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.
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.

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

Methods

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