Characterizing variability in state-level regulations governing opioid treatment programs

Abstract

Abstract Introduction: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. A focus on evidence-based state-level regulation of OTPs may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. These data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health. Materials and Methods: Utilizing legal mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All legal mapping research was conducted between November 2017 and March 2019. Results: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in less than 25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size or political leanings. Conclusions: Wide-ranging variability in the regulations of OTPs exists across the U.S. The majority of state OTP regulations are not congruent with best practices.