Predictors of availability of long-acting medication for opioid use disorder

Drug Alcohol Depend. 2019 Nov 1;204:107586. doi: 10.1016/j.drugalcdep.2019.107586. Epub 2019 Sep 25.

Abstract

Background: The U.S. Food and Drug Administration has approved three long-acting medications for opioid use disorder (MOUD): extended-release naltrexone (XR-NTX) in 2010, a subdermal buprenorphine implant in 2016, and a depot buprenorphine injection in 2017. Long-acting MOUD options may improve adherence while reducing diversion, but their availability compared to daily-dosing MOUD has not been well-characterized. The objective of this analysis was to characterize the availability of long-acting MOUD in substance use disorder treatment settings in the United States.

Methods: Using the 2017 National Survey on Substance Abuse Treatment Services (N-SSATS) and state-level opioid overdose mortality, we examined associations between state- and facility-level factors and offering long-acting MOUD, which included XR-NTX and the buprenorphine implant. We constructed multivariable mixed logistic regression models for both types of long-acting MOUD.

Results: Nationwide, 38% (n = 5141) of substance use treatment facilities provided any kind of MOUD (daily or long-acting). Of these, 62% provided XR-NTX, whereas only 3% offered the buprenorphine implant. Facilities in the East North Central, East South Central, West North Central and Mountain regions had higher odds of offering XR-NTX, as did federally-funded facilities, and facilities in states with the highest opioid overdose mortality rates.

Conclusions: In 2017, XR-NTX was available at most of the minority of facilities offering MOUD, but the buprenorphine implant was not. Increasing the availability of MOUD, including long-acting options, is necessary to address unmet need for opioid use disorder treatment.

Keywords: Buprenorphine; Health services; MOUD; Naltrexone; Opioid use disorder; Treatment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Buprenorphine / administration & dosage
  • Delayed-Action Preparations / administration & dosage
  • Female
  • Forecasting
  • Humans
  • Male
  • Naltrexone / administration & dosage
  • Narcotic Antagonists / administration & dosage*
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / epidemiology*
  • Surveys and Questionnaires*
  • United States / epidemiology

Substances

  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Narcotic Antagonists
  • Buprenorphine
  • Naltrexone