Study finds medication treatment for opioid use disorder offered at only a third of outpatient mental health facilities

Only a third of outpatient community mental health treatment facilities in 20 states with the highest opioid related overdose deaths report offering medication treatment for opioid use disorders, suggesting efforts may be needed to strengthen such services, according to a new RAND study.

Among the 450 clinics surveyed, factors that increased the likelihood that clinics would provide medication for opioid use disorders included being a certified behavioral health clinic and providing integrated mental and substance use disorder treatment.

Researchers found that most clinics that did not offer medication treatment said they referred patients to other clinics for such care, with many sending patients to sites that are within the same treatment system. The findings are published in the journal JAMA Network Open.

"Outpatient community mental health treatment facilities can be an important part of the treatment ecosystem for individuals with opioid use disorders," said Jonathan Cantor, lead author of the study and a policy researcher at RAND. "Further attention is needed to address challenges to offering medication treatment, and to assess whether referral models cited by many of the clinics are effective at meeting patients' needs."

States included in the study all have experienced high drug overdose rates. They are Arizona, California, Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Maryland, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, West Virginia and Wyoming.

More than 80,000 Americans died from opioid overdoses in 2021. The standard of care for treating people with opioid use disorder includes the use of medications such as buprenorphine, methadone and naltrexone to aid recovery, an approach associated with reductions in health care use as well as decreased overdose mortality.

Despite its effectiveness, medication treatment remains underused with a recent study finding that nearly 90% of those with opioid use disorder did not receive such care.

Because an estimated 25% of adults with opioid use disorder have a co-occurring mental illness, outpatient community mental health treatment facilities are a potentially important access point for those who can benefit from medication treatment.

To provide an accurate, representative picture of the availability of medication treatment for opioid use disorder in community outpatient mental health treatment facilities, RAND researchers surveyed 450 clinics from April to July 2023 to ask whether they provided such services. The sample included both private and public facilities that accepted public funds as payment for treatment.

The study found that clinics that offered integrated treatment services for people with substance use disorders were more than five times as likely to offer medication treatment as facilities without integrated services. Facilities that reported having a specialized treatment program for treating people with co-occurring mental health and substance use disorders were more than twice as likely to provide medication management.

"Our findings suggest that offering integrated substance use disorder services for people with co-occurring mental illnesses is a potential avenue toward improving uptake of medication-assisted treatment among those with opioid use disorder," Cantor said.

Other characteristics that were associated with an increased likelihood of offering medication treatment for opioid use disorder include facilities offering housing services and having on-site laboratory services.