Effects of Medication-Assisted Treatment on Treatment Retention and the Role of Payment Source

Background and Purpose: Public health concerns regarding individuals with opioid use disorder (OUD) in the U.S. have increased due to the alarming rates of opioid-related fatalities. OUD treatment with Medication-assisted treatment (MAT) has proven to be effective. This study explores the link between MAT and treatment retention and the role of payment sources on the link between MAT and treatment retention.

Methods: This cross-sectional study utilized the 2018 Treatment Episode Data Set-Discharges for discharge episodes with OUD in non-intensive outpatient service settings that did not complete treatment (n = 62,656) in 32 states and the District of Columbia. The dependent variable is treatment retention which was measured by the length of stay at treatment. The independent variable is MAT in the treatment plan. Covariates are payment sources, gender, race, marital status, frequency of opioid use at admission, co-occurring mental disorder, and Medicaid expansion. We used univariate and bivariate analyses to examine the sample’s demographic and length of stay characteristics. We also examined the effects of MAT on the length of stay after controlling for all covariates by running a random intercept model with linear regression to account for variation between states.

Results: The majority of the sample was male (51.7%), White (80.5%), and not married (85.1%). Treatment episodes included 53.6% of the sample with MAT in the treatment plan, 60.7% not having a co-occurring mental disorder, 66.1% having Medicaid as a primary payment source, and 78.2 % receiving treatment in Medicaid expansion states. Age ranges between 25 and 39 made up most of the sample (59.0%). Male, race other than White and Black, married, receiving MAT, less opioid use, co-occurring mental disorder, residents in Medicaid expanded states, and treatment completion were positively associated with treatment retention. MAT was positively associated with treatment retention, controlling for all covariates. This study also found that different payment sources while receiving MAT had different effects on treatment retention (e.g., Self-pay has longer retention when receiving MAT), compared to Medicaid or other payment sources. Findings also included that substantial variation between states on treatment retention existed when individuals with OUD receive MAT.

Conclusions and Implications: These findings underscore the importance of utilizing MAT in the outpatient treatment of OUD. Increasing access to MAT and stabilizing access for individuals with OUD should receive more attention, acknowledging differences in substance use treatment infrastructure and policies between states. In addition, there is a possibility that some payment sources may have more obstructive regulations that hinder longer treatment retention, compared to self-pay. Therefore, obstructive regulations of each payment source to patients and providers must be identified and modified.