Facility, community, and state-level correlates of overdose education and naloxone provision in substance use treatment facilities in the United States.

BACKGROUND: This study examined which characteristics of substance use disorder (SUD) treatment facilities and their surrounding areas are associated with offering overdose education and naloxone (OEN). METHODS: We linked data from eight national sources regarding 12,146 SUD treatment facilities (from the 2024 National Directory of Drug and Alcohol Use Treatment Facilities) and the communities and states where they operate. Regression analyses tested whether facility OEN provision was associated with facility type (with cluster analysis used to group facilities based on services offered) and selected facility, ZIP code, and state characteristics. FINDINGS: In a generalized linear mixed model, odds of OEN provision were higher in facilities that: used medications for opioid use disorder (Adjusted Odds Ratio [AOR] 7.21; 95% Confidence Interval [CI] 5.97-8.71); offered testing for HIV/hepatitis (AOR 2.39; 95% CI, 2.00-2.86); were government-operated (AOR 2.37; 95% CI, 1.81-3.11) vs. private for-profit; accepted Medicaid (AOR 2.36; 95% CI, 2.01-2.77); or were in metropolitan (vs. non-metropolitan) areas (AOR 1.27; 95% CI, 1.06-1.53). In facility cluster analysis (based on 191 facility characteristics/services), adjusted odds of OEN provision were lowest in the cluster characterized by outpatient services, low use of medications for opioid use disorder, and few social/medical/tailored services. Odds of OEN provision were highest in the cluster characterized by offering "detoxification," residential care, buprenorphine and naltrexone, and comprehensive medical and social services. CONCLUSIONS: OEN provision is lowest in SUD treatment facilities that do not use medications for opioid use disorder, offer relatively few social or medical services, and/or are located in non-metropolitan areas.