title: Profiting and providing less care: comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States.
abstract: BACKGROUND
  Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes.
  
  
  OBJECTIVE
  To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations.
  
  
  METHODS
  Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036).
  
  
  METHODS
  Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors.
  
  
  RESULTS
  Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3).
  
  
  CONCLUSIONS
  For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.
authors.affiliation: *Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center †Robert Wood Johnson Foundation Clinical Scholars Program ‡Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA §Department of Medicine, Division of Hospital Medicine ∥Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Bachhuber
authors.forename: William N
authors.initials: WN
authors.lastname: Southern
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
mesh_terms: D003430:Cross-Sectional Studies; D006505:Hepatitis / Q000175:diagnosis; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D009939:Organizations, Nonprofit / Q000458:organization & administration* / Q000706:statistics & numerical data; D017149:Private Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D017150:Public Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000175:diagnosis; D012947:Social Work / Q000458:organization & administration / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States