Background Substance use disorder (SUD) remains a critical public health crisis in the United States, with high prevalence and overdose mortality rates. Despite the availability of effective treatments, including medications that significantly reduce overdose risk, fewer than 20% of Americans with active SUD receive treatment annually. Single State Agencies (SSAs), which oversee federal funding and regulate SUD treatment programs, hold significant authority to impose licensure and reporting requirements intended to promote treatment quality. Methods This study presents findings from a national survey of SSAs across 50 states and the District of Columbia (94% response rate) conducted between 2020 and 2021, examining their roles in licensing SUD programs and setting requirements to promote evidence-based clinical practice. Results Results reveal that 58.3% of SSAs were responsible for licensing SUD treatment programs, with most requiring reporting primarily from publicly funded programs rather than all licensed providers. Staffing and clinical practice requirements varied substantially across treatment settings: opioid treatment programs and inpatient withdrawal management services were most frequently subject to medical staffing and supervision mandates, while outpatient programs were less regulated in these respects. Few SSAs required minimum staffing ratios or mandated medical professionals on staff in outpatient settings, limiting access to medication-based treatments. While patient placement criteria and clinical assessments were commonly required, clinical supervision requirements were inconsistent, and data reporting was often limited. Across treatment settings, treatment and aftercare/discharge planning were commonly required. Conclusions The study findings indicate that agency requirements in many states allow for SUD treatment practices and staffing arrangements that are inconsistent with evidence-based care. Balancing quality improvements with maintaining access to care may necessitate additional resources and technical support for treatment programs to meet higher standards. Enhancing licensure requirements may be a critical step toward closing persistent gaps in SUD treatment quality and expanding access to lifesaving interventions.
Yelton et al. (Thu,) studied this question.