(87) Availability of Medications for Alcohol Use Disorder in Substance Use Treatment Facilities

Background & Introduction: Approximately 29.5 million individuals suffer from alcohol use disorder (AUD) with a cost to the US economy of $249 billion in 2010. Complications of AUD are becoming more prevalent, as illustrated by the 60% increase between 2007 and 2017 in the number of alcohol-associated liver disease patients listed for transplant. Additionally, the alcohol-related cirrhosis death rate increased by almost 50% between 2000 and 2019. AUD also has psychosocial consequences that negatively impact mental health and quality of life.

FDA approved medications for AUD (MAUD) include naltrexone, acamprosate, and disulfiram which all have shown to have positive impacts on reducing drinking and increase abstinence to alcohol. Despite the existence and evidence in support of MAUD (naltrexone, disulfiram, and acamprosate), only 2.2% of individuals with AUD >18 years old received medication-assisted treatment in the past year. This shortfall poses a significant risk to patients and society . In this study, we seek to investigate factors associated with the provision of MAUD and MAUD rate changes in substance use treatment settings.

Methods: We conducted a retrospective review of publicly available data available through the National Survey of Substance Abuse Treatment Services (N-SSATs) between 2017-2020. This time range was selected because 2017 was the first year N-SSATs collected data on availability of specific MAUDs and 2020 was the last year. Data from N-SUMHSS were used for 2021 and 2022, and were analyzed separately due to differences in survey design. The primary outcome was the frequency that at least 1 type of MAUD was offered at any single substance use treatment center . Secondarily, we analyzed the trend for each specific type of MAUD over the study period and determined factors, that predict offering specific types of services . Descriptive statistics were used to describe the study data, Pearson’s correlation (r ) or Spearman’s rho (s) as appropriate to describe trends, and binomial logistic regression to determine factors associated with the primary outcome of interest ( offering MAUD). IBM SPSS® statistical software was used to conduct all analyses, and all p-values were reported to the 0.05 significance level.

Results: Using the N-SSATs data, in 2017, complete data were available for 13,585 facilities, and of these facilities, 4,592 (33.8%) offered at least 1 form of MAUD. In 2020, complete data were available for 16,066 facilities, 7,182 (44.7%) of which offered at least 1 form of MAUD. There was a linear increase in the proportion of facilities that offered at least 1 form of MAUD during the entire study period (r=0.97, p=0.014), with an absolute increase of 56.4% and a 32.2% increase in rate. Most facilities offered naltrexone (in either oral or extended release formulations) compared to acamprosate or disulfiram ( 31.7% , vs. 22.7% or vs. 21.7%, p< 0.001). There were increases in the proportion of facilities that offered naltrexone ER (r=0.99, p=0.007, 59.1% change in rate),naltrexone oral (r=0.98, p=0.01, 47.1% change in rate), acamprosate (r=0.97, p=0.009, 32.2% change in rate), and disulfiram (r=0.96, p=0.023, 30.4% change in rate).
Predictors of offering at least 1 form of MAUD in substance use treatment facilities included whether the facility offered treatment for co-occurring serious mental illness (aOR: 1.5, 95% CI: [1.4, 1.7], p< 0.001), whether the organization that operates the facility is a tribal government (aOR: 6.95, 95% CI: [4.9, 10], p< 0.001), offers drug or alcohol urine screening (aOR: 3.5, 95% CI: [3.0,4.1], p< 0.001), offers a comprehensive mental health assessment or diagnosis (aOR: 2.99, 95% CI: [2.7, 3.3], p< 0.001), and offers buprenorphine extended-release (aOR: 56.3, 95% CI: [44.0,72.0], p< 0.001). Non-significant predictors of offering of MAUD included whether the facility offers substance use education (p=0.73) and whether the facility offered a comprehensive substance abuse assessment or diagnosis (p=0.56).
Utilizing the N-SUMHSS data, we found that in 2021, of 14,069 substance use treatment facilities with complete data, 5,381 (38.2%) of facilities offered at least 1 form of MAUD, and this increased to 6,270 (42.0%) out of 14,916 facilities in 2022 (p < 0.001).

Conclusion & Discussion: Using several complimentary datasets, between 2017-2022, we found that there was an increase in availability of at least one type of MAUD across all substance use treatment facilities. This was also true for availability of each type of MAUD, including naltrexone, disulfiram, and acamprosate. Although not directly indicated by this study, the increase in provision of these services could be associated with increasing acceptability for utilization of medication-based treatments for treatment for substance use disorders in these treatment settings, due to regulations and policies put in place to encourage their utilization. For example, it is notable that the largest predictor of provision of these services is provision of buprenorphine. Consequently, it may follow that substance use treatment facilities that are more accepting of medication-based treatments such as buprenorphine, would also be more receptive to offering MAUDs as well. There is a paucity of literature investigating barriers for provision of MAUD. Future studies should further investigate reasons for implementation barriers as well as interventions that can help improve provision of MAUDs in these treatment settings.

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