Less than half of opioid treatment programs (OTPs) throughout the U.S. offer the full range of FDA-approved medications for opioid use disorder (MOUD). Only 45% of all OTPs provide methadone, buprenorphine and naltrexone access, which is up from 33% in 2017, according to a new study.

Although access to all three MOUDs has risen, the newly published data underscore significant barriers to the broader expansion of their use and availability. 

OTPs that offer all three medications were more likely to accept Medicare, be nonprofit or government-operated and also provide integrated services, such as peer support, telemedicine and MOUD education, researchers found. This is noteworthy because Medicare only began paying for care at OTPs in 2020 using weekly bundled payments.

This reiterates past research that determined “accepting Medicare as a form of payment was associated with receiving forms of accreditation that indicate an OTP provides higher-quality care,” according to the study.

For-profit entities and smaller community-based OTPs tend to lag behind in this regard and are less likely to offer the full range of MOUD treatment options.

There are also significant geographic differences in the availability of additional MOUD from OTPs. Providers in the southern U.S. were more likely to offer buprenorphine but significantly less likely to offer all three MOUDs, according to the study. In contrast to past research, which found limited availability of prescribers providing buprenorphine in the South, this new data may mean OTPs could be a critical access point in the region for this specific MOUD.

“OTPs may have the potential to compensate buprenorphine prescriber shortages in these areas,” researchers wrote, “as OTPs may have greater capacity for large volumes of patients with OUD compared with office-based opioid treatment facilities and may be eligible for more flexible telehealth practices than practitioners providing care in clinics.”

OTPs that operate in areas with a higher proportion of residents who have income levels below the federal poverty line and a higher population of uninsured individuals were also less likely to offer the full range of MOUD treatments – which “may be due to lower rates of reimbursement and payment in these areas,” researchers wrote.

Interestingly, OTPs that offered naltrexone – which is not favored as a first-line treatment for OUD due to higher cost and lower adherence – had higher odds of offering mental health services. Researchers theorize that this could be because “OTPs that succeed in overcoming initial dispensing challenges are those with a preexisting infrastructure to support services that may require more dedicated staff time and resources.” 

While OTPs only account for 12.4% of all substance use disorder treatment facilities in the U.S., they are still considered a key treatment system for addiction and serve upwards of 409,000 patients each year. Because of this, expanding the availability of MOUD treatments as opioid addiction rates climb is critical.

The results from this study indicate there is an ongoing disconnect between the reality of MOUD availability and evidence-based practice. Closing this gap, researchers note, will require “additional effort, such as financial incentives or staff training,” to widen the availability of MOUD treatments that can be accessed from OTPs.