The Relationship Between Treatment Center Services and Number of Opioid-related Deaths in the United States Before and After a Declaration of a National Opioid Crisis

Opioid-related deaths are a national problem that have increased over the past two decades. Multiple policy interventions have been enacted to decrease opioid misuse and expand treatment. The Comprehensive Addiction and Recovery Act (CARA) was passed in July 2016, just before declaring the opioid epidemic a National Emergency in 2017. CARA was enacted to combat the opioid epidemic by providing more funding yearly for items including but not limited to prevention, treatment, and opioid overdose reversal. To evaluate the impact of these policy changes, we carried out secondary data analysis for the period 2011-2019 using the CDCs Wide-ranging Online Data for Epidemiologic Research and National Survey of Substance Abuse Treatment Services databases. Research variables included: a comparison of the 50 states across the 2011-2019 timeframe, the number of opioid treatment centers, the percentage of government funding for facilities per state, percentage of opioid treatment facilities which offer free/low-income services and the opioid death rate. We also assessed differences in low-income access to opioid treatment services by comparing Medicaid expansion states versus non-Medicaid expansion states. While both the number of treatment facilities per state and opioid death rates nearly doubled during this time, there was little to no association between them (R2 ranging from: 0.094-0.188 for years 2013-2019). Our research suggests that while state-level differences in opioid use disorder treatment facility characteristics related to access to care, they were only weakly associated with opioid-related deaths. This analysis may be used in the planning of subsequent actions against the national opioid epidemic and invites further inquiry into the impact of state Medicaid expansion on drug-specific opioid usage and mortality.