The Effect of Opioid Abatement Funds on the Utilization of Medications for Opioid Use Disorder

OBJECTIVE: To evaluate whether opioid abatement fund allocations to treatment programs influence the utilization of medications for opioid use disorder (MOUD). STUDY SETTING AND DESIGN: The study employed a synthetic difference-in-differences design and a triple-differences model using a state-year panel to estimate the effects of abatement fund spending on MOUD utilization. The study examined both general treatment allocations and MOUD-specific program funding. DATA SOURCES AND ANALYTIC SAMPLE: Data on state opioid abatement fund allocations were obtained from the Kaiser Family Foundation tracker. In 2022-2023, 33 states allocated funds to general treatment and 31 to MOUD-specific programs. Treatment variables were defined as binary indicators of whether a state allocated any funds to these categories. The primary outcome was MOUD-related admissions from 2016 to 2023, obtained from the Treatment Episode Data Set-Admissions. Outcomes were measured as substance use treatment admissions per 100,000 population, MOUD admissions per 100,000 population, and MOUD admissions as the proportion of all substance use treatment admissions. PRINCIPAL FINDINGS: Spending in the general treatment category led to a 13.2% increase in overall substance use treatment admissions (p = 0.06), but not with MOUD utilization. In states prohibiting supplantation, defined as prohibiting the use of abatement funds to replace existing opioid program expenditures, both general treatment and MOUD-specific allocations significantly increased MOUD admission rates by 232.7% (p = 0.009) and 157.7% (p = 0.07), respectively. No significant effects were observed in states allowing supplantation. Among individuals with opioid use disorder, allocations on both general treatment and MOUD-specific programs in no-supplantation states significantly increased substance use treatment admissions. CONCLUSIONS: General treatment investments modestly increase overall substance use treatment utilization, but effects on MOUD utilization were not detectable in the early implementation period. Exploratory analyses suggest larger effects in states prohibiting supplantation, though these estimates rest on few comparison states and require further confirmation.