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

AuthorAndrew Sullivan,Changwe Park
Published date01 September 2022
Date01 September 2022
ANNALS, AAPSS, 703, September 2022 285
DOI: 10.1177/00027162231156291
Do Federal
Grants for
Assisted Opioid
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
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
Andrew Sullivan is an assistant professor of public
administration at University of Central Florida. His
research focuses on homeless services and collaborative
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.
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.

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