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Drug Alcohol Depend. 2019 Sep 25;204:107586. doi: 10.1016/j.drugalcdep.2019.107586. [Epub ahead of print]

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

Author information

1
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. (MC: 5717), Stanford, CA 94305, United States. Electronic address: clshover@stanford.edu.
2
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. (MC: 5717), Stanford, CA 94305, United States; Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (152-MPD), Palo Alto, CA 94304, United States. Electronic address: knh@stanford.edu.

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

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