Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021.
Treatment setting among individuals with opioid use and criminal legal involvement, housing instability, or Medicaid insurance, 2015-2021.
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DOI：
10.1016/j.dadr.2023.100179
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发表时间：
2023-09
期刊：
影响因子：
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通讯作者：
Winkelman, Tyler N A
中科院分区：
文献类型：
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作者：
Shearer, Riley D;Howell, Benjamin A;Khatri, Utsha G;Winkelman, Tyler N A
有法律的参与的人在急性环境中有更高的治疗几率。住房不稳定的人在急性环境中接受治疗的几率更高。在医生办公室接受阿片类药物治疗与接受药物治疗有关。与刑事法律的参与（CLI），住房不稳定，或医疗补助保险的个人可能会遇到障碍，在某些情况下获得物质使用治疗。先前的研究发现，这些群体中的个体不太可能接受阿片类药物使用障碍（MOUD）的药物治疗，但治疗环境在低MOUD率中可能发挥的作用尚不清楚。我们使用2015年至2021年的全国代表性调查数据进行了一项横断面研究。我们估计了在各种环境中接受药物使用治疗的CLI，住房不稳定或医疗补助保险的个人比例。我们使用多变量逻辑回归来估计治疗设置中组与MOUD接收之间的关联。与CLI，住房不稳定或医疗补助保险的个人相比，与不属于这些群体的个人相比，他们更有可能在医院，康复和精神卫生机构接受药物使用治疗。然而，所有群体在医生办公室接受药物使用治疗的比率相似。在医生办公室接受治疗与接受MOUD的可能性最高相关（aOR 4.73 [95% CI：2.2.15-10.43]）。在多种治疗环境中，CLI或住房不稳定的个人不太可能接受MOUD。CLI，住房不稳定或医疗补助保险的个人更有可能在MOUD使用率较低的地方获得物质使用治疗。需要在整个治疗环境中访问MOUD，以改善经历结构性劣势或低收入患者的治疗参与和保留。
People with legal involvement had higher odds of treatment in acute settings. People with housing instability had higher odds of treatment in acute settings. Opioid use treatment in a doctor's office was associated with receiving medication. 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. 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. 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. 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.