Facilities Dispensing Methadone
This chapter presents trends in facility characteristics for 1996 to 2002. It should be kept in mind, however, that the list frame, methods, and survey instrument have changed during this period. These changes are detailed in Appendix C.
Table 2.1 and Figure 1. The increase in the number of reporting facilities from 10,641 in 1996 to 13,720 in 2002 is due primarily to improved survey methodology rather than to an actual increase in the number of facilities. The principal improvements were an increase in the response rate from 86 percent in 1996 to 96 percent in 2002, and an extensive effort to improve the coverage of the facility universe (described in Appendix C).
Table 2.1 and Figure 1. In 2002, a total of
1,080 facilities (8 percent of all facilities) reported that
they dispensed methadone or levo-alpha acetyl
methadol (LAAM) as part of an Opioid Treatment
Program (OTP) certified by the Center for Substance
Abuse Treatment (CSAT), SAMHSA. Prior to May 18, 2001, such programs required approval by the
Food and Drug Administration (FDA). In previous
years, the UFDS and N-SSATS surveys counted all
facilities reporting that they dispensed methadone or LAAM. In the 2002 N-SSATS, facilities
reporting that they had OTPs were verified against a
list supplied by CSAT.
Table 2.1 and Figure 2. Facilities are described
in terms of ownership, i.e., the type of entity
owning or responsible for the operation of the facility:
private for-profit, private non-profit, or
government (Federal, State, local, or tribal). Despite
year-to-year fluctuations in the number of facilities
reporting, the overall structure of the treatment system (as
reflected in the N-SSATS ownership data) changed very little over the time period.
On March 29, 2002, private non-profit facilities made up the bulk of the system (61 percent). Since 1996, this proportion has remained relatively constant. Private for-profit facilities accounted for 25 percent of responding facilities. Fluctuations in the proportion of private-for-profit facilities are probably because of SAMHSA's efforts to expand survey coverage to these facilities, followed by the decision to exclude solo practitioners that were not State agency-approved. Eleven percent of facilities were owned by State or local governments on March 29, 2002, while the Federal government owned 2 percent and tribal governments owned 1 percent of reporting facilities.
Table 2.2 and Figure 3. Facilities may offer treatment programs or groups designed to address the specific needs of certain populations. These groups include dually-diagnosed clients (persons with co-occurring mental and substance abuse disorders), adolescents, persons with HIV/AIDS, pregnant/postpartum women, women only, men only, gays and lesbians, and seniors/older adults. Data on programs or groups for dually-diagnosed clients, adolescents, persons with HIV/AIDS and pregnant/postpartum women were collected beginning in 1997. Information on the provision of programs or groups for women only was added in 1999, and information on programs or groups for gays and lesbians, men only, and seniors/older adults was added in 2000. The proportion of facilities offering programs or groups for each of the special populations has remained relatively stable. From 1997-2002, just under half of all facilities offered programs or groups for dually-diagnosed clients, between 34 and 39 percent offered programs or groups for adolescents, between 19 and 24 percent offered programs or groups for persons with HIV/AIDS, and between 19 and 22 percent offered programs or groups for pregnant/postpartum women. On March 29, 2002, programs or groups for women only were available in 38 percent of all facilities; for men only, in 30 percent; for seniors/older adults in 14 percent, and for gays and lesbians in 13 percent.
Table 2.3 and Figure 4. In general, the term
"managed care" refers to the prepaid health care
sector (e.g., HMOs) where care is provided under a
fixed budget within which costs are "managed."
Approximately 51 percent of facilities had agreements
or contracts with managed care organizations in
2002, compared to 42 percent in 1996. The
percentage of facilities with managed care agreements or
contracts increased between 1996 and 1999 for all ownership categories. Between 1999 and
2002, however, the proportion generally stabilized or
declined slightly. Private non-profit and private for-profit facilities had the highest proportion of
facilities with managed care agreements or
contracts, at 55 percent and 53 percent on March 29,
2002, respectively. Among local and State
government-owned facilities, 41 percent and 35
percent, respectively, had managed care agreements or
contracts. Facilities owned by Federal or tribal
governments were least likely to have agreements or contracts with managed care organizations,
at 19 percent and 22 percent, respectively.
Table 2.4. In most States, the proportion of facilities having agreements or contracts with managed care organizations increased between 1996 and 2002. There was wide variation among States in the proportions of facilities with such agreements or contracts.