Hospitals and substance use disorder services in the time of the opioid epidemic.

OBJECTIVE: To test whether the opioid epidemic increased hospitals' offerings of substance use services.

DATA SOURCES/STUDY SETTING: This study employs data from the 2010 and 2015 American Hospital Association Annual Survey.

STUDY DESIGN: A multilevel, cross-sectional design was utilized to examine associations between county-level overdose rates and hospital substance use services.

DATA COLLECTION/EXTRACTION METHODS: The analytic sample consisted of 3365 acute care hospitals that answered pertinent survey questions.

PRINCIPAL FINDINGS: In 2010, 334 hospitals offered inpatient opioid services and 588 hospitals offered outpatient services, compared to 327 and 577, respectively, in 2015, indicating that more hospitals dropped services than added them as overdose rates increased. Factors other than growing need weigh more heavily in hospitals' determination to offer substance use services, including resources, mission, and the presence of psychiatric facilities within their communities. Importantly, hospitals that employ medical home models had greater odds of offering outpatient substance abuse services in 2015 OR, 95 percent CI (1.54; 1.23-1.93; P < 0.0001).

CONCLUSIONS: Hospitals are either not willing or equipped to increase substance use services in response to growing need.