Medication-assisted treatment for substance use disorders within a national community health center research network

ABSTRACT

Background: The Affordable Care Act increases access to treatment services for people who suffer from substance use disorders (SUDs), including alcohol use disorders (AUDs) and opioid use disorders (OUDs). This increased access to treatment has broad implications for delivering health services and creates a dramatic need for transformation in clinical care, service lines, and collaborative care models. Medication-assisted treatments (MAT) are effective for helping SUD patients reach better outcomes. This article uses electronic health record (EHR) data to examine the prevalence of EHR-documented SUDs, patient characteristics, and patterns of MAT prescribing and screening for patients within the Community Health Applied Research Network (CHARN), a national network of 17 community health centers that facilitates patient-centered outcomes research among underserved populations. Methods: Hierarchical generalized linear models examined patient characteristics, SUD occurrence rates, MAT prescription, and human immunodeficiency virus (HIV) and hepatitis virus C screening for patients with AUDs or OUDs. Results: Among 572,582 CHARN adult patients, 16,947 (3.0%) had a documented AUD diagnosis and 6,080 (1.1%) an OUD diagnosis. Alcohol MAT prescriptions were documented for 547 AUD patients (3.2%) and opioid MAT for 1,764 OUD patients (29.0%). Among OUD patients, opioid MAT was significantly associated with HIV screening (odds ratio [OR] = 1.31, P < .001) in OUD patients, as was alcohol MAT among AUD patients (OR = 1.30, P = .013). Conclusions: These findings suggest that effective opioid and alcohol MAT may be substantially underprescribed among safety-net patients identified as having OUDs or AUDs.

KEYWORDS:

• Community health centers
• medication-assisted treatment
• substance use disorders

Funding

This work was supported by the Health Resources and Services Administration, contract HHSH250201400001C, and by grant UB3HA20236. HRSA had no role in any of the listed activities in the study.

The authors declare that they have no conflicts of interest.

Author contributions

Traci Rieckmann, PhD; John Muench, MD, MPH; Mary Anne McBurnie, PhD; and Phillip Crawford made substantial contributions to conception and design, acquisition of data, and writing and interpretation of the findings. Michael C. Leo, PhD; and Phillip Crawford, PhD, made substantial contributions to analysis and interpretation of data. Conall O’Cleirigh PhD; Kenneth H. Mayer, MD; Kevin Fiscella, MD, MPH; Nicole Wright, PsyD, CSAC, ICADC; Maya Doe-Simkins, MPH; Matthew Cuddeback, LCSW; Elizabeth Salisbury-Afshar, MD, MPH; and Christine Nelson, PhD, RN, made substantial contributions to reviewing and critically revising the article for important intellectual content. Daren Ford and Jennifer Stubbs made contributions in content revisions and formatting and presentation of the materials. All authors have provided final approval of the version to be published. Additional acknowledgements are available as in Supplemental Material.

Notes

¹ OUD (ICD-9 [International Classification of Diseases Ninth Revision] codes 304, 304.01, 304.02, 305.5, 305.51, 305.52, 304.7, 304.71, 304.72) or AUD (ICD-9 codes 291.0, 291.1, 291.2, 291.3, 291.4, 291.5, 291.81, 291.82, 291.89, 291.9, 303.00, 03.01, 303.02, 303.9, 303.91, 303.92, 305, 305.01, 305.02).