In the midst of the coronavirus pandemic, emerging evidence suggests drug overdoses, including opioid overdoses, are increasing., As safety net primary care providers, community health centers play a significant role in efforts to address the ongoing opioid crisis and have become a major source of medication-assisted treatment (MAT), the standard of care for those with opioid use disorder (OUD). It is unclear whether health centers have the capacity to meet increasing demand due to the pandemic. This issue brief presents findings from a 2019 survey of community health centers on activities related to the prevention and treatment of OUD, with a focus on MAT, to assess services and capacity prior to the recent surge in need. Key findings include:
As of 2019, an increasing share of health centers were providing MAT services. Nearly two-thirds of health centers (64%) reported offering MAT onsite, up from 48% in 2018. Health centers in Medicaid expansion states were more likely than those in non-expansion states to provide MAT onsite in 2019 (70% vs. 50%).
Most health centers that provide MAT offer multiple treatment options for patients experiencing OUD. The majority (65%) of health centers with a MAT program offered at least two out of three available MAT medications for OUD, with buprenorphine (89%) and naltrexone (69%) most commonly offered. To ensure a continuum of care for OUD patients seeking treatment, health centers refer to a variety of providers; however, health centers with a MAT program are more likely than those without MAT onsite to refer patients to more intensive providers like residential treatment programs (71% vs. 46%), inpatient detox programs (69% vs. 50%), and partial hospitalization programs (36% vs. 22%).
Health centers face many challenges meeting the high demand for OUD treatment. Despite increasing MAT services and treatment options from 2018, nearly half (47%) of health centers reported that they did not have the capacity to treat all patients seeking MAT. Among health centers that attempted to refer patients for MAT services, 66% said they face provider shortages in their community when doing so.
Targeted federal grants from 2016 to 2019 helped health centers to bolster MAT programs and establish new ones, although health centers continue to rely heavily on Medicaid to sustain MAT programs and services long-term. However, the high cost of providing MAT services remains a barrier in Medicaid expansion and non-expansion states alike, and these barriers will likely remain even as the coronavirus pandemic poses new challenges for health centers’ finances and capacity to provide OUD services.