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

Abstract

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. (J. Stud. Alcohol Drugs, 74, 258-265, 2013)

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…Historically, the core technology of SUD treatment has been psychosocial counseling delivered by counselors (Roman et al, 2000), and the majority of nonOTPs do not employ physicians (Knudsen et al, 2012). Most programs have been slow to integrate pharmacotherapy into their menu of services, with fewer than 40% of specialty organizations offering buprenorphine treatment (Abraham et al, 2013). However, the diffusion of buprenorphine among physicians represents an example of the integration of SUD treatment into the mainstream health care system that has been advocated in policy circles in recent years (Buck, 2011).…”

Capsule Commentary on D’Onofrio et al., Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention

“…3 Treatment barriers including scarcity of buprenorphine prescribers and coverage gaps have been well documented, particularly within marginalized groups. 4,5 The results at the 2-month mark indicate that patients offered continued treatment were more likely to use it. This finding suggests the need for concerted efforts by clinicians, payers and policymakers alike to address not only the barriers to buprenorphine therapy initiation, but also the challenges that limit its continued use.…”

The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources

“…Buprenorphine requires physicians to either meet credentialing requirements or complete an 8-hour training (Fiellin, 2007;West et al, 2004). Even with this regulatory requirement, rates of buprenorphine adoption in specialty SUD treatment are similar to those for the other medications, albeit still quite low (Abraham et al, 2013).…”

“…Organizational structure is often correlated with the quality of SUD treatment services (Alexander et al, 1998;Heinrich and Fournier, 2004;Heinrich and Hill, 2008;Rodgers and Barnett, 2000). Structural characteristics, such as location within medical settings (Abraham et al, 2013), accreditation , and government ownership , tend to be positively correlated with medication availability in cross-sectional analyses.…”

“…SUD treatment organizations were once quite isomorphic in that nearly all endorsed a 12-step model of recovery (Roman et al, 2000;White, 1998), but this orientation is no longer ubiquitous . Findings regarding the relationship between endorsement of the 12-step model and medication adoption have been mixed, with some studies reporting a negative association (Friedmann et al, 2010;Roman, 2007, 2008), whereas others have found no relationship (Abraham et al, , 2013Knudsen et al, 2007). A related cultural orientation is the degree to which spirituality is emphasized as part of a program's treatment philosophy.…”