Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 12:8:100179.
doi: 10.1016/j.dadr.2023.100179. eCollection 2023 Sep.

Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021

Riley D Shearer  1   2 , Benjamin A Howell  3   4 , Utsha G Khatri  5 , Tyler N A Winkelman  1   6
Affiliations

Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021

Riley D Shearer et al. Drug Alcohol Depend Rep. .

Abstract

Background: Individuals with criminal legal involvement (CLI), housing instability, or Medicaid insurance may experience barriers accessing substance use treatment in certain settings. Previous research has found individuals in these groups are less likely to receive medications for opioid use disorder (MOUD), but the role treatment setting may play in low rates of MOUD is unclear.

Methods: We conducted a cross-sectional study using nationally representative survey data from 2015 to 2021. We estimated the proportion of individuals who had CLI, housing instability, or Medicaid insurance who received substance use treatment in a variety of settings. We used multivariable logistic regressions to estimate the associations between group and the receipt of MOUD across treatment settings.

Results: Individuals with CLI, housing instability, or Medicaid insurance were more likely to receive substance use treatment in hospitals, rehabilitation, and mental health facilities compared with individuals not in these groups. However, all groups accessed substance use treatment in doctors' offices at similar rates. Treatment at a doctor's office was associated with the highest likelihood of receiving MOUD (aOR 4.73 [95% CI: 2.2.15-10.43]). Across multiple treatment settings, Individuals with CLI or housing instability were less likely to receive MOUD.

Conclusions: Individuals with CLI, housing instability, or Medicaid insurance are more likely to access substance use treatment at locations associated with lower rates of MOUD use. MOUD access across treatment settings is needed to improve engagement and retention in treatment for patients experiencing structural disadvantage or who have low incomes.

Keywords: Criminal legal involvement; Homelessness; MOUD; Opioid use disorder; Substance use treatment.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Fig 1
Fig. 1
Percent of individuals with criminal legal involvement, housing instability, and Medicaid insurance who received substance use treatment in each treatment setting—United States, 2015-2021
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Blevins C.E., Rawat N., Stein M.D. Gaps in the substance use disorder treatment referral process: provider perceptions. J. Addict. Med. 2018;12:273–277. doi: 10.1097/ADM.0000000000000400. - DOI - PMC - PubMed
    1. Dunn K.E., Huhn A.S., Strain E.C. Differential adoption of opioid agonist treatments in detoxification and outpatient settings. J. Subst. Abuse Treat. 2019;107:24–28. doi: 10.1016/j.jsat.2019.10.002. - DOI - PMC - PubMed
    1. Englander H., Gregg J., Levander X.A. Envisioning minimally disruptive opioid use disorder care. J. Gen. Intern. Med. 2022:1–5. doi: 10.1007/s11606-022-07939-x. - DOI - PMC - PubMed
    1. Finlay A.K., Harris A.H.S., Timko C., Yu M., Smelson D., Stimmel M., Binswanger I.A. Disparities in access to medications for opioid use disorder in the veterans health administration. J. Addict. Med. 2021;15:143–149. doi: 10.1097/ADM.0000000000000719. - DOI - PMC - PubMed
    1. Han B.H., Doran K.M., Krawczyk N. National trends in substance use treatment admissions for opioid use disorder among adults experiencing homelessness. J. Subst. Abuse Treat. 2022;132 doi: 10.1016/j.jsat.2021.108504. - DOI - PubMed