Only a third of mental health clinics offer medication for opioid use disorder

Despite high rates of opioid use disorder (OUD) among people with mental health disorders, only a third of community outpatient mental health treatment settings in 20 high-burden states offered medication for OUD, a cross-sectional study showed.

Among 450 community outpatient mental health treatment facilities surveyed, weighted estimates showed that 34% offered medications for OUD, reported Jonathan Cantor, PhD, of the RAND Corporation in Santa Monica, Calif., and co- authors of Open JAMA Network.

Facility-level factors associated with an increased likelihood of offering medications for OUD included:

• Have Certified Community Behavioral Health Clinic (CCBHC) status: OR 2.11 (95% CI 1.08-4.11)
• Providing integrated treatment for mental and substance use disorders: OR 5.21 (95% CI 2.44-11.14)
• Have a specialized treatment program for patients with both mental health and substance use disorders: OR 2.25 (95% CI 1.14-4.43)
• Providing housing services: OR 2.54 (95% CI 1.43-4.51)
• Offer laboratory tests: OR 2.15 (95% CI 1.12-4.12)

Facilities that accepted state-funded health insurance plans other than Medicaid as payment had increased odds of offering medications for OUD (OR 1.95, 95% CI 1.01-3 .76), while facilities that accepted funds from state mental health agencies had reduced odds (OR 0.43, 95% CI 0.19–0.99).

Despite evidence of their effectiveness, one study found that 90% of people with OUD do not receive medication, Cantor and co-authors noted.

“Here we demonstrate the fact that if you want to receive evidence-based care and you have co-occurring disorders, it’s really difficult,” Cantor said. Page Med today.

Expanding the provision of OUD medications at these facilities could potentially improve access for the more than 13 million people with co-occurring disorders who use these facilities each year, the authors said.

For this study, Cantor and colleagues focused on the 20 states with the highest burden of overdose deaths and contacted 642 community outpatient mental health treatment facilities; Staff from 450 facilities, including all CCBHCs, responded to the telephone survey from April to July 2023.

Among facilities that provided medications for OUD, 47% reported screening patients for OUD, and 20% reported not knowing whether they screened patients for OUD; 82% offered telehealth for OUD and 60% offered telehealth specifically for OUD medications. The average wait time for such an appointment was 12.7 days.

The majority of responding facilities (84%) reported providing buprenorphine, with 96% offering oral/sublingual forms, 43% offering injectable buprenorphine, and less than 1% offering subcutaneous implants. Seventy percent offered naltrexone and 14% offered methadone.

Among facilities that did not offer medications for OUD, about 7% said they planned to offer these medications in the future, while 39% said they were unsure whether to offer them. this type of medication. However, 87% of these facilities reported that they referred patients to other facilities for OUD medications: 38% referred patients to other facilities within the same organization, 48% referred patients to a clinic mental health, 67% to a substance use disorder treatment facility. or an opioid treatment program, and 9% to a health clinic.

Because Cantor and his team focused on 20 states, their results might not be generalizable to others, they noted. Cantor said he would like to conduct a national study to determine whether medication supply rates for OUD are similar in other states, with the goal of having the same granular level of data currently available to OUD clinics. substance use disorders.

Other limitations to the study included that respondents were asked whether medications for OUD were offered, but did not indicate how many patients actually received medications. The authors also did not track respondent characteristics (receptionist or behavioral health director), which could have affected responses.

The survey also did not take into account disparities in OUD medication use between different groups, Cantor said, adding that he hopes more studies will focus on disparities between people suffering from concurrent disorders.

“It’s a very vulnerable population, so we want to make sure that people who need treatment get it,” he said.