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Residential vs. Outpatient Treatment for OUD: Which One Works Best?

September 1, 2022
Meg Brunner, MLIS
Hartung DM, et al. Association between treatment setting and outcomes among Oregon Medicaid patients with opioid use disorder: A retrospective cohort study. Addiction Science & Clinical Practice 2022;17:45.
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Key points: 

  • Residential treatment is often thought of as the highest intensity option for opioid use disorder, but few studies have actually compared it to outpatient care
  • This study used data from the SAMHSA Treatment Episodes Dataset (TEDS) to see whether people in residential vs. outpatient treatment for OUD had better outcomes
  • Analysis found that the most important factor for preventing overdose deaths was the use of medications for OUD (buprenorphine, e.g.) – not treatment setting
  • Other outcome measures did not differ significantly between treatment settings
  • Without more compelling evidence, efforts to expand access to treatment should focus on building capacity for outpatient MOUD treatment, rather than on residential care

Residential treatment is common for opioid use disorder (OUD), however few studies have compared it to outpatient treatment to see if one setting actually worked better than the other. Given the expense of residential care, and the need to expand treatment availability nationwide, knowing which setting results in better outcomes seems important. 

Using data from the SAMHSA Treatment Episodes Dataset (TEDS), this study, CTN-0086, compared clinical outcomes for Medicaid beneficiaries with OUD receiving residential or outpatient treatment to see what differences between these two treatment settings and modalities might exist.

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Researchers used data from individuals treated for OUD between 2014 and 2017, looking at the association between treatment setting and outcomes (such as opioid overdose, other emergency department (ED) visits, hospital admissions, and treatment retention). They also evaluated how medications for opioid use disorder (MOUD; i.e., buprenorphine, methadone, or naltrexone) impacted outcomes for patients in each treatment setting.

Of 3,293 individuals treated for OUD, 957 (29%) received treatment in a residential facility. MOUD use was higher among those treated as outpatients (43%) compared to those in residential settings (19%). 

The risk of overdose or an opioid-related ED encounter or hospital admission did not differ between treatment settings alone, however MOUD use in either setting was associated with a significant reduction in overdose risk, suggesting that, at least for overdose, medication treatment for OUD matters more than treatment setting. 

Residential care was associated with greater odds of retention at 6 months but not at 1-year, and it was only associated with greater odds of retention for individuals not receiving MOUD – no benefit to residential care was seen in those who were taking MOUD.

Conclusions: Residential treatment is often considered the highest intensity of treatment for people with OUD and may be especially helpful for people with unstable housing, co-morbid mental health conditions, or high medical need. However, compared to outpatient treatment, residential treatment was not associated with greater reductions in opioid overdose or opioid-related ED encounters/hospitalizations. Importantly, MOUD use was associated with a significant reduction in opioid overdose risk for everyone, independent of treatment setting, underscoring its importance. Without more compelling evidence of benefit associated with residential treatment, efforts to expand access to OUD treatment should focus on broadening outpatient MOUD treatment capacity.  

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