Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field.

Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

Suicidal behavior, opioid use disorder, and behavioral health treatment: Prevalence and correlates among adults in the United States 2015-2018.

BACKGROUND: Past research shows that individuals with opioid use disorder (OUD) have a higher rate of co-occurring mental health conditions, but little research has examined suicidal behavior (suicidal ideation and/or attempts) and utilization of behavioral health services among individuals with OUD using a nationally representative sample. METHODS: Using the 2015-2018 National Survey of Drug Use and Health, this study examines the risk of suicidal behavior among individuals with OUD. In addition, the study examines how utilization of behavioral health treatment among individuals with OUD might mitigate the risk of suicidal behavior. RESULTS: The rate of suicidal behavior was higher among individuals with OUD (22%) than among those without OUD (4%). Among those with OUD, 43% reported receiving neither substance use disorder nor mental health treatment. Multivariable logistic regression estimates indicate that individuals with OUD had odds of suicidal behavior 2.9 times as high as those without OUD. Odds of suicidal behavior among people with OUD were 49% lower with substance use disorder treatment, 5% lower with mental health treatment, and 28% lower with both. CONCLUSION: Individuals with OUD have a high risk of suicidal behavior, which can be mitigated with utilization of behavioral health treatment. These findings underscore the importance of policy initiatives directed at increasing treatment utilization among those with OUD.

Utilization of Mental Health Services in Educational Setting by Adolescents in the United States.

BACKGROUND: Schools play an important role as providers of mental health services for adolescents; however, information on the broader picture of utilization of mental health services in educational versus other settings is limited because of the lack of national-level data. METHODS: Using multinomial logistic regression models based on national-level data from the 2012-2015 National Survey on Drug Use and Health, we explore the characteristics of adolescents who received mental health treatment in educational and other settings. In addition, the study examines the reasons for seeking services in various treatment settings. RESULTS: The analysis finds that while the majority of adolescents who access mental health services receive care at noneducational settings, slightly more than one-third of them received services only in an educational setting. Adolescents who had public insurance, were from low-income households, and were from racial/ethnic minority groups were more likely to access services in an educational setting only. Common reasons for accessing services in educational settings included problems with schools, friends, and family members. CONCLUSIONS: Despite increased access to treatment in outpatient settings in the last decade, schools play an important role in providing access to mental health services for disadvantaged populations.

Racial and Ethnic Differences in Encounters Related to Suicidal Behavior Among Children and Adolescents With Medicaid Coverage During the COVID-19 Pandemic.

This cohort study evaluates rates of encounters for suicidal behavior by race and ethnicity among children with Medicaid coverage during vs before the COVID-10 pandemic.

Prescribing patterns of buprenorphine waivered physicians.

BACKGROUND: DATA 2000 enabled physicians with approved training to be waivered to prescribe buprenorphine for the treatment of opioid use disorders (OUD) for a limited number of patients. A rule change in 2016 increased the patient limit for certain buprenorphine waivered physicians from 100 to 275. This study examines the prescribing patterns of buprenorphine prescribers by waiver limit status (30- or 100-patient limit). METHODS: Prescription Monitoring Program (PMP) data from Ohio, California, and Maine were used to identify prescriptions for buprenorphine for OUD from January 2010 to April 2015. Analysis of prescribing patterns by prescriber waiver status included monthly patient censuses and treatment episode duration by state, year, and the frequency with which prescribers were near their respective patient limits. RESULTS: In the three states, 8638 physicians initiated 468,148 buprenorphine episodes. The adjusted mean monthly patient census was 42.9 for 100-patient waivered prescribers, 13.6 patients for 30-patient waivered prescribers, and 7.6 patients for prescribers unassociated with a waiver. Half (48.5%) of episodes were associated with 100-patient waivered prescribers, 26.9% with 30-patient waivered prescribers, and 24.4% with non-waivered prescribers. 30-patient waivered physicians were more likely to have no buprenorphine treatment episodes in a given month than 100-patient waivered prescribers. CONCLUSIONS: Most buprenorphine prescribers practice well under their current patient limit and have numerous months with no patient episodes. For the few high prescribers, increasing the maximum patient limit beyond 100 has the potential to improve access but alone may not have widespread impact unless integrated into complementary approaches toward increasing prescriber capacity.

Educational Outcomes Associated With School Behavioral Health Interventions: A Review of the Literature.

BACKGROUND: There is an unmet need for behavioral health support and services among children and adolescents, which school behavioral health has the potential to address. Existing reviews and meta-analyses document the behavioral health benefits of school behavioral health programs and frameworks, but few summaries of the academic benefits of such programs exist. We provide exemplars of the academic benefits of school behavioral health programs and frameworks. METHODS: A literature review identified school behavioral health-related articles and reports. Articles for inclusion were restricted to those that were school-based programs and frameworks in the United States that included an empirical evaluation of intervention academic-related outcomes. RESULTS: Findings from 36 primary research, review, and meta-analysis articles from the past 17 years show the benefits of school behavioral health clinical interventions and targeted interventions on a range of academic outcomes for adolescents. CONCLUSION: Our findings are consistent with reports documenting health benefits of school behavioral health frameworks and programs and can facilitate further efforts to support school behavioral health for a range of stakeholders interested in the benefits of school behavioral health programs and frameworks on academic outcomes.