Association for Public Policy Analysis & Management

Background. Previous research has identified disparities in the accessibility of

pharmacotherapies for opioid use disorder (OUD) treatment. The Affordable Care Act, the Drug

Addiction Treatment Act, and the CURES Act are three federal efforts to expand access to

treatment.

Objectives. This study examined whether federal efforts to increase insurance access,

pharmacotherapy prescribing, and funding for OUD relief are associated with increases in the

uptake of pharmacotherapies across states.

Methods. Data were drawn from the 2013, 2015, and 2016 National Survey of Substance Abuse

Treatment Services, the 2014 National Survey on Drug Use and Health, the US Census Bureau,

SAMHSA, and the Correlates of State Policy Project from Michigan State University. Data were

aggregated to the state-level to measure pharmacotherapy access.

Results. Seemingly unrelated regression (SUR) model results showed that buprenorphine (5.4%)

and naltrexone (13.9%) accessibility have increased since 2013, while methadone access has

decreased (-3.9%). States with higher percentages of facilities that accept private and Medicaid

insurance and states that receive more SAPT funding offered higher rates of pharmacotherapies.

However, uptake remains low and there are disparities in access across states.

Conclusions. Results indicate that market factors such as insurance coverage and federal funding

are positively associated with increased access to pharmacotherapies, showing promise for

increased uptake as a result of the CURES Act of 2016. There remain disparities in access for

those who reside in states with larger rural populations (South 29%, Midwest 29%). The majority

of African Americans (54%) reside in the South, 19% in the Midwest, and 36% of Latinos reside

in the South, suggesting that minority populations may disproportionately lack access.

Acceptance of Medicaid was also lowest in the South, suggesting that Southern residents may

disproportionately lack access to pharmacotherapies.

Keywords: opioid treatment, pharmacotherapy, innovation, evidence-based

practice, market inefficiency