Only a Third of Mental Health Clinics Offer Meds for Opioid Use Disorder

Despite high rates of opioid use disorder (OUD) among people with mental health disorders, only a third of community outpatient mental health treatment facilities in 20 high-burden states offered medications for OUD, a cross-sectional study showed.

Among the 450 community outpatient mental health treatment facilities surveyed, weighted estimates showed that 34% offered medications for OUD, reported Jonathan Cantor, PhD, of the RAND Corporation in Santa Monica, California, and co-authors in JAMA Network Open.

Facility-level factors associated with increased odds of offering medications for OUD included:

• Having Certified Community Behavioral Health Clinic (CCBHC) status: OR 2.11 (95% CI 1.08-4.11)
• Providing integrated mental and substance use disorder treatment: OR 5.21 (95% CI 2.44-11.14)
• Having a specialized treatment program for patients with both mental and substance use disorders: OR 2.25 (95% CI 1.14-4.43)
• Offering housing services: OR 2.54 (95% CI 1.43-4.51)
• Offering laboratory testing: OR 2.15 (95% CI 1.12-4.12)

Facilities that accepted state-financed health insurance plans other than Medicaid as a form of payment had increased odds of offering medications for OUD (OR 1.95, 95% CI 1.01-3.76), while facilities that accepted state mental health agency funds had reduced odds (OR 0.43, 95% CI 0.19-0.99).

Despite evidence of their effectiveness, a study found that 90% of people with OUD do not receive medications, Cantor and co-authors noted.

“Here, we’re demonstrating the fact that if you do want to receive evidence-based care and do have co-occurring disorders, it’s definitely difficult,” Cantor told MedPage Today.

Expanding the delivery of medications for OUD in these facilities has the potential to improve access for the more than 13 million people with co-occurring disorders who use the facilities annually, the authors said.

For this study, Cantor and colleagues focused on the 20 states with the greatest burden of overdose deaths and contacted 642 community outpatient mental health treatment facilities; staff from 450 facilities including all CCBHCs responded to the phone survey from April to July 2023.

Of the facilities that provided medications for OUD, 47% reported screening patients for OUD, and 20% said they did not know if they screened patients for OUD; 82% offered telehealth for OUD, and 60% offered telehealth specifically for medications for OUD. The mean wait time for such an appointment was 12.7 days.

The majority of responding facilities (84%) said they provided buprenorphine, with 96% offering oral/sublingual forms, 43% offering injectable buprenorphine, and fewer than 1% offering subcutaneous implants. Seventy percent offered naltrexone, and 14% offered methadone.

Among facilities that did not offer medications for OUD, approximately 7% said they planned to offer these medications in the future, while 39% said they weren’t sure if they would offer this type of medication. However, 87% of these facilities said they refer patients to other facilities for OUD medications — 38% referred patients to other facilities within the same organization, 48% referred patients to a mental health clinic, 67% to a substance use disorder treatment facility or opioid treatment program, and 9% to a health clinic.

Because Cantor and team focused on 20 states, their results may not be generalizable to others, they noted. Cantor said he would like to conduct a national study to determine whether rates of provision of medications for OUD are similar in other states, with the goal of having the same granular level of data that’s currently available for substance use disorder clinics.

Other limitations to the study included the fact that survey respondents were asked whether medication for OUD is offered, but did not report on how many patients actually received medication. The authors also did not track characteristics of respondents (receptionist vs behavioral health director), which could have affected responses.

The survey also didn’t capture disparities in use of medications for OUD across different groups, Cantor said, adding that he hopes more studies will focus on disparities among people with co-occurring disorders.

“It’s a very vulnerable population. So, we want to make sure that people who need treatment get it,” he said.

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