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. 2019 Dec 1:205:107616.
doi: 10.1016/j.drugalcdep.2019.107616. Epub 2019 Oct 17.

Characteristics and current clinical practices of opioid treatment programs in the United States

Christopher M Jones  1 , Danielle J Byrd  2 , Thomas J Clarke  3 , Tony B Campbell  2 , Chideha Ohuoha  4 , Elinore F McCance-Katz  5
Affiliations

Characteristics and current clinical practices of opioid treatment programs in the United States

Christopher M Jones et al. Drug Alcohol Depend. .

Abstract

Background: Given rising rates of opioid use disorder (OUD) and related consequences, opioid treatment programs (OTPs) can play a pivotal role in the U.S. opioid crisis. There is a paucity of recent research to guide how best to leverage OTPs in the opioid response.

Methods: We conducted a national survey of U.S. OTPs using a 46-question electronic survey instrument covering three domains: 1) OTP characteristics; 2) services offered; and 3) current clinical practices. Descriptive statistics and multivariable logistic regression examined variables in these domains.

Results: Among responding OTPs, 32.4% reported using all three medications for OUD treatment; 95.8% used methadone, 61.8% used buprenorphine, and 43.9% used naltrexone. The mean (SD) number of patients currently receiving methadone was 383 (20.4), buprenorphine 51 (7.0), extended-release naltrexone 6 (1.0). Viral hepatitis testing was provided by 60.9% of OTPs, 15.3% provided hepatitis B vaccination, 14.9% provided hepatitis A vaccination, and 12.6% provided medication treatment for hepatitis C virus infection. HIV testing was provided by 60.7% of OTPs, 9.5% provided pre-exposure prophylaxis, and 8.4% provided medication treatment for HIV. OTP characteristics associated with using all three forms of medications for OUD included: providing medication for alcohol use disorder (aOR = 5.24, 95% CI:2.99-9.16), providing telemedicine services (aOR = 3.82, 95% CI:2.14-6.84), and directly providing naloxone to patients (aOR = 2.57, 95% CI:1.53-4.29). Multiple barriers to providing buprenorphine and extended-release naltrexone were identified.

Conclusions: Efforts are needed to increase availability of all medications approved to treat OUD in OTPs, integrate infectious disease-related services, and expand the reach of OTPs in the U.S.

Keywords: Buprenorphine; Infectious disease; Methadone; Naltrexone; Opioid treatment program; Opioid use disorder; Psychosocial services.

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