Typology of laws restricting access to methadone treatment in the United States: A latent class analysis

Anna Conway; Noa Krawczyk; Frances McGaffey; Sheri Doyle; Vanessa Baaklini; Alison D Marshall; Carla Treloar; Corey S Davis; Samantha Colledge-Frisby; Jason Grebely; Magdalena Cerdá

doi:10.1016/j.drugpo.2023.104141

Typology of laws restricting access to methadone treatment in the United States: A latent class analysis

Int J Drug Policy. 2023 Sep:119:104141. doi: 10.1016/j.drugpo.2023.104141. Epub 2023 Aug 2.

Authors

Affiliations

¹ The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia. Electronic address: a.conway@unsw.edu.au.
² Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.
³ The Pew Charitable Trusts, Philadelphia, United States.
⁴ The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia.
⁵ Centre for Social Research in Health, UNSW, Sydney, Australia.
⁶ Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Los Angeles, United States.
⁷ National Drug Research Institute, Curtin University, Melbourne, Australia; National Drug and Alcohol Research Centre, Burnet Institute, Melbourne, Australia.
⁸ The Kirby Institute, UNSW, Sydney, Australia.

PMID: 37540917
DOI: 10.1016/j.drugpo.2023.104141

Abstract

Background: In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership.

Methods: A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated.

Results: States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22).

Conclusions: States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.

Keywords: Law; Methadone; Opioid agonist treatment; Opioid treatment program; USA.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid* / therapeutic use
Humans
Latent Class Analysis
Methadone / therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
United States

Substances

Analgesics, Opioid
Methadone

Grants and funding

K01 DA055758/DA/NIDA NIH HHS/United States