Do Federal Grants for Medication-Assisted Opioid Treatment Reduce Homelessness?

• DOI: http://doi.org/10.1177/00027162231156291
• Published date: 01 September 2022
• Date: 01 September 2022

ANNALS, AAPSS, 703, September 2022 285

DOI: 10.1177/00027162231156291

Do Federal

Grants for

Medication-

Assisted Opioid

Treatment

Reduce

Homelessness?

By

ANDREW SULLIVAN

and

CHANGWE PARK

1151523ANN THE ANNALS OF THE AMERICAN ACADEMYDO FEDERAL GRANTS FOR MAT REDUCE HOMELESSNESS?

research-article2023

The federal government awarded $115 million to local

entities between 2015 and 2018 for medication-assisted

treatment (MAT) programs to treat opioid use disorder.

These programs integrate the use of medications with

counseling and behavioral therapies to reduce with-

drawal symptoms and other adverse, individual-level

effects of opioid misuse. Mounting evidence shows the

benefits of MAT interventions among individuals, but

little is known of whether these programs have proso-

cial, community-level effects. We examine the effect of

MAT programs on one such community-level outcome:

homelessness. Our event study design shows that MAT

grants did not have a discernable relationship to home-

lessness at the community level; and we argue that

while MAT may be an effective approach to treating

opioid use disorder among individuals, more must be

done to scale up its effects of these programs on

community-level outcomes like homelessness.

Keywords: medication-assisted treatment; homeless-

ness; opioid use disorder; interaction

weighted estimator; continuums of care

Introduction

Between 1999 and 2019, approximately 841,000

deaths induced by drug overdose were reported

in the United States (Centers for Disease Control

and Prevention [CDC] 2020). Approximately

two million people aged 12 years or over suf-

fered from opioid use disorder (OUD)—a

repetitive use of opioids that may result in loss

of social functioning—in the previous year

according to the 2018 National Survey on Drug

Correspondence: Andrew.sullivan@ucf.edu

Andrew Sullivan is an assistant professor of public

administration at University of Central Florida. His

research focuses on homeless services and collaborative

governance.

Changwe Park is a doctoral candidate in the College of

Pharmacy at the University of Kentucky. Her research

studies multi-level preventive interventions targeting

the opioid crisis.

286 THE ANNALS OF THE AMERICAN ACADEMY

Use and Health (Substance Abuse and Mental Health Services Administration

[SAMHSA] 2019). The increasing prevalence of OUD has spilled over to com-

munities, exacerbating problems like poorer general health, unemployment, and

child maltreatment (Chapman, this volume; Harris et al. 2020; Langford 2021;

Maclean et al., this volume). An additional consequence has been an increase of

homelessness, partially through mechanisms like unemployment (Lozano-Rojas

et al. 2020).

An effective intervention in battling the opioid crisis is medication-assisted

treatment (MAT) for individuals with OUD. MAT uses evidence-based medica-

tions and behavioral therapies to treat OUD by reducing withdrawal symptoms

and giving individuals tools that enable them to become less dependent on opi-

oids. To expand the utilization of MAT in communities, the federal government

implemented multi-faceted policies. The U.S. Department of Health and

Human Services (HHS) allocated $9 billion in grants to state and local govern-

ments between 2016 and 2019 through the nation’s 14,000 substance abuse facilities

(HHS 2021). The SAMHSA has provided medication-assisted treatment–

prescription drug and opioid addiction (MAT-PDOA) grants to communities

since 2015. These grants are meant to enhance integrated patient care programs,

increase the number of people with OUD receiving MAT, and eventually

decrease the number of people with OUD. SAMHSA targeted these grants to

local governments, nonprofits, and/or for-profits in states with either the highest

rates of primary treatment admission for opioids or a dramatically increasing rate.

Between 2015 and 2018, SAMHSA distributed about $115 million in grants. As

of February 2021, MAT was provided to 1.27 million people (HHS 2021). A

robust research literature attests to the ways in which MAT can benefit individu-

als, but we know little of whether MAT programs have prosocial, community-

level effects.

In this study, we asked whether MAT-PDOA grants decreased the number of

people experiencing homelessness in communities. To our knowledge, this study

will be the first empirical analysis of community level outcomes for MAT-PDOA

grants. A plethora of previous studies have examined the association between

opioid misuse and homelessness. Bradford and Bradford (2020), for example,

studied the relationship between county-level eviction rates and mortality

induced by all opioids (prescription and heroin), cocaine, psychostimulant, ben-

zodiazepine, antidepressant, and alcohol poisoning. They found that higher evic-

tion rates related to increased deaths in these categories, with the largest effects

for opioids, heroin, and benzodiazepines.

Several other studies suggested that the consequences of the opioid crisis

intertwine with homelessness. The supply-side restriction of prescription opioids

could be related to decreasing homelessness, possibly through alterations in pov-

erty and the labor market (Lozano-Rojas et al. 2020). Shifting controlled sub-

stance classification schedules of hydrocodone from III to II reduced its supply,

as schedule II substances have more restrictions on their use; schedule II means

higher abuse and addiction potential than schedule III substances (U.S.

Department of Justice 2022). This led to a decrease in homelessness in commu-

nities with high exposure to hydrocodone compared to those with low exposure.