Role of state policies in the adoption of naltrexone for substance abuse treatment.

摘要

OBJECTIVE: To examine state policies associated with adoption of a pharmaceutical agent-naltrexone-by substance abuse treatment facilities to treat alcohol-dependent clients. DATA SOURCES: Facility-level data from the 2003 National Survey of Substance Abuse Treatment Services, and state-level data on policy and environmental factors from publicly available sources. STUDY DESIGN: We use facility- and state-level data in a cross-sectional, multilevel model to analyze state-level policies that are associated with treatment facilities' naltrexone adoption. DATA COLLECTION/EXTRACTION METHODS: The analysis uses survey data. PRINCIPAL FINDINGS: State Medicaid policies supporting the use of generic drugs, reducing drug costs, and permitting managed care organizations to establish policies encouraging use of generics were associated with higher odds of naltrexone adoption (by up to 96 percent). State policies limiting access to pharmaceutical technologies through Medicaid preferred drug lists, restricting access to pharmacy networks, and imposing general limitations on use of Medicaid benefits for rehabilitation for substance abuse treatment were associated with reduced odds of naltrexone adoption. CONCLUSIONS: Policy levers that are available to state governments are associated with the adoption of pharmaceutical technologies such as naltrexone that could help meet widespread need for access to clinically proven and cost-effective treatments for substance abuse.