Receipt of Medications for Alcohol and Opioid Use Disorders: The Importance of Service Utilization Patterns.

Medications for alcohol use disorder (MAUD) and opioid use disorder (MOUD) are underutilized evidence-based treatments. While patients often receive treatment in multiple medical treatment settings, it is unknown whether certain treatment settings or combinations of settings are associated with increased receipt of MAUD or MOUD. Data from the cross-sectional 2019 National Survey on Drug Use and Health were used to identify treatment settings where adult respondents received any past year alcohol treatment (n = 476, 33% female) or, separately, opioid treatment (n = 337, 38% female). Three-stage latent class analysis assessed the patterns of treatment settings utilization and their associations with receipt of MAUD or MOUD, adjusting for potential confounders. Only 10.9% of those in alcohol treatment received MAUD while 40.9% of those in opioid treatment received MOUD. Analyzing different treatment settings visited by respondents, a four-class model best fit the MAUD sample while a three-class model best fit the MOUD sample. There were significant differences in receipt of MAUD by treatment setting classes in unadjusted models (p < 0.05). There were no significant differences in receipt of MOUD across treatment utilization classes, but MOUD receipt was associated with severity of opioid use in all treatment setting classes. People in treatment for alcohol or opioid use were more likely to receive medication if their use was more severe, and were more likely to receive MAUD if they accessed care in many settings. As MOUD and especially MAUD are underutilized, these findings highlight opportunities to increase access to evidence-based care for alcohol and opioid use disorders.