Thread by @ml_barnett

🚨 New in @JAMA_current 🚨

"Secret shopper" survey of 368 residential addiction programs for opioid use

TL;DR:

Fewer than 1/3rd offered maintenance treatment with buprenorphine while over 1 in 5 actively discouraged buprenorphine use

More below

jamanetwork.com/journals/jama/…

@JAMA_current Lots written about shoddy quality at residential addiction programs, but there is little hard data out there

We set out to get data on what programs offer to potential patients

Led by @tamarabeetham w/ coauthors @BrendanSaloner @DrSarahWakeman + Marema Gaye, Richard Frank

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman We called 368 residential programs as "secret shoppers" posing as individuals looking for opioid use disorder (OUD) treatment.

We asked what therapies do they offer, and do they nudge callers in any direction?

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman Major findings:

Only 29% of programs offered buprenorphine as maintenance treatment, the evidence-based standard.

31% offered bupe, but only for short term "detox" - this could be worse than nothing at all!

21% *actively* *discouraged* callers from using bupe at all

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman Some other concerning results:

Programs accredited by CARF or the Joint Commission had no better rates of offering buprenorphine than others and had similar rates of discouraging bupe.

These should be "gold stars" of quality but clearly something is missing.

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman Callers were offered a whopping 38 other therapies at >5 facilities.

92% offered some kind of 12-step programming

Many programs offered standard therapies like CBT or group therapy.

But many others offered less evidence-based therapies like yoga, animal therapy, or massage.

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman Bottom line - only a fraction of these expensive facilities meet a bare minimum standard of offering evidence-based therapy and many push debunked stigma against this therapy.

Accreditation is clearly not a mechanism for accountability that is working here.

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman At the same time, lots of facilities offer superficially enticing but clinically irrelevant therapies like art therapy, animal therapy, or massage.

There is definitely reform needed and more accountability in this industry. Much more to come soon from this survey , stay tuned.

@JAMA_current @tamarabeetham @BrendanSaloner @DrSarahWakeman Thanks again to my stellar colleagues for their hard work on this.

@tamarabeetham was a superstar pulling all of this together and leading the charge.

A huge pleasure to work with
@BrendanSaloner @DrSarahWakeman Marema Gaye and Richard Frank