title: Patterns in admission delays to outpatient methadone treatment in the United States.
abstract: Waiting lists for methadone treatment have existed in many U.S. communities, but little is known nationally about what patient and service system factors are related to admission delays that stem from program capacity shortfalls. Using a combination of national data sources, this study examined patterns in capacity-related admission delays to outpatient methadone treatment in 40 U.S. metropolitan areas (N = 28,920). Patient characteristics associated with admission delays included racial/ethnic minority status, lower education, criminal justice referral, prior treatment experience, secondary cocaine or alcohol use, and co-occurring psychiatric problems. Injection drug users experienced fewer delays, as did self-pay patients and referrals from health care and addiction treatment providers. Higher community-level utilization of methadone treatment was associated with delay, whereas delays were less common in communities with higher utilization of alternative modalities. These findings highlight potential disparities in timely admission to outpatient methadone treatment. Implications for improving treatment access and service system monitoring are discussed.
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore MD 21201, USA. jgryczynski@friendsresearch.org
authors.forename: Jan
authors.initials: J
authors.lastname: Gryczynski
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: David S
authors.initials: DS
authors.lastname: Salkever
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008913:Minority Groups; D058850:Opiate Substitution Treatment / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data / Q000639:trends*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D010045:Outpatients; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D044469:Racial Groups; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone