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

Kenneth A Feder; Yuzhong Li; Kathryn N Burke; Lauren Byrne; Isha K Desai; Brendan Saloner; Noa Krawczyk

doi:10.1016/j.josat.2024.209545

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

J Subst Use Addict Treat. 2024 Oct 21:168:209545. doi: 10.1016/j.josat.2024.209545. Online ahead of print.

Authors

Kenneth A Feder¹, Yuzhong Li², Kathryn N Burke³, Lauren Byrne⁴, Isha K Desai⁵, Brendan Saloner⁴, Noa Krawczyk⁶

Affiliations

¹ 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.
² 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.
³ Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States of America.
⁴ 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.
⁵ 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.
⁶ 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.

PMID: 39442630
DOI: 10.1016/j.josat.2024.209545

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.

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