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Background: The Substance Abuse and Mental Health Administration (SAMHSA) has invested substantial resources in Certified Community Behavioral Health Centers (CCBHCs) to integrate mental health and addiction treatment and to address the nation's epidemic of opioid-related morbidity and mortality.Methods: Using an audit or "secret shopper" method, we surveyed 311 CCBHCs listed in SAMHSA's Behavioral Health Treatment Services Locator to identify the proportion of centers that offer buprenorphine and/or methadone treatment and the proportion of these that offer a prescriber visit during patients' first visit to the center.Results: We received responses from 82.6% (n = 257) of the CCBHCs that we attempted to contact. Of those contacted, 33.9% said they offered agonist therapy, 33.5% said they could refer patients to a buprenorphine or methadone provider, and 32.7% said they could neither offer nor refer patients for agonist therapy. Of the agencies contacted, only 2.7% could confirm the availability of a prescriber visit at the patient's first visit to the CCBHC.Conclusions: Despite significant federal investment to integrate addiction and mental health treatment in CCBHCs, CCBHCs have not generally become providers of low-threshold buprenorphine and/or methadone treatment for opioid use disorder. Policy-makers should consider how to better incentivize low-threshold access to buprenorphine and methadone treatment in the nation's network of CCBHCs. [ABSTRACT FROM AUTHOR]

Background: Research has shown buprenorphine/naloxone to be an effective medication for treating individuals with opioid use disorder. At the same time, treatment discontinuation rates are reportedly high though much of the extant evidence comes from studies of the Medicaid population.Objectives: To examine the pattern and determinants of buprenorphine/naloxone treatment discontinuation in a population of commercially insured individuals.Research Design: We performed a retrospective observational analysis of Massachusetts All Payer Claims Data (MA APCD) covering years 2013 through 2017. We defined treatment discontinuation as a gap of 60 consecutive days without a prescription for buprenorphine/naloxone within a time frame of 24 months from the initiation of treatment. A mixed-effect Cox proportional hazard model examined the associated risk of discontinuing treatment with baseline predictors.Subjects: A total of 5134 individuals who were commercially insured during the study period.Measures: Buprenorphine/naloxone treatment discontinuation.Results: Overall 75% of individuals had discontinued treatment within two years of initiating treatment, and median time to discontinuation was 300 days. Patients aged between 18 and 24 years (HR = 1.436, 95%, CI = 1.240-1.663) and receiving treatment from prescribers with high panel-size (HR = 1.278, 95% CI = 1.112-1.468) had higher risk of discontinuing treatment. On the contrary, patients receiving treatment from multiple prescribers had lower associated risk of treatment discontinuation.Conclusions: A substantial percentage of patients discontinue treatment well before they can typically meet criteria for sustained remission. Further investigations should assess the clinical outcomes following premature discontinuation and identify strategies for retaining patients in treatment. [ABSTRACT FROM AUTHOR]