A recent survey of US-based opioid treatment programs (OTPs) suggests that many programs should increase the use of methadone, buprenorphine, and extended-release naltrexone in treating opioid use disorder (OUD). Additionally, the survey found several predictive factors for using these 3 medications to treat patients with OUD. Findings from this survey were published in Drug and Alcohol Dependence.
The survey included 497 OTPs in the United States, which represents approximately 31% of all OTPs in the country. Programs responded to a 46-question survey instrument that covered 3 domains frequently reported in peer-reviewed studies: OTP characteristics; services offered; and current clinical practices.
A somewhat similar proportion of OTPs were not for profit (47.5%) and for profit (52.5%), and the majority of programs had been in operation for >20 years (46.7%). More than one-quarter of responding OTPs (32.4%) used methadone, buprenorphine, and extended-release naltrexone for treating OUD. A greater proportion of OTPs reported using methadone (95.8%), followed by buprenorphine (61.8%) and naltrexone (43.9%). At the time of the survey (August 2018 to October 2018), the mean number of patients receiving methadone was 383, followed by 51 for buprenorphine and 6 for extended-release naltrexone.
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In a multivariable logistic regression analysis, OTPs had a greater odds of offering all 3 medications if they provided medication for alcohol use disorder (adjusted odds ratio [aOR], 5.24; 95% CI, 2.99-9.16), telemedicine services (aOR, 3.82; 95% CI, 2.14=6.84), and naloxone (aOR, 2.57; 95% CI, 1.53=4.29). The only characteristic associated with lower odds of offering all 3 medications was geographic location of OTPs (South vs Northeast: aOR, 0.34; 95% CI, 0.16-0.73).
Approximately 77.3% of all OTPs reported ≥1 barrier to accepting additional patients in their program. More than half (60.9%) of OTPs provided viral hepatitis testing, whereas only 15.3% offered hepatitis B vaccination and 14.9% provided hepatitis A vaccination. Only 12.6% of OTPs reported providing medication treatment for hepatitis C virus infection. A majority of OTPs (60.7%) reported offering testing for HIV. Only 9.5% of OTPs reported providing pre-HIV-exposure prophylaxis, and 8.4% offered medication treatment for HIV.
Limitations of the study included the low response rate, the survey’s cross-sectional design, and the self-reported nature of OTP location (ie, urban, rural, and suburban).
Based on the findings, the researchers suggest this survey highlights the need for further efforts centered “on training and incentivizing clinicians to provide care at OTPs” as well as “patient and public education on the use of medications to treat OUD and the availability of OTPs.”
Reference
Jones CM, Byrd DJ, Clarke TJ, et al. Characteristics and current clinical practices of opioid treatment programs in the United States. Drug Alcohol Depend. 2019;205:107616.
