Despite Opioid Epidemic, Most Substance Use Disorder Treatment Programs Turn Medicare Enrollees Away
Discussant: Lindsay Allen
Methods. This study uses data from the National Survey of Substance Abuse Treatment Services, the Medicare Geographic Variation file, and the National Directory of Drug and Alcohol Abuse Treatment Facilities to examine the availability of OUD treatment for Medicare enrollees within the specialty addiction treatment system from 2007 to 2016. We use geographic information from the 2017 Directory to create a map of county-level access to treatment programs that accept Medicare insurance and offer buprenorphine or injectable naltrexone in 2016.
Results. In 2016, only 13.8% of treatment programs accepted Medicare and offered an FDA-approved medication treatment for OUD. Further, only 20.8% of US counties had at least one program that offered one or more such medications. We use logistic regression to examine the likelihood that a treatment program accepts Medicare and offers buprenorphine or injectable naltrexone (n=116,390). The odds of offering OUD treatment medication for Medicare enrollees were greater for programs that accepted Medicaid (OR= 3.47) and private insurance (OR= 6.15). Private for-profit (OR=0.72) and private non-profit treatment programs (OR=0.74) were less likely than publicly-owned programs to accept Medicare. The odds of accepting Medicare were lower for treatment programs located in the Midwest (OR=0.56), South (OR=0.47), and West (OR= 0.49), compared to the Northeast.
Conclusion. With increased demand for OUD treatment among older adults, and the rapidly aging US population, improving access to quality treatment for this population is critical. Our findings indicate serious gaps in the availability of OUD treatment in the specialty treatment system for Medicare enrollees.
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