Oldfield Benjamin J, Chen Kevin, Joudrey Paul J, Biegacki Emma T, Fiellin David A
From the Fair Haven Community Health Care, New Haven, CT (BJO); Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (BJO, ETB, DAF); Office of Ambulatory Care and Population Health, New York City Health and Hospitals Corporation, New York, NY (KC); Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY (KC); Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (PJJ); Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (DAF); and Yale School of Public Health, New Haven, CT (DAF).
J Addict Med. 2023;17(4):477-480. doi: 10.1097/ADM.0000000000001158. Epub 2023 Mar 16.
This study aimed to describe addiction treatment facilities by their offerings of medications for alcohol use disorder (MAUD) and/or for opioid use disorder (MOUD), and by their offering services to groups with barriers to care: uninsured and publicly insured, youth, seniors, individuals preferring to receive care in Spanish, and sexual minority individuals.
We examined addiction treatment facility survey data in 6 US states. We performed bivariate analyses comparing facilities that offered MAUD, MOUD, and both (main outcomes). We then constructed a multivariable model to identify predictors of offering MAUD, MOUD, or both, including exposures that demonstrate programming for special populations.
Among 2474 facilities, 1228 (50%) responded between October 2019 and January 2020. Programs were offered for youth (30%), elderly (40%), Spanish-speaking (37%), and sexual minority populations (39%), with 58% providing MAUD, 67% providing MOUD, and 56% providing both. Among those providing MAUD, MOUD, or both, a majority (>60% for all exposures) offered programming to vulnerable populations. With Delaware as reference, Louisiana (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.12-0.67) and North Carolina (aOR, 0.33; 95% CI, 0.15-0.72) facilities had lesser odds of offering both MAUD and MOUD. All exposures identifying facilities offering treatment to vulnerable groups were associated with offerings of MAUD and/or MOUD except for offerings to youth; these facilities had less odds of offering MOUD (aOR, 0.31; 95% CI, 0.31-0.62).
There are facility-level disparities in providing MAUD and MOUD by state, and facilities with youth programming have lesser odds of offering MOUD than other facilities.
本研究旨在通过酒精使用障碍药物治疗（MAUD）和/或阿片类药物使用障碍药物治疗（MOUD）的提供情况，以及为存在护理障碍的群体提供服务的情况来描述成瘾治疗机构，这些群体包括未参保和参加公共保险的人群、青少年、老年人、更喜欢接受西班牙语护理的个体以及性少数群体个体。
我们研究了美国6个州的成瘾治疗机构调查数据。我们进行了双变量分析，比较提供MAUD、MOUD以及两者都提供的机构（主要结果）。然后我们构建了一个多变量模型，以确定提供MAUD、MOUD或两者都提供的预测因素，包括针对特殊人群的项目展示情况。
在2474个机构中，有1228个（50%）在2019年10月至2020年1月期间做出了回应。为青少年（30%）、老年人（40%）、讲西班牙语的人群（37%）和性少数群体（39%）提供了项目，58%的机构提供MAUD，67%的机构提供MOUD，56%的机构两者都提供。在提供MAUD、MOUD或两者都提供的机构中，大多数（所有暴露情况均>60%）为弱势群体提供了项目。以特拉华州为参照，路易斯安那州（调整后的优势比[aOR]，0.28；95%置信区间[CI]，0.12 - 0.67）和北卡罗来纳州（aOR，0.33；95% CI，0.15 - 0.72）的机构同时提供MAUD和MOUD的可能性较小。除了针对青少年的项目外，所有表明为弱势群体提供治疗的机构暴露情况都与MAUD和/或MOUD的提供有关；这些机构提供MOUD的可能性较小（aOR，0.31；95% CI，0.31 - 0.62）。
在按州提供MAUD和MOUD方面存在机构层面的差异，并且开展青少年项目的机构提供MOUD的可能性比其他机构小。
