits. Moreover, a greater number of regulations in the Physical Facilities Management category (e. g., rules related to restrooms, lighting, and signage) was positively correlated with both deaths and hospitalizations. The number of regulations in the Staffing Requirement category was positively associated with emergency visits. In adjusted analysis, the number of regulations in the Physical Facilities Management category was positively associated with opioid-related deaths. Conclusions: States with a higher number of regulations had poorer opioid-related outcomes. Additional research is needed to support policy decisions that can improve access to OTPs and reduce avoidable deaths, hospitalizations, and emergency visits.

Automated summary

This study found that the number and type of state regulations for opioid treatment programs (OTPs) are associated with opioid-related deaths, hospitalizations, and emergency department visits. A greater number of regulations was positively correlated with deaths and emergency visits. Regulations in the Physical Facilities Management category were also positively correlated with deaths and hospitalizations. Adjusted analysis showed that regulations in the Physical Facilities Management category were positively associated with opioid-related deaths.