Financial factors and the implementation of medications for treating opioid use disorders.
OBJECTIVE
Despite the established effectiveness of pharmacotherapies for treating opioid use disorders, implementation of medications for addiction treatment (MAT) by specialty treatment programs is limited. This research examined relationships between organizational factors and the program-level implementation of MAT, with attention paid to specific sources of funding, organizational structure, and workforce resources.


METHODS
Face-to-face structured interviews were conducted in 2008 to 2009 with administrators of 154 community-based treatment programs affiliated with the National Institute on Drug Abuse's Clinical Trials Network; none of these programs exclusively dispensed methadone without offering other levels of care. Implementation of MAT was measured by summing the percentages of opioid patients receiving buprenorphine maintenance, methadone maintenance, and tablet naltrexone. Financial factors included the percentages of revenues received from Medicaid, private insurance, criminal justice, the Federal block grant, state government, and county government. Organizational structure and workforce characteristics were also measured.


RESULTS
Implementation of MAT for opioid use disorders was low. Greater reliance on Medicaid was positively associated with implementation after controlling for organizational structure and workforce measures, whereas the association for reliance on criminal justice revenues was negative.


CONCLUSIONS
The implementation of MAT for opioid use disorders by specialty addiction treatment programs may be facilitated by Medicaid but may be impeded by reliance on funding from the criminal justice system. These findings point to the need for additional research that considers the impact of organizational dependence on different types of funding on patterns of addiction treatment practice.
Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536, USA. Hannah.Krudsen@uky.edu
Hannah K
HK
Knudsen
Paul M
PM
Roman
D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use; D003155:Community Mental Health Centers / Q000191:economics / Q000458:organization & administration; D003416:Criminal Law / Q000191:economics*; D005380:Financing, Government / Q000191:economics* / Q000458:organization & administration; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration; D006280:Health Workforce / Q000191:economics / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D009270:Naloxone / Q000191:economics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics*; D009293:Opioid-Related Disorders / Q000191:economics* / Q000534:rehabilitation*; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000458:organization & administration; D014481:United States
D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone