Philly’s system for treating opioid use disorder is fragmented, study finds

A new study is drawing a detailed picture  of the opioid use disorder crisis in Philadelphia, and the results are eye-opening.

Using geographic information systems (GIS) mapping and focus groups around the city, researchers at Thomas Jefferson University have found that Philadelphia’s “robust” treatment system is also “siloed” and “fragmented.”

The findings show that individuals living with substance use describe several social determinants of health that create barriers to care. Among those complex needs are transportation, comorbid mental and physical health conditions, wounds, language issues and child care.

“We did a bunch of interviews with people who have accessed the opioid use disorder treatment system in Philadelphia,” said Erin Kelly, assistant professor at Thomas Jefferson University. “And while many had great experiences, many had experienced a lot of barriers both to getting into treatments and staying in treatment.”

This research project was funded by Pew Charitable Trusts last year. Kelly — along with research assistant professor Megan Reed — both conducted this qualitative analysis to provide insights on individuals seeking treatment around the city.

The goal was also to provide foundational research on the capacity of substance use treatment facilities in Philadelphia to provide equitable access and high retention.

“What are the barriers to entering in the treatments in Philadelphia? What are the barriers to staying in treatment in Philadelphia? And what does the system look like as a whole?” Reed said. “We did surveys with methadone providers. We did a bunch of focus groups with people who had accessed the treatment system and then we literally mapped where treatment is and thought a lot about access and transportation.”

Among their findings was that the assessment process for individuals going into treatment — inpatient and outpatient care — was exhausting and arduous, particularly at assessment centers.

“People regularly describe this process as taking up to 18 hours,” Reed said. “And these are people who are trying to get treatment and they’re going through the assessment process while they’re in active withdrawal, which was described as pretty agonizing. And many times people talked about leaving treatment, or leaving the assessment process early, or going through the entire assessment process and being told there are no slots available for you. You need to come back tomorrow.”

Mapping access to care

The report also assessed data provided by the city of Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) to map out locations of care, using GIS mapping.

Of the mapped locations, 26% are ones that the Substance Abuse and Mental Health Services Administration (SAMHSA) lists as treatment for individuals with private insurance. Twelve programs within the city limits accept public insurance.

  • January 19, 2024
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