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Background: Medications for Opioid Use Disorder (MOUD) are an effective method to treat persons with opioid use disorder (OUD). Longer treatment times are associated with better health outcomes, yet treatment retention rates remain low. This study aimed to assess patient characteristics and experiences associated with retention in treatment., Methods: Data were from an observational cohort study of OUD treatments. Among persons receiving buprenorphine or methadone, log-binomial regression models assessed the relationship between patient characteristics and experiences and three retention outcomes: retention in any OUD treatment, retention in the index treatment (OUD treatment being administered at the time when patients were screened for study eligibility), and 6-month retention in the index treatment., Results: Individuals being treated with methadone at the start of the study compared to those treated with buprenorphine were more likely to remain in their same index treatment at the 18-month follow-up (aPR = 1.35; 95 % CI = 1.11-1.65), and to have remained on their index treatment for 6-months or longer (aPR = 1.22; 95 % CI = 1.14-1.32), but were not significantly more likely to remain in any OUD treatment overall. Individuals residing five miles or less from treatment were more likely to have been retained in any OUD treatment (aPR = 1.06; 95 % CI = 1.00-1.12), to remain in their index treatment at the 18-month follow-up (aPR = 1.21; 95 % CI = 1.08-1.36), and to have remained in their index treatment for 6 months or more (aPR = 1.08; 95 % CI = 1.02-1.13). Individuals without health insurance were less likely to be retained in any OUD treatment (aPR = 0.86; 95 % CI = 0.78-0.95)., Conclusion: The prevalence of retention in any OUD treatment was higher for individuals residing five miles or less from treatment. These findings expand on previous studies that have shown distance to and location of treatment sites can impact treatment access and retention. Lack of health insurance was also associated with lower retention in any OUD treatment in this study. Given the high burden associated with overdose deaths, it is important to understand and address barriers to retention in treatment., Competing Interests: Declaration of competing interest The authors Vanessa I. Villamil, Natasha Underwood, Laura J. Cremer, Cherie R. Rooks-Peck, Xinyi Jiang, Gery P. Guy have no conflicts of interest to disclose., (Published by Elsevier Inc.)

Background: While overall opioid prescribing has been decreasing in the United States, the rates of prescribing at the county level have been variable. Previous studies show that social determinants of health (the social and economic conditions in which we live) may play a role in opioid prescribing; however, researchers have not examined this relationship across US counties. This cross-sectional study seeks to determine whether county-level sociodemographic characteristics (e.g., economic, housing, social environment, healthcare environment, and population characteristics) are associated with county level differences in opioid dispensing., Methods: Data from 2,881 counties in the United States from 2017 to 2018 were used for this study. Opioid dispensing was measured using morphine milligram equivalents (MME) per capita. Spatial error models were used to measure the association between county-level sociodemographic characteristics and MME per capita while adjusting for spatial correlation between neighboring counties., Results: In the adjusted model, counties with a higher percentage of people below the poverty line, with less than a 4-year college degree, and without health insurance were associated with higher MME dispensed per capita, as were counties with higher percentages of families headed by a single parent, persons separated or divorced, and those with disabilities. Conversely, minority race/ethnicity and rural population were associated with lower opioid dispensing., Conclusions: County-level sociodemographics can differ in their association with opioid dispensing, hence examining which county-level factors help in improving opioid prescribing, and implementing overdose prevention strategies that tackle these factors is important., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.