Individual and Health Policy Factors Associated With Positive Heroin and Opioid Treatment Response: United States, 2018

Am J Public Health. 2022 Feb;112(S1):S66-S76. doi: 10.2105/AJPH.2021.306503.


Objectives. To identify client- and state-level factors associated with positive treatment response among heroin and opioid treatment episodes in the United States. Methods. We used national data from 46 states using the Treatment Episode Dataset‒Discharges (2018) to identify heroin and opioid treatment episodes (n = 162 846). We defined positive treatment response as a decrease in use between admission and discharge. We used multivariable regression, stratified by race/ethnicity, to identify demographic, pain-related, and state-level factors associated with positive treatment response. Results. Lower community distress was the strongest predictor of better treatment outcomes across all racial/ethnic groups, particularly among White and American Indian/Alaska Native episodes. A primary opioid of heroin was associated with worse outcomes among White and Hispanic episodes. Legislation limiting opioid dispensing was associated with better outcomes among Hispanic episodes. Buprenorphine availability was strongly associated with better outcomes among Black episodes. Conclusions. State-level variables, particularly community distress, had greater associations with positive treatment outcomes than client-level variables. Public Health Implications. Changes in state-level policies and increased resources directed toward areas of high community distress have the potential to improve opioid use disorder treatment and reduce racial/ethnic disparities in treatment outcomes. (Am J Public Health. 2022;112(S1):S66-S76.

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use
  • Buprenorphine / therapeutic use
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Male
  • Opiate Substitution Treatment / statistics & numerical data*
  • Opioid-Related Disorders / drug therapy*
  • Outcome Assessment, Health Care
  • Racial Groups / statistics & numerical data*
  • United States


  • Analgesics, Opioid
  • Buprenorphine