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Kennedy-Hendricks A, Song M, McCourt AD, Sharfstein JM, Eisenberg MD, Saloner B. Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment. Health Aff (Millwood) 2024; 43:732-739. [PMID: 38709972 DOI: 10.1377/hlthaff.2023.01306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.
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Smart R, Grant S, Gordon AJ, Pacula RL, Stein BD. Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder. JAMA HEALTH FORUM 2022; 3:e223285. [PMID: 36218944 PMCID: PMC10041351 DOI: 10.1001/jamahealthforum.2022.3285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Importance In the US, recent legislation and regulations have been considered, proposed, and implemented to improve the quality of treatment for opioid use disorder (OUD). However, insufficient empirical evidence exists to identify which policies are feasible to implement and successfully improve patient and population-level outcomes. Objective To examine expert consensus on the effectiveness and the ability to implement state-level OUD treatment policies. Evidence Review This qualitative study used the ExpertLens online platform to conduct a 3-round modified Delphi process to convene 66 stakeholders (health care clinicians, social service practitioners, addiction researchers, health policy decision-makers, policy advocates, and persons with lived experience). Stakeholders participated in 1 of 2 expert panels on 14 hypothetical state-level policies targeting treatment engagement and linkage, evidence-based and integrated care, treatment flexibility, and monitoring or support services. Participants rated policies in round 1, discussed results in round 2, and provided final ratings in round 3. Participants used 4 criteria associated with either the effectiveness or implementability to rate and discuss each policy. The effectiveness panel (n = 29) considered policy effects on treatment engagement, treatment retention, OUD remission, and opioid overdose mortality. The implementation panel (n = 34) considered the acceptability, feasibility, affordability, and equitability of each policy. We measured consensus using the interpercentile range adjusted for symmetry analysis technique from the RAND/UCLA appropriateness method. Findings Both panels reached consensus on all items. Experts viewed 2 policies (facilitated access to medications for OUD and automatic Medicaid enrollment for citizens returning from correctional settings) as highly implementable and highly effective in improving patient and population-level outcomes. Participants rated hub-and-spoke-type policies and provision of financial incentives to emergency departments for treatment linkage as effective; however, they also rated these policies as facing implementation barriers associated with feasibility and affordability. Coercive policies and policies levying additional requirements on individuals with OUD receiving treatment (eg, drug toxicology testing, counseling requirements) were viewed as low-value policies (ie, decreasing treatment engagement and retention, increasing overdose mortality, and increasing health inequities). Conclusions and Relevance The findings of this study may provide urgently needed consensus on policies for states to consider either adopting or deimplementing in their efforts to address the opioid overdose crisis.
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Affiliation(s)
- Rosanna Smart
- Economics, Sociology, and Statistics Department, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Sean Grant
- Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 30 N. 1900 E., Salt Lake City, UT 84132, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, USA
| | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089, USA
| | - Bradley D. Stein
- Behavioral and Policy Sciences Department, RAND Corporation, 4570 Fifth Ave. #600, Pittsburgh, PA 15213, USA
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Abraham AJ, Yarbrough CR, Harris SJ, Adams GB, Andrews CM. Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System. Psychiatr Serv 2021; 72:148-155. [PMID: 33267651 PMCID: PMC8262068 DOI: 10.1176/appi.ps.202000049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research has examined the effect of Medicaid expansion on access to physicians with buprenorphine waivers, but less attention has been paid to Medicaid's impact on opioid use disorder medication availability within the specialty substance use disorder treatment system. To address this gap in the literature, this study examined the impact of Medicaid expansion on availability of opioid medications in specialty programs. METHODS This study used data from the National Survey of the Substance Abuse Treatment Services (2002-2017), containing all known substance use disorder treatment programs in the United States, to examine the effect of Medicaid expansion on the availability of opioid use disorder medications by treatment program ownership type (publicly owned, private for profit, and private nonprofit) among opioid treatment programs (OTPs) and non-OTPs. RESULTS The effects of Medicaid expansion were limited to nonprofit and for-profit OTPs. Medicaid expansion was associated with 135.1% and 57.5% increases in the number of nonprofit and for-profit OTPs offering injectable naltrexone, respectively, and with a 64.4% increase in the number of nonprofit OTPs offering buprenorphine. Nonprofit and for-profit OTPs compose <10% of the treatment system, indicating that improvements in opioid use disorder treatment associated with Medicaid expansion were limited to a small share of the specialty system. CONCLUSIONS The limited impact of Medicaid expansion on the specialty treatment system may perpetuate disparities in the accessibility and quality of opioid use disorder treatment for Medicaid enrollees and fail to alleviate high rates of opioid use disorder and opioid overdose deaths in this vulnerable population.
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Affiliation(s)
- Amanda J Abraham
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens (Abraham, Harris); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Health Policy and Management, College of Public Health, University of Georgia, Athens (Adams); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia (Andrews)
| | - Courtney R Yarbrough
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens (Abraham, Harris); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Health Policy and Management, College of Public Health, University of Georgia, Athens (Adams); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia (Andrews)
| | - Samantha J Harris
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens (Abraham, Harris); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Health Policy and Management, College of Public Health, University of Georgia, Athens (Adams); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia (Andrews)
| | - Grace Bagwell Adams
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens (Abraham, Harris); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Health Policy and Management, College of Public Health, University of Georgia, Athens (Adams); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia (Andrews)
| | - Christina M Andrews
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens (Abraham, Harris); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Health Policy and Management, College of Public Health, University of Georgia, Athens (Adams); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia (Andrews)
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State criminal justice policy context and opioid agonist treatment delivery among opioid treatment admissions, 2015. Drug Alcohol Depend 2020; 206:107654. [PMID: 31735533 PMCID: PMC7377924 DOI: 10.1016/j.drugalcdep.2019.107654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Criminal justice referral to treatment is associated with reduced odds of receiving opioid agonist treatment (OAT), the gold-standard treatment for opioid use disorder. States vary substantially in the extent of criminal justice system involvement in opioid treatment; however, the effects on treatment provision are not clear. We examined whether state-level criminal justice involvement in the substance use treatment system modified the association between criminal justice referral to treatment and OAT provision among opioid treatment admissions. METHODS We conducted a random effects logistic regression to investigate how the effects of criminal justice referral to treatment on OAT provision differed in states with high vs. low state-level criminal justice involvement in opioid treatment, adjusting for individual and state-level covariates, among 22 states in the 2015 Treatment Episode Dataset-Admissions. RESULTS Criminal justice referral to treatment was associated with an 85% reduction in the odds of receiving OAT, compared to other sources of treatment referral (OR = 0.15; 95% CI: 0.15, 0.16). Among opioid treatment admissions resulting from criminal justice referral in 2015, receiving treatment in high criminal justice involvement states was associated with a 63% reduction in the odds of OAT provision, compared to opioid treatment received in low criminal justice involvement states (interaction OR = 0.37, 95% CI: 0.11, 0.89). CONCLUSION The effects of criminal justice referral to treatment on OAT provision varied by criminal justice involvement in opioid treatment at the state level. Targeted interventions should increase access to OAT in states that rely on the criminal justice system for opioid treatment referrals.
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Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics 2020; 17:55-69. [PMID: 31907876 PMCID: PMC7007488 DOI: 10.1007/s13311-019-00814-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.
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Affiliation(s)
- Amanda J. Abraham
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Christina M. Andrews
- College of Social Work, University of South Carolina, 1512 Pendleton St., Room 309, Columbia, SC 29208 USA
| | - Samantha J. Harris
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Peter D. Friedmann
- University of Massachusetts Medical School Baystate, 280 Chestnut St., Springfield, MA 01199 USA
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Abstract
Objective: Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications. Method: The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications. Analyses examined public health data on regional opioid addiction patterns, characteristics of the local health insurance market, and their associations with coverage for opioid addiction pharmacotherapy. Results: Most (70%) of the 44 participating ADAMHS Boards paid for opioid treatment medications. For payment policy, all Boards required behavioral therapy to be provided in conjunction with opioid agonist or opioid antagonist therapy, and 27% of the Boards limited length of a buprenorphine therapy regimen. Higher local opioid treatment admission rates were associated with higher rates of Board funding for opioid treatment pharmacotherapy. Environmental variables (eg, overdose fatality rates or the behaviors of private insurance payers) were not associated with ADAMHS support for opioid agonist or antagonist medication. Conclusions: The analysis highlights the policy preferences of these payers. Follow-up studies should examine the payer decision-making processes, preferences, and attitudes that affect support for pharmacotherapy for opioid dependence.
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Winograd RP, Wood CA, Stringfellow EJ, Presnall N, Duello A, Horn P, Rudder T. Implementation and evaluation of Missouri's Medication First treatment approach for opioid use disorder in publicly-funded substance use treatment programs. J Subst Abuse Treat 2019; 108:55-64. [PMID: 31277891 DOI: 10.1016/j.jsat.2019.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Leaders of Missouri's State Targeted Response to the opioid crisis (STR) grant have prioritized increasing access to treatment medications for opioid use disorder (MOUD) through a "Medication First" approach. This conceptual framework prioritizes rapid, sustained, low-barrier access to MOUD for optimal impact on decreased illicit drug use and mortality. Medication First principles and practices were facilitated through state-level structural changes and disseminated to participating community treatment programs via a multi-pronged, multi-disciplinary approach. In the first nine months of STR, 14 state-contracted treatment agencies operating 38 sites used STR funding to implement the Medication First model. METHODS We utilized state billing and service data to make comparisons before and during STR on the following outcomes: MOUD utilization, timely access to MOUD, amount of psychosocial services delivered, treatment retention at 1, 3, and 6 months, and monthly price of treatment. We conducted follow-up analyses examining differences across MOUD types (no medication, methadone, buprenorphine, oral naltrexone, mixed antagonist + agonist, and extended release naltrexone). RESULTS During STR, MOUD utilization increased (44.8% to 85.3%), timeliness of MOUD receipt improved (Median of 8 days vs. 0 days), there were fewer psychosocial services delivered, treatment retention improved at one, three, and six month timeframes, and the median cost per month was 21% lower than in the year prior to STR. All differences were driven by increased utilization of buprenorphine. CONCLUSIONS Findings suggest Medication First implementation through STR was successful in all targeted domains. Though much more work is needed to further reduce logistical, financial, and cultural barriers to improved access to maintenance MOUD, the steps taken through Missouri's STR grant show significant promise at making swift and drastic transformations to a system of care in response to a growing public health emergency.
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Affiliation(s)
- Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States.
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Erin J Stringfellow
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Ned Presnall
- Department of Psychiatry, Washington University, 1 Brookings Dr, St. Louis, MO 63130, United States
| | - Alex Duello
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Phil Horn
- Missouri Institute of Mental Health, University of Missouri St. Louis, 4633 World Parkway Circle Dr., St. Louis, MO 63134, United States
| | - Tim Rudder
- Missouri Department of Mental Health, 1706 East Elm St., Jefferson City, MO 65101, United States
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McCarty D. A Changing Landscape for Treatment of Alcohol and Drug Use Disorders. Am J Public Health 2019; 109:838-839. [PMID: 31067113 DOI: 10.2105/ajph.2019.305080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Dennis McCarty
- Dennis McCarty is with the School of Public Health, Oregon Health & Science University-Portland State University, Portland
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Hinde J, Bray J, Kaiser D, Mallonee E. The influence of state-level policy environments on the activation of the Medicaid SBIRT reimbursement codes. Addiction 2017; 112 Suppl 2:82-91. [PMID: 28074562 DOI: 10.1111/add.13655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/12/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022]
Abstract
AIMS To examine how institutional constraints, comprising federal actions and states' substance abuse policy environments, influence states' decisions to activate Medicaid reimbursement codes for screening and brief intervention for risky substance use in the United States. METHODS A discrete-time duration model was used to estimate the effect of institutional constraints on the likelihood of activating the Medicaid reimbursement codes. Primary constraints included federal Screening, Brief Intervention and Referral to Treatment (SBIRT) grant funding, substance abuse priority, economic climate, political climate and interstate diffusion. Study data came from publicly available secondary data sources. RESULTS Federal SBIRT grant funding did not affect significantly the likelihood of activation (P = 0.628). A $1 increase in per-capita block grant funding was associated with a 10-percentage point reduction in the likelihood of activation (P = 0.003) and a $1 increase in per-capita state substance use disorder expenditures was associated with a 2-percentage point increase in the likelihood of activation (P = 0.004). States with enacted parity laws (P = 0.016) and a Democratic-controlled state government were also more likely to activate the codes. CONCLUSION In the United States, the determinants of state activation of Medicaid Screening, Brief Intervention and Referral to Treatment (SBIRT) reimbursement codes are complex, and include more than financial considerations. Federal block grant funding is a strong disincentive to activating the SBIRT reimbursement codes, while more direct federal SBIRT grant funding has no detectable effects.
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Affiliation(s)
- Jesse Hinde
- RTI International, Research Triangle Park, NC, USA.,Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeremy Bray
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - David Kaiser
- RTI International, Research Triangle Park, NC, USA
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Chor KHB, Wisdom JP, Olin SCS, Hoagwood KE, Horwitz SM. Measures for Predictors of Innovation Adoption. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:545-73. [PMID: 24740175 DOI: 10.1007/s10488-014-0551-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.
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Affiliation(s)
- Ka Ho Brian Chor
- Center for Mental Health Implementation and Dissemination Science in States for Children, Adolescents, and Families (IDEAS Center), Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA,
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Pagano A, Tajima B, Guydish J. Barriers and Facilitators to Tobacco Cessation in a Nationwide Sample of Addiction Treatment Programs. J Subst Abuse Treat 2016; 67:22-9. [PMID: 27296658 DOI: 10.1016/j.jsat.2016.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/12/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Smoking rates among addiction treatment clients are 3-4 times higher than those of the general population. Recent studies indicate that ceasing tobacco use during treatment may improve recovery outcomes. Across the United States, publicly funded addiction treatment programs vary widely in terms of their tobacco policies and tobacco cessation services offered to clients. METHODS The study reported here is the qualitative component of a larger study. Twenty-four programs were recruited from a random sample of publicly funded programs participating in the NIDA Clinical Trials Network. Semi-structured interviews were administered by phone to program directors. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS While all directors expressed interest in helping clients to quit smoking, they cited numerous barriers to implementing tobacco policies and services. These included smoking culture, client resistance, lack of resources, staff smoking, and environmental barriers. Directors also cited several factors that they believed would support tobacco cessation. These included financial support, enhanced leadership, and state mandates against smoking in addiction treatment programs. CONCLUSION Addiction treatment programs are beginning to place more emphasis on tobacco cessation during treatment. However, furthering this goal requires substantial infrastructural and cultural change. These qualitative study findings may help to inform Single State Agencies (SSAs) to support publicly funded addiction treatment programs in their tobacco cessation efforts. In order to maximize effectiveness, state-level policies regarding tobacco cessation during treatment should be informed by ongoing dialogue between service providers and SSAs.
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Affiliation(s)
- Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE), Oakland, CA, 94612.
| | - Barbara Tajima
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118
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Nielson EM. Substance Abuse Counselors' Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation. JOURNAL OF DRUG AND ALCOHOL RESEARCH 2016. [PMID: 28626597 PMCID: PMC5473661 DOI: 10.4303/jdar/235982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to better understand the relationship between substance abuse counselors’ personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders. Methods A phenomenological qualitative study enrolled 12 practicing substance abuse counselors. Results Within this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients’ struggles. Discussion Since empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors’ recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments.
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Affiliation(s)
- Elizabeth M Nielson
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
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Burns RM, Pacula RL, Bauhoff S, Gordon AJ, Hendrikson H, Leslie DL, Stein BD. Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013. Subst Abus 2015; 37:63-9. [PMID: 26566761 DOI: 10.1080/08897077.2015.1080208] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND State Medicaid policies play an important role in Medicaid enrollees' access to and use of opioid agonists, such as methadone and buprenorphine, in the treatment of opioid use disorders. Little information is available, however, regarding the evolution of state policies facilitating or hindering access to opioid agonists among Medicaid enrollees. METHODS During 2013-2014, we surveyed state Medicaid officials and other designated state substance abuse treatment specialists about their state's recent history of Medicaid coverage and policies pertaining to methadone and buprenorphine. We describe the evolution of such coverage and policies and present an overview of the Medicaid policy environment with respect to opioid agonist therapy from 2004 to 2013. RESULTS Among our sample of 45 states with information on buprenorphine and methadone coverage, we found a gradual trend toward adoption of coverage for opioid agonist therapies in state Medicaid agencies. In 2013, only 11% of states in our sample (n = 5) had Medicaid policies that excluded coverage for methadone and buprenorphine, whereas 71% (n = 32) had adopted or maintained policies to cover both buprenorphine and methadone among Medicaid enrollees. We also noted an increase in policies over the time period that may have hindered access to buprenorphine and/or methadone. CONCLUSIONS There appears to be a trend for states to enact policies increasing Medicaid coverage of opioid agonist therapies, while in recent years also enacting policies, such as prior authorization requirements, that potentially serve as barriers to opioid agonist therapy utilization. Greater empirical information about the potential benefits and potential unintended consequences of such policies can provide policymakers and others with a more informed understanding of their policy decisions.
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Affiliation(s)
| | | | | | - Adam J Gordon
- b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.,c Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Hollie Hendrikson
- d National Conference of State Legislatures , Denver , Colorado , USA
| | | | - Bradley D Stein
- a RAND Corporation , Pittsburgh , Pennsylvania , USA.,b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
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Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D. A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation. Health Serv Res 2015; 50:1125-45. [PMID: 25532616 PMCID: PMC4545350 DOI: 10.1111/1475-6773.12273] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). DATA SOURCES/STUDY SETTING Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009. STUDY DESIGN/DATA COLLECTION The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. PRINCIPAL FINDINGS Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. CONCLUSIONS Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.
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Affiliation(s)
- Traci Rieckmann
- Address correspondence to Traci Rieckmann, Ph.D., Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., CSB 669, Portland, OR 97239; e-mail:
| | - Amanda Abraham
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Janet Zwick
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Caitlin Rasplica
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - Dennis McCarty
- Amanda Abraham, Ph.D., is with the Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA
- Janet Zwick, L.C.S.W., is with the Zwick Healthcare Consultants LLC, Urbandale, IA
- Caitlin Rasplica, B.A., is with the Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR
- Dennis McCarty, Ph.D., is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
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Fields D, Roman P. Longitudinal Examination of Medical Staff Utilization in Substance Use Disorder Treatment Organizations. J Subst Abuse Treat 2015. [PMID: 26219681 DOI: 10.1016/j.jsat.2015.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined changes in utilization of medical staff within organizations specializing in treatment of patients with substance use disorder (SUD) at two points in time (2007 and 2010). Utilization was calculated as the number of hours paid weekly for psychiatrists, physicians, nurses, and other medical staff working as employees or on contract. Study data come from a longitudinal national sample of 274 substance use disorder treatment centers. Average utilization of medical staff by these SUD treatment organizations increased by 26% from 2007 to 2010. The results showed that growing SUD treatment centers that obtained more referrals from health care providers, used case managers to coordinate comprehensive approaches to patient care, provided medication assisted treatment (MAT), and that were connected more closely with hospitals made increased use of medical staff over the 2007-2010 period. In 2010, these organizations seem to have been moving in directions consistent with trends forecasted for the SUD treatment environment after implementation of the Affordable Care Act.
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Affiliation(s)
- Dail Fields
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA.
| | - Paul Roman
- Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia, Athens, GA, USA; Department of Sociology, University of Georgia, Athens, GA, USA.
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16
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Sloan FA, Eldred LM. Do preferences of drinker-drivers differ? INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2015; 15:241-268. [PMID: 27878705 PMCID: PMC5123438 DOI: 10.1007/s10754-015-9169-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/03/2015] [Indexed: 06/06/2023]
Abstract
Why people engage in illegal activities is not well understood. Using data collected for this research from eight cities in four states, this study investigates alternative explanations as to why people drive while intoxicated (DWI). We find that preferences and subjective beliefs about arrest/incarceration of persons who drink and drive do differ systematically from others in terms of benefits and costs of drink and driving, and in their risk tolerance. While most findings imply that DWI is a deliberate choice, we do find that drinker drivers tend to be more impulsive and lack self-control in their drinking.
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Affiliation(s)
- Frank A. Sloan
- Department of Economics, 213 Social Sciences Building, Box 90097, Duke University, Durham, NC 27708
| | - Lindsey M. Eldred
- Department of Economics, 213 Social Sciences Building, Box 90097, Duke University, Durham, NC 27708
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Knudsen HK, Roman PM. Service delivery and pharmacotherapy for alcohol use disorder in the era of health reform: Data from a national sample of treatment organizations. Subst Abus 2015; 37:230-7. [PMID: 25893539 DOI: 10.1080/08897077.2015.1028699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although there is a growing literature examining organizational characteristics and medication adoption, little is known about service delivery differences between specialty treatment organizations that have and have not adopted pharmacotherapy for alcohol use disorder (AUD). This study compares adopters and nonadopters across a range of treatment services, including levels of care, availability of tailored services for specific populations, treatment philosophy and counseling orientations, and adoption of comprehensive wraparound services. METHODS In-person interviews were conducted with program leaders from a national sample of 372 organizations that deliver AUD treatment services in the United States. RESULTS About 23.6% of organizations had adopted at least 1 AUD medication. Organizations offering pharmacotherapy were similar to nonadopters across many measures of levels of care, tailored services, treatment philosophy, and social services. The primary area of difference between the 2 groups was for services related to health problems other than AUD. Pharmacotherapy adopters were more likely to offer primary medical care, medications for smoking cessation, and services to address co-occurring psychiatric conditions. CONCLUSIONS Service delivery differences were modest between adopters and nonadopters of AUD pharmacotherapy, with the exception of health-related services. However, the greater adoption of health-related services by organizations offering AUD pharmacotherapy represents greater medicalization of treatment, which may mean these programs are more strongly positioned to respond to opportunities for integration under health reform.
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Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
| | - Paul M Roman
- b Owens Institute for Behavioral Research and Department of Sociology , University of Georgia , Athens , Georgia , USA
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Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, Starr S. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:13. [PMID: 25884206 PMCID: PMC4395880 DOI: 10.1186/s13011-015-0009-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/11/2015] [Indexed: 11/16/2022]
Abstract
Background Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption. Methods We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings. Results County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity. Conclusions This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization’s decision to begin buprenorphine use and that physician availability influences an organization’s ability to expand buprenorphine use over time. Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.
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Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Carol Sherbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Mark Zehner
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Andy Quanbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Dennis McCarty
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon, 97239-3098, USA.
| | - Jee-Seon Kim
- University of Wisconsin-Madison, School of Education, 1057 Educational Sciences, Madison, WI, 53706, USA.
| | - Sandy Starr
- Ohio Department of Mental Health and Addiction Services (OhioMHAS), 30 East Broad Street, 8th Floor, Columbus, Ohio, 43215, USA.
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Knudsen HK, Roman PM. Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations. J Subst Abuse Treat 2015; 49:1-7. [PMID: 25218918 PMCID: PMC4277913 DOI: 10.1016/j.jsat.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year ("recent adoption"), (2) plans to adopt an innovation in the upcoming year ("planned adoption"), or (3) no actual or planned adoption ("non-adoption"). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n=93) or planned adoption (n=62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean=4.47, SD=1.03), improvement in the program's reputation with referral sources (mean=4.00, SD=1.33), reputational improvement with clients and their families (mean=3.98, SD=1.31), and reductions in treatment dropout (mean=3.75, SD=1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may enhance efforts to increase subsequent adoption.
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Affiliation(s)
- Hannah K Knudsen
- University of Kentucky, Department of Behavioral Science, 141 Medical Behavioral Science Building, Lexington, KY 40536-0086.
| | - Paul M Roman
- University of Georgia, Owens Institute for Behavioral Research and Department of Sociology, 106 Barrow Hall, Athens, GA, 30602-2401.
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Knudsen HK, Roman PM. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources. J Stud Alcohol Drugs 2014; 75:476-85. [PMID: 24766760 DOI: 10.15288/jsad.2014.75.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. METHOD Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. RESULTS Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. CONCLUSIONS Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Paul M Roman
- Owens Institute for Behavioral Research and Department of Sociology, University of Georgia, Athens, Georgia
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21
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Integrating substance abuse treatment into HIV care: missed opportunities in the AIDS Drug Assistance Program. J Acquir Immune Defic Syndr 2013. [PMID: 23202815 DOI: 10.1097/qai.0b013e31827ee56c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Untreated substance use disorders (SUD) among HIV patients contribute to worse HIV care outcomes and increased HIV transmission. Although there are clinical and policy recommendations for integrated SUD and HIV treatment, payment issues including complex funding streams are a barrier. OBJECTIVES We assessed the availability of guideline-concordant medication-assisted therapies to treat alcohol, tobacco, and opioid dependence on state-administered AIDS Drug Assistance Programs (ADAPs), an important source of drug coverage for low-income HIV patients. We examined which medication-assisted therapies are most likely to be included on formularies and variation of these therapies across states. RESEARCH DESIGN We reviewed state-specific ADAP formularies from 1997 to 2009 for the presence of guideline-concordant medication-assisted therapies to treat alcohol, tobacco, and opioid dependence. RESULTS The most frequently included medication-assisted therapies were those to treat tobacco dependence, followed by opioid dependence. Few states covered alcohol dependence medications. In each year, <10% of states covered all recommended medications and <50% covered a partial formulary for at least 1 SUD. CONCLUSIONS ADAPs could provide access to medication-assisted therapies for SUD for a significant number of HIV patients, but these medications have not been widely covered throughout the program's history. Increased availability of medication-assisted therapies through ADAP could facilitate integrated HIV and SUD care.
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Abstract
Little is known about the organizational and environmental factors associated with the employment of nurses in substance abuse treatment programs. Using data collected from the administrators of 250 publicly funded substance abuse treatment programs, this study examined the organizational and environmental correlates of nurse employment in these settings. Negative binomial regression models indicated that the number of nurses employed by treatment programs was positively associated with government ownership, location within a healthcare setting, and the availability of detoxification services. Outpatient-only programs employed fewer nurses than programs with inpatient/residential services. Two environmental factors were associated with nurse employment. Programs that more strongly endorsed a scale of financial barriers employed significantly fewer nurses, whereas programs indicating that funding from state contracts could be used to pay for healthcare providers employed significantly more nurses. These findings suggest that organizational decisions about employing nurses may reflect both the characteristics of the program and the funding environment. Future research should continue to examine the employment of nurses in substance abuse treatment settings, particularly given the shifting environment due to the implementation of healthcare reform.
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Andrews CM, D'Aunno TA, Pollack HA, Friedmann PD. Adoption of evidence-based clinical innovations: the case of buprenorphine use by opioid treatment programs. Med Care Res Rev 2013; 71:43-60. [PMID: 24051897 DOI: 10.1177/1077558713503188] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and characteristics of staff; organizations' technical and social support for the innovation; local market dynamics and competition; and state policies governing the innovation. Results indicate that buprenorphine use increased 24% for detoxification and 47% for maintenance therapy between 2005 and 2011. Buprenorphine use was positively related to reliance on private insurance and availability of state subsidies to cover its cost and inversely related to the percentage of clients who injected opiates, county size, and local availability of methadone. The results indicate that financial incentives and market factors play important roles in opioid treatment programs' decisions to adopt evidence-based clinical innovations such as buprenorphine use.
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Abraham AJ, Knudsen HK, Rieckmann T, Roman PM. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. J Stud Alcohol Drugs 2013; 74:258-65. [PMID: 23384373 PMCID: PMC3568164 DOI: 10.15288/jsad.2013.74.258] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/28/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Prior research suggests that publicly funded substance use disorder (SUD) treatment programs lag behind privately funded programs in adoption of evidence-based practices, resulting in disparities in access to high-quality SUD treatment. These disparities highlight a critical public health concern because the majority of SUD patients in the United States are treated in the publicly funded treatment sector. This study uses recent data to examine disparities in access to physicians and availability of medications for the treatment of SUDs between publicly and privately funded SUD treatment programs. METHOD Data were collected from 595 specialty SUD treatment programs from 2007 to 2010 via face-to-face interviews, mailed surveys, and telephone interviews with treatment program administrators. RESULTS Publicly funded programs were less likely than privately funded programs to have a physician on staff, even after controlling for several organizational characteristics that were associated with access to physicians. The results of negative binomial regression indicated that, even after taking into account physician access and other organizational variables, publicly funded programs prescribed fewer SUD medications than privately funded SUD treatment programs. CONCLUSIONS Patients seeking treatment in publicly funded treatment programs continue to face disparities in access to high-quality SUD treatment that supports patients' choices among a range of medication options. However, implementation of the Affordable Care Act may facilitate greater access to physicians and use of medications in publicly funded SUD treatment programs.
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Affiliation(s)
- Amanda J Abraham
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina 29208, USA.
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Knudsen HK, Oser CB, Abraham AJ, Roman PM. Physicians in the substance abuse treatment workforce: understanding their employment within publicly funded treatment organizations. J Subst Abuse Treat 2012; 43:152-60. [PMID: 22301083 DOI: 10.1016/j.jsat.2011.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/22/2011] [Accepted: 12/12/2011] [Indexed: 11/29/2022]
Abstract
The employment of physicians by substance abuse treatment organizations is understudied, despite physicians' importance in implementing pharmacotherapy and integrating treatment into the broader system of medical care. Drawing on data collected from 249 publicly funded treatment organizations, this study examined organizational and environmental factors associated with the employment of physicians in these settings. A negative binomial regression model indicated that greater numbers of physicians were employed when organizations offered detoxification services, were embedded in health care settings, and were larger in size. Funding barriers, including the costs of physicians and inadequate reimbursement by funders, were negatively associated with physician employment. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field. Increasing physician employment may be challenging in the current economic climate.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.
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