Elsevier

Addictive Behaviors

Volume 86, November 2018, Pages 96-103
Addictive Behaviors

Correlates of specialty substance use treatment among adults with opioid use disorders

https://doi.org/10.1016/j.addbeh.2018.03.012Get rights and content

Highlights

  • 2488 NSDUH respondents in our sample met criteria for a past-year opioid use disorder (OUD).

  • This represents 1,929,027 adults in the U.S.

  • 8.3% of those with an OUD received specialty substance abuse treatment in the prior year.

  • Unemployment, an arrest history, & comorbid substance use disorders were correlates of receiving treatment.

Abstract

Aims

To identify factors associated with the receipt of specialty substance use treatment among adults with opioid use disorders (OUD).

Design

Cross-sectional study based on 2010–2014 National Surveys on Drug Use and Health (NSDUH).

Setting and participants

Adults with a past-year OUD (n = 2488). The sample is representative of non-institutionalized US adults.

Measurements

Past-year OUD was determined using DSM-IV criteria. Past-year specialty substance use treatment was defined as receiving treatment for drug use at any of the following locations: rehabilitation facilities, hospitals (inpatient only), outpatient mental health centers, private doctors' offices, or methadone clinics. Multivariable logistic regression models were used to measure the independent association between potential correlates and specialty substance use treatment receipt.

Findings

Of adults with an OUD, 8.3% received past-year specialty substance use treatment. In a fully adjusted logistic regression model, the following factors were associated with increased odds of receiving specialty substance use treatment: ≥ 35 years old (adjusted Odds Ratio (aOR) = 2.55, 95% Confidence Interval (CI) = 1.04–6.26); unemployment (aOR = 1.92, 95% CI = 1.02–3.61); not in the labor force (aOR = 2.16, 95% CI = 1.15–4.06); never been married (aOR = 2.14, 95% CI = 1.04–4.39); arrested in past 12 months (aOR = 4.43, 95% CI = 2.45–7.99); opioid dependence (aOR = 3.82, 95% CI = 2.06–7.10); alcohol use disorder (aOR = 2.44, 95% CI = 1.44–4.11); and another drug use disorder (aOR = 3.22, 95% CI = 1.95–5.32). Living in a non-metropolitan county (aOR = 0.29, 95% CI = 0.12–0.68) and fair/poor health (aOR = 0.38, 95% CI = 0.17–0.86) were associated with decreased odds of receiving specialty substance use treatment.

Conclusions

These findings suggest a need for the following efforts: strategies to increase individuals' recognition of their need for OUD treatment, expansion of insurance coverage for substance use treatment, expansion of earlier intervention services, adoption of a chronic care approach to substance use treatment, and an expansion of treatment capacity for rural communities.

Introduction

There has been a dramatic increase in opioid use in the United States in the last two decades. From 1999 to 2010, sales of prescription opioids in the U.S. nearly quadrupled (Centers for Disease Control and Prevention (CDC), 2011), and the prevalence of prescription opioid misuse and abuse increased in parallel (McHugh, Nielsen, & Weiss, 2015). These increases are thought to have contributed to a subsequent increase in heroin use as the prevalence of past-year heroin use nearly doubled between 2005 and 2012 (Substance Abuse and Mental Health Services Administration, 2013). As a result of increases in prescription opioid and heroine abuse, drug overdoses, the majority of which are opioid-related, are now the leading cause of accidental death in the U.S (Levi, Segal, & Martin, 2015).

The increase in opioid abuse in the U.S. has meant an increase in the number of individuals needing treatment (Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality, 2015). From 2003 to 2013, the number of U.S. individuals aged 12 years or older with an opioid use disorder (OUD) increased from 1.6 million to 2.4 million (Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States, 2015). A variety of evidence-based treatments for OUD exist in the U.S., including pharmacologic treatments such as methadone, buprenorphine and naltrexone. Medication-assisted therapy (MAT), now considered to be the frontline treatment for OUD, uses pharmacologic interventions in combination with psychosocial interventions such as motivational interviewing and cognitive behavioral therapy (Schuckit, 2016). Unlike in other countries where MAT is more accessible (European Monitoring Centre for Drugs and Drug Addiction, n.d.; Merrill, 2002), U.S. federal laws and regulations limit where opioid agonist pharmacotherapies can be administered. Methadone can only be dispensed at federally certified opioid treatment programs, and buprenorphine can only be prescribed by physicians who have completed special training (Substance Abuse and Mental Health Services Administration, 2015). Despite increased demand, very few individuals in need of treatment receive MAT or other treatment. Between 2009 and 2013, only 21.5% of individuals aged 12 and older with an OUD received any treatment in the previous year (Saloner & Karthikeyan, 2015).

Although there is substantial unmet need for treatment (Becker et al., 2008; Saloner & Karthikeyan, 2015), our knowledge of factors associated with receiving treatment is limited. Barriers to accessing treatment in the U.S. include insufficient health insurance coverage, insufficient treatment capacity, and the stigma of addiction and treatment (Appel, Ellison, Jansky, & Oldak, 2004; Becker et al., 2008; Jones, Campopiano, Baldwin, & McCance-Katz, 2015). As state and federal governments in the U.S. try to address unmet treatment need for those with OUD, particularly by expanding treatment capacity, it is important to first understand who is likely to receive treatment. Doing so requires understanding the complex patient-level factors that influence treatment. Previous studies using national data have rarely focused on identifying correlates of receiving evidence-based treatments among adults with OUD. Prior studies have examined individuals with any substance use disorder (SUD) (Grella, Karno, Warda, Moore, & Niv, 2009; Harris & Edlund, 2005; Wu, Ringwalt, & Williams, 2003) or have been limited to adolescents or veterans with OUD (Finlay et al., 2016; Oliva, Harris, Trafton, & Gordon, 2012; Shiner, Leonard Westgate, Bernardy, Schnurr, & Watts, 2017; Wu, Blazer, Li, & Woody, 2011). A recent study by Wu et al. (Wu, Zhu, & Swartz, 2016) investigated correlates of receiving treatment among adults and adolescents with OUD but did not include patient-level factors, such as criminal history and employment status, that may be particularly salient for vulnerable populations.

In this study, we aimed to identify correlates of receiving substance use treatment at a specialty treatment facility among adults with OUD in the U.S. Using a large, nationally representative sample, we: 1) examined potential correlates of treatment receipt as guided by the Gelberg-Andersen behavior model of health services utilization; 2) estimated the prevalence of perceived need of treatment; and 3) evaluated reported reasons for not receiving treatment. We focused on adults since adolescents and adults with OUD are distinct populations who differ in the treatment options available to them (American Society of Addiction Medicine, n.d.) and likely face different barriers to treatment. Unlike several previous studies (Feder et al., 2017; Saloner & Karthikeyan, 2015; Wu et al., 2016), we chose to only consider treatment received at facilities that could offer evidence-based treatments for OUD.

Section snippets

Data source

Data for this study come from individual waves of the National Survey on Drug Use and Health (NSDUH), a nationally representative, cross-sectional survey conducted annually in the continental U.S. NSDUH provides national estimates of alcohol and illicit drug use, substance use disorders, and treatment for those disorders. NSDUH samples from civilian, non-institutionalized U.S. residents aged 12 years and older. NSDUH uses multi-stage area probability sampling of dwelling units, including

Results

Of individuals with OUD, 8.3% received specialty treatment in the past 12 months (95% confidence interval (CI): 6.5% to 10.5%). Among those who received specialty treatment, 66.4% received treatment at 2 or more different specialty treatment facilities. Approximately one quarter (25.7%) of all respondents who received specialty treatment received treatment at 4 or more different specialty treatment facilities. As shown in Table 1, rehabilitation facilities were the most common treatment

Discussion

In a large, nationally representative sample of adults with OUD in the U.S., we found that the prevalence of specialty substance use treatment receipt was low, as was the perceived need of treatment. Factors positively associated with past-year receipt of specialty substance use treatment included older age, being unemployed or out of the labor force, having never been married, an arrest in the past 12 months, opioid dependence (vs. abuse), having an AUD, and having another drug use disorder.

Role of funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Contributors

All authors have contributed to and approved the final manuscript. Eric Romo and Kate Lapane designed the initial study and protocol. Eric Romo performed literature searches, conducted the analyses, and wrote the first draft of the manuscript. Christine Ulbricht, Robin Clark, and Kate Lapane provided input throughout the conduct of the study and edited subsequent versions of the manuscript.

Conflict of interest

There are no conflicts of interest.

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