Characteristics of Individuals who Receive Opioid Agonist Substitution Treatment

Introduction. The United States is in the midst of a crisis of harmful use of opioids. Over the past three decades, opioid overdose deaths, related hospitalizations, and use disorders have all increased sharply. Because of these increases, an American is now more likely to die of drug poisoning than in a motor vehicle crash. The best-supported treatments for opioid use disorder include pharmacotherapy. These treatments supplement counseling and psychosocial interventions with medications like methadone and buprenorphine that counteract the maladaptive changes induced in the brain by extended opioid misuse, ameliorating the symptoms of opioid withdrawal. Treatments that include pharmacotherapy reduce overdose risk, improve daily functioning, and increase treatment retention as compared to treatments that do not include medication. Although treatments that include pharmacotherapy are the standard of care for opioid use disorders, they are underutilized. This paper uses a large sample of treatment admissions for opioid use disorder in the United States to examine characteristics predictive of receiving treatments that include pharmacotherapy. Methods. Data come from the 2014 Treatment Episode Dataset – Admissions (TEDS-A), which is maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment programs receiving any public funds (from State and/or Federal sources) are requested to provide admission-level data on publicly and privately funded clients for the dataset. The TEDS-A captures a significant share of all admissions to treatment facilities across the United States, especially those that reflect public spending. Logistic regression models were utilized to assess the association of receiving pharmacotherapy treatment with a number of demographic, treatment, and disorder characteristics. A state fixed-effects estimator was used to account for strongly correlated responses within states. Results. Fewer than one third of treatment admissions for an opioid use disorder involved pharmacotherapy. Characteristics potentially indicative of disorder severity – most strongly opioid use on a daily basis, but also a past history of treatment, injection drug use, heroin use, and benzodiazepine use – were all associated with increased odds of receiving pharmacotherapy. Among the factors most associated with receiving pharmacotherapy treatment were referring oneself to treatment, as opposed to a medical or non-medical professional, and receiving treatment in a non-intensive outpatient setting, as opposed to intensive outpatient or residential settings. Conclusion. Our results demonstrate that, even among patients receiving treatment for opioid use disorder, pharmacotherapy is uncommon. Moreover, other than age and frequency of use, the factors that most influence whether an admitted patient receives pharmacotherapy are the source that referred the client to treatment and the type of program where treatment is provided. This suggests that these factors are potential levers that could help facilitate access to pharmacotherapy. For example, more could be done to encourage medical and non-medical professionals who work with individuals with opioid use disorder to refer clients to programs that offer pharmacotherapy, and to incorporate pharmacotherapy into existing intensive outpatient and inpatient programs. These steps can help increase utilization of high-quality opioid use disorder treatment and ameliorate the harms of the opioid crisis.