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Facilitating Factors and Barriers to the Use of Medications in Publicly Funded Addiction Treatment Organizations

Knudsen, Hannah K. PhD; Roman, Paul M. PhD; Oser, Carrie B. PhD

Journal of Addiction Medicine: June 2010 - Volume 4 - Issue 2 - p 99-107
doi: 10.1097/ADM.0b013e3181b41a32
Original Article

Objectives: Publicly funded addiction treatment organizations have been slow to adopt pharmacotherapies. Few studies have examined the organizational factors associated with adoption of different types of medication in this treatment sector. This study identifies the organization-level facilitators and barriers to the use of medications in publicly funded addiction treatment organizations.

Methods: Face-to-face interviews with 318 administrators of a representative sample of publicly funded addiction treatment centers in the United States.

Results: Only 23.4% of programs reported using any of the 5 Food and Drug Administration-approved pharmacotherapies for treating addiction. An additional 14.3% of programs only used medications approved for the treatment of psychiatric disorders. Multivariate multinomial logistic regression results revealed that the odds of adoption of addiction pharmacotherapies were significantly greater in government-owned programs and in programs with more medical personnel. Programs that relied more heavily on non-Medicaid public funding tended to be less likely to adopt addiction treatment medications. Greater contact with pharmaceutical representatives was positively associated with medication adoption.

Conclusions: Current public funding policies and lack of access to medical personnel are barriers to the adoption of medications by publicly funded addiction treatment organizations. Efforts to promote adoption may also benefit from greater detailing activities by pharmaceutical representatives. These findings suggest that the large research investment devoted to developing addiction treatment medications may have limited public health impact because of the characteristics of the publicly funded service delivery system and the limited attention given to this system by commercial purveyors of medications.

From the Department of Behavioral Science and Center on Drug and Alcohol Research (HKK), College of Medicine, University of Kentucky, Lexington, KY; Department of Sociology (PMR), Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, Athens, GA; and Department of Sociology and Center on Drug and Alcohol Research (CBO), University of Kentucky, Lexington, KY.

Received for publication April 2, 2009; accepted June 22, 2009.

Send correspondence and reprint requests to Hannah K. Knudsen, PhD, Department of Behavioral Science, University of Kentucky, 109 College of Medicine Office Building, Lexington, KY 40536-0086. e-mail:

Supported by National Institute on Drug Abuse Grant R01DA14482 and K01DA021309, and Robert Wood Johnson Foundation's Substance Abuse Policy Research Program Grant 65111.

National Institute on Drug Abuse and Robert Wood Johnson Foundation's Substance Abuse Policy Research Program had no role in the conduct of this research or in the analysis and interpretation of the data.

© 2010 American Society of Addiction Medicine