ORLANDO, Florida ― There is a wide variation in the availability of drugs to treat substance use disorder (SUD) among US states, with some having significantly better access to SUD medications than others, new research shows. Moreover, the variability does not reflect need.

"In one state, alcohol dependence might be very high, but the state does not offer the medication for treatment," lead author Amanda J. Abraham, PhD, University of Georgia, in Atlanta, told Medscape Medical News.

Perhaps not surprisingly, said Dr. Abraham, insurance also plays a role.

"States that have a high prevalence of employer-based insurance have a greater availability of SUD medications compared to those with less employer-based insurance, so as you might expect, private insurance plans are going to cover those medications, but for the uninsured, it is a different situation entirely," she said.

The findings were presented here at the American Society of Addiction Medicine (ASAM) 45th Annual Medical-Scientific Conference.

National Dataset

Currently, SUD treatment is delivered in more than 14,000 specialty programs that are primarily funded through government block grants and contracts administered through each state's single state authority (SSA). Each SSA acts independently, hence the wide variability from state to state in SUD treatment availability.

Dr. Amanda Abraham

For the study, Dr. Abraham and colleague Traci Rieckmann, PhD, from Oregon Health and Science University, in Portland, examined variation among states in the availability of disulfiram (Antabuse, Odyssey Pharmaceuticals, Inc), acamprosate (Campral, Forest Laboratories, Inc), oral naltrexone, injectable naltrexone (Vivitrol, Alkermes, Inc) methadone, and buprenorphine.

They analyzed data from the 2011 National Survey of Substance Abuse Treatment Services (N-SSATS), the 2011 National Survey on Drug Use and Health (NSDUH), 2010-2011 US Census Bureau, the 2011 Area Health Resource File (AHRF), and the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA).

"N-SSATS is an annual census of specialty treatment facilities in the US and represents almost all, about 95%, of US treatment programs. It is the only national dataset that includes treatment facilities in each state," Dr. Abraham said.

Then the researchers mapped SUD medication availability and state prevalence of SUD.The results of the analysis showed that availability of SUD medications varied from 12.9% to 71.4%.

For many states with high levels of treatment need, the availability of SUD medications was actually low.

In addition to a higher percentage of employer-based health insurance, a higher percentage of females older than 16 years and a higher percentage of mental health workers, substance abuse workers, and mental health counselors were associated with a greater availability of SUD medication.

By contrast, states with more uninsured individuals and those in which there was a high percentage of individuals living below the federal poverty level had lower SUD drug availability.

"For example, Georgia was fairly concordant with the need for treatment and the number of patients actually getting treatment, because we have pretty low dependence rates for alcohol and illicit drugs. But in Florida, it was just the opposite. There, the need for treatment was high, and the number of patients getting treatment was relatively low," Dr. Abraham said.

"My hope in doing this research is that access to medications improves and that the barriers to care in each state can be identified."

Dr. Abraham added that she plans to study the effect that the Affordable Care Act (ACA) will have on the availability of SUD treatment.

"We are collecting data right now in Medicaid expansion states vs non-Medicaid expansion states to see what role the ACA will have in management of SUDs."

Highlights Important Disparities

Gavin Bart, MD, PhD, of the University of Minnesota Medical School, Minneapolis, and chair of the ASAM's Medical-Scientific Program Committee, told Medscape Medical News that this study addresses "a very important issue of access to treatment."

Dr. Gavin Bart

"Through the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, US taxpayers have spent hundreds of millions of dollars on research that proves the effectiveness of medications used in the treatment of substance use disorders," said Dr. Bart, who was not involved in the research.

"This poster emphasizes that, across the board, far too many people are not able to access these beneficial medications. It also shows that those with the fewest resources, the poor and underinsured, are the least likely to receive these medications," he said.

Dr. Bart added that this type of data can help inform policy and lead to change "so that in the era of parity and the Affordable Care Act, we can now use available legislative tools to make sure that all people have access to proven treatments."

Dr. Abraham and Dr. Bart report no relevant financial relationships.

American Society of Addiction Medicine (ASAM) 45th Annual Medical-Scientific Conference. Poster 18. Presented April 11, 2014.


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