Category
Applied
Description
Background: Medications for opioid use disorder (MOUD) reduce overdose risk and improve retention in care, yet implementation at treatment entry remains uneven across the United States. Study objectives and hypotheses: To examine national and state-level patterns in MOUD use at treatment admission from 2014 through 2023 and to identify state-year characteristics associated with higher utilization. We hypothesized that MOUD use would vary substantially across states and would be lower in state years with greater structural disadvantage.
Methods: A repeated cross-sectional ecological study was conducted using the Treatment Episode Data Set-Admissions public use file. The analytic sample included adult admissions from 2014 through 2023 with opioid dependence and a valid MOUD status at admission. Descriptive analyses summarized MOUD use nationally, by subgroup, and by state. Adjusted binomial-logit state-year models evaluated associations between state-level admission composition and MOUD utilization.
Results: The analytic sample included 3,003,886 admissions, of which 38.1% had MOUD use at admission. National utilization increased from 26.7% in 2014 to 42.7% in 2018 and was 38.2% in 2023. State-level weighted utilization ranged from 0.0% to 84.8%. In adjusted state-year models, higher Hispanic composition and greater non-intensive outpatient treatment composition were associated with higher odds of MOUD utilization, while greater homelessness composition was associated with lower odds. Sensitivity analyses showed the same general pattern.
Conclusion: MOUD utilization at treatment admission remained uneven across states, service settings, and admission populations. These findings suggest persistent implementation gaps in evidence-based opioid use disorder treatment at entry into care.
Keywords: MOUD utilization, States, Homeless, Service setting, Opioid Use Disorder
National Trends and State-Level Correlates of Medications for Opioid Use Disorder Utilization Among Treatment Admissions in the United States, 2014-2023
Applied
Background: Medications for opioid use disorder (MOUD) reduce overdose risk and improve retention in care, yet implementation at treatment entry remains uneven across the United States. Study objectives and hypotheses: To examine national and state-level patterns in MOUD use at treatment admission from 2014 through 2023 and to identify state-year characteristics associated with higher utilization. We hypothesized that MOUD use would vary substantially across states and would be lower in state years with greater structural disadvantage.
Methods: A repeated cross-sectional ecological study was conducted using the Treatment Episode Data Set-Admissions public use file. The analytic sample included adult admissions from 2014 through 2023 with opioid dependence and a valid MOUD status at admission. Descriptive analyses summarized MOUD use nationally, by subgroup, and by state. Adjusted binomial-logit state-year models evaluated associations between state-level admission composition and MOUD utilization.
Results: The analytic sample included 3,003,886 admissions, of which 38.1% had MOUD use at admission. National utilization increased from 26.7% in 2014 to 42.7% in 2018 and was 38.2% in 2023. State-level weighted utilization ranged from 0.0% to 84.8%. In adjusted state-year models, higher Hispanic composition and greater non-intensive outpatient treatment composition were associated with higher odds of MOUD utilization, while greater homelessness composition was associated with lower odds. Sensitivity analyses showed the same general pattern.
Conclusion: MOUD utilization at treatment admission remained uneven across states, service settings, and admission populations. These findings suggest persistent implementation gaps in evidence-based opioid use disorder treatment at entry into care.
Keywords: MOUD utilization, States, Homeless, Service setting, Opioid Use Disorder
