Community Health Centers and Medication-Assisted Treatment for Opioid Use Disorder
Appendix A
| Table 1: Barriers to Operating a MAT Program Among Health Centers Providing MAT Onsite | |||
| Barriers to Operating a MAT Program | All Health Centers with a MAT Program | Health Centers in Medicaid Expansion States | Health Centers in Non-Expansion States |
| Lack of physical space for MAT program | 29% | 29% | 29% |
| High costs to provide MAT | 27% | 23%* | 40% |
| It is difficult to fit in the frequent appointments required for patients to receive their MAT medications | 23% | 22% | 24% |
| Our providers have limited skills and/or confidence to provide MAT | 22% | 21% | 23% |
| Many of our patients with opioid use disorder are uninsured and we would not be reimbursed for providing MAT services | 22% | 16%* | 41% |
| We do not face any barriers in operating our MAT program | 21% | 24% | 13% |
| Our providers have concerns about diversion of MAT medications | 20% | 18% | 26% |
| Cumbersome administrative requirements serve as a deterrent to providing MAT | 14% | 13% | 16% |
| Our health center is not able to provide the psychosocial and behavioral therapy components of MAT | 7% | 7% | 4% |
| Other barrier to establishing or expanding a MAT program | 25% | 25% | 24% |
| NOTE: *Significantly different from health centers in non-expansion states (p<.01). SOURCE: GW/KFF 2019 Health Center Survey. |
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| Table 2: Barriers to Establishing a MAT Program Among Health Centers that do not Provide MAT Onsite | |
| Barriers to Establishing a MAT Program | All Health Centers without a MAT Program |
| Our providers have limited skills and/or confidence to provide MAT | 42% |
| Lack of physical space for MAT program | 37% |
| Our providers have concerns about diversion of MAT medications | 33% |
| High costs to provide MAT | 30% |
| Cumbersome administrative requirements serve as a deterrent to providing MAT | 28% |
| Many of our patients with opioid use disorder are uninsured and we would not be reimbursed for providing MAT services | 22% |
| Our health center is not able to provide the psychosocial and behavioral therapy components of MAT | 17% |
| It is difficult to fit in the frequent appointments required for patients to receive their MAT medications | 15% |
| Opioid use disorder is not a significant problem at our health center so we do not need to establish a MAT program | 14% |
| Our leadership and/or providers prefer an abstinence-focused model to address opioid use disorder | 8% |
| Health center leadership have not identified opioid use disorder as a priority area of focus | 7% |
| Other barrier to establishing a MAT program | 23% |
| NOTE: Comparisons for health centers without onsite MAT services in Medicaid expansion and non-expansion states are not shown because there are no significant differences at the p <.05 level. SOURCE: GW/KFF 2019 Health Center Survey. |
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Appendix B
2019 Survey of Community Health Centers
(All other questions released separately)
Q18. Looking back on the past year, has your health center seen an increase in patients:
With prescription opioid use disorder? [Yes, No, Don’t Know]
With nonprescription opioid use disorder? [Yes, No, Don’t Know]
Q19. Does your health center provide medication-assisted treatment (MAT) medications for opioid use disorder on-site? [Respondents who selected “no” skipped to question 23.]
Yes, we provide MAT medications and opioid use disorder counseling on-site.
Yes, we provide MAT medications on-site, but not opioid use disorder counseling.
No, we do not provide MAT medications on-site.
Q20. Does your health center provide on-site MAT services at all of your health center’s sites or only at some sites?
All sites
Only some sites
Q21. Please indicate if your health center provides the following medications for opioid use disorder.
Methadone [Yes, No, Don’t Know]
Buprenorphine (brand names include Suboxone, Zubsolv, and Subutex) [Yes, No, Don’t Know]
Naltrexone (brand names include Vivitrol and ReVia) [Yes, No, Don’t Know]
Q22. Does your health center currently have the capacity to treat on-site all patients who seek MAT serviced for opioid use disorder?
Yes, we have capacity to treat all patients who seek MAT services
No, we do not have capacity to treat all patients who seek MAT services
Don’t know
Q23. Does your health center face provider shortages when attempting to refer patients elsewhere for MAT services?
We do not attempt to make referrals
Yes, we face provider shortages when trying to refer
No, we do not face provider shortages when trying to refer
Don’t know
Q24. Does your health center refer patients with opioid use disorder to any of the following providers, programs, or community based organizations to create a continuum of care for recovery services? (Check all that apply).
No, we do not refer patients to other providers, programs, or organizations (if so, please do not select other options)
Certified community behavioral health clinics
Opioid treatment programs
Health departments
Inpatient detoxification programs
Residential treatment programs
Partial hospitalization programs
Recovery coaches or peer mentors
Other providers, programs, or organizations (please specify)
Q25. Does your health center face any of the following barriers to establishing or operating a medication-assisted treatment (MAT) program? (Check all that apply).
No, opioid use disorder is not a significant problem at our health center so we do not need to establish a MAT program
Health center leadership have not identified opioid use disorder as a priority area of focus
Our leadership and/or providers prefer an abstinence-focused model to address opioid use disorder
Our providers have limited skills and/or confidence to provide MAT
Our providers have concerns about diversion of MAT medications
Our health center is not able to provide the psychosocial and behavioral therapy components of MAT
Cumbersome administrative requirements serve as a deterrent to providing MAT
Many of our patients with opioid use disorder are uninsured and we would not be reimbursed for providing MAT services
High costs to provide MAT
It is difficult to fit in the frequent appointments required for patients to receive their MAT medications
Lack of physical space for MAT program
We do not face any barriers in operating our MAT program
Other barrier to establishing or expanding a MAT program (please specify)
Q26. Does your health center distribute naloxone (Narcan or Evzio) for opioid overdose reversals?
Yes
No
Don’t know