Chapter 8 presents data on the reason for discharge and median length of stay (LOS) in treatment for the 62,564 discharges aged 12 and older from outpatient medication-assisted opioid therapy (i.e., therapy with methadone or buprenorphine) in 2009. Thirty-eight of the 45 reporting States and jurisdictions had discharges from this type of service [Table 8.1]. Discharges aged 12 and older from outpatient medication-assisted opioid therapy included 94 percent from outpatient treatment and 6 percent from intensive outpatient treatment (see Chapter 1).

Reason for Discharge

Table 8.1 and Figure 8.1. Of the 62,564 discharges aged 12 and older from outpatient medication-assisted opioid therapy in 2009:

• 14 percent (n = 8,486) completed treatment
• 17 percent (n = 10,442) were transferred to further treatment
• 42 percent (n = 26,285) dropped out of treatment
• 12 percent (n = 7,723) had treatment terminated by the facility
• 15 percent (n = 9,628) failed to complete treatment for other reasons
  

Median Length of Stay (LOS)

Table 1.4 and Figure 8.2. The median LOS in 2009 for outpatient medication-assisted opioid therapy discharges aged 12 and older was 161 days. By reason for discharge, the median LOS for outpatient medication-assisted opioid therapy discharges was:

• 197 days among those who completed treatment
• 165 days among those who transferred to further treatment
• 19 days among those who dropped out of treatment
• 231 days among those whose treatment was terminated by the facility
• 196 days among those who failed to complete treatment for other reasons
  
  

Characteristics at Admission

Table 1.6. Outpatient medication-assisted opioid therapy discharges aged 12 and older displayed some major differences from all discharges aged 12 and older combined. Of outpatient medication-assisted opioid therapy discharges aged 12 and older:

• 61 percent were male compared to 68 percent of all discharges
• 4 percent were aged 12 to 20 compared to 14 percent of all discharges
• 17 percent were non-Hispanic Black compared to 20 percent of all discharges; 20 percent were of Hispanic origin compared to 14 percent of all discharges
• 94 percent reported opiates as the primary substance of abuse compared to 21 percent of all discharges
• 69 percent reported daily use of the primary substance in the month before treatment entry compared to 38 percent of all discharges; 16 percent reported no substance use in the month before treatment entry compared to 29 percent of all discharges
• 76 percent reported one or more prior treatment episodes compared to 58 percent of all discharges
• 73 percent were self- or individual referrals to treatment compared to 33 percent of all discharges; 6 percent were referred to treatment through the criminal justice system compared to 38 percent of all discharges; 21 percent were referred through health care or community sources compared to 29 percent of all discharges
  

Treatment Completion

Tables 8.2 and 8.3. Table 8.2 enumerates the characteristics at admission of discharges aged 12 and over from outpatient medication-assisted opioid therapy by reason for discharge. Table 8.3 is based on Table 8.2. It presents two related proportions: a) the percent distribution of characteristics at admission among discharges completing treatment or transferring to further treatment compared to those who did not complete treatment, and b) the combined rate of completion or transfer to further treatment by characteristic at admission. Table 8.3 also provides the median LOS among outpatient medication-assisted opioid therapy discharges aged 12 and over that completed treatment.

Linkage of discharge records from 2009 to admission records from 2000 to 2009 means that the maximum length of stay (LOS) in treatment included in this report is 10 years. However, outpatient medication-assisted opioid therapy can have a much longer duration. Indeed, some admissions may receive this form of treatment for an indefinite period. Because this report includes data only on discharges, it will underestimate LOS in treatment for those receiving outpatient medication-assisted opioid therapy. Similarly, the number and proportion of treatment completers will reflect only those who have been discharged because treatment is complete and not those who successfully remain in long-term outpatient medication-assisted opioid therapy. In addition, the characteristics at admission of those admitted to and discharged from outpatient medication-assisted opioid therapy within 10 years may differ from those of admissions who remain in such therapy for longer than 10 years.

Completion/Transfer Rates and Characteristics at Admissions

The overall combined treatment completion/transfer rate among outpatient medication-assisted opioid therapy discharges aged 12 and over was 30 percent.

• Among variables whose categories represented a continuum—age, frequency of use, number of prior treatment episodes, and level of education—higher completion/transfer rates among outpatient medication-assisted opioid therapy discharges were associated with these three:
  
  • Less frequent use—the completion/transfer rate fell from 41 percent among discharges who reported no substance use in the month before treatment entry to 27 percent among discharges who reported daily substance use
  • No prior treatment episodes—the completion/transfer rate for discharges with one or more prior treatment episodes was 29 percent compared with 34 percent of discharges reporting no prior treatment episodes
  • Higher educational level—34 percent of discharges with more than 12 years of education completed treatment or transferred to further treatment; the rate fell to 27 percent among discharges with fewer than 12 years of education
    
• Among other characteristics (race/ethnicity, primary substance, treatment referral source, employment status), the completion/transfer rate among outpatient medication-assisted opioid therapy discharges aged 12 and over ranged from:
  
  • 26 percent among discharges of Hispanic origin to 32 percent among non-Hispanic White discharges
  • 29 percent of discharges who reported opiates as the primary substance to 49 percent of discharges who reported alcohol
  • 28 percent of discharges who were self- or individually referred to treatment to 44 percent of discharges who were referred to treatment through the criminal justice system
  • 29 percent of discharges who were unemployed/not in labor force to 34 percent of discharges who were employed
    

Median LOS among Discharges Completing Treatment

The overall median LOS in 2009 among discharges aged 12 and older completing outpatient medication-assisted opioid therapy was 197 days.

• The median LOS was longest (327 days) among discharges of Hispanic origin
• The median LOS was shortest among discharges who reported alcohol (91 days) as the primary substance
  

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