# Organizational factors associated with quality of care for opioid use disorders among transition-age adults in Medicaid

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $726,809

## Abstract

Project Summary
Transition-age (TA) adulthood—between ages 18 to 25—is a distinct and critical developmental period where
unique biological, psychological, and social changes are occurring. Brain development continues into the latter
part of this period, with neurological structures associated with reward sensitivity and self-regulation continuing
to form. Social roles are in flux, with reduced parental monitoring and shifts in societal expectations that
presage lifetime functioning at the personal, familial, and community levels. Substance use disorders (SUD)
and mental health conditions are more prevalent in this age group than at other ages, 14.4% and 29.4%
respectively in 2019. Effective treatment at this age has the potential for large long-term payoffs. Over the past
decade, there has been a large rise in the prevalence of opioid use disorders (OUD) among TA adults. Yet, the
treatment system for OUD performs poorly for TA adults: they are less likely to obtain scientifically supported
treatment and more likely to leave treatment early. Although the most efficacious treatment for OUD is
pharmacotherapy, naturalistic studies demonstrate that there are large gaps in receipt of medications for opioid
use disorder (MOUD), low adherence to these medications, and poor outcomes for most TA adults who enter
treatment. Few current studies of quality in OUD treatment programs account for individual, organizational, and
contextual factors that vary over time. In particular, variation in the quality of treatment programs occurs within
the complex interplay of social and ecological factors related to communities, treatment programs, and
characteristics of the patient. Specifically, social determinants of health, such as poverty and racial/ethnic
disparities, create added barriers to obtaining and sustaining scientifically supported treatments. A better
understanding of the program characteristics associated with higher quality care for TA adults with OUD will
inform organizational changes, payer incentives, and government policies to improve treatment for this poorly
served population. Because of rapid organizational changes caused by the COVID-19 public health
emergency, there is an opportunity to explore whether new forms of SUD treatment delivery—telehealth,
liberalization in provision of pharmacotherapy—lead to improved treatment engagement and outcomes for TA
adults. The proposed longitudinal study will combine data from multiple sources, including Medicaid and a
state registry of SUD treatment episodes, to examine three aspects of OUD treatment quality for approximately
65,000 TA adults entering treatment for OUD between 2012 and 2025: 1) access to MOUD; 2) adherence to
pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). To guide our study, we
propose a conceptual model that draws from the Donabedian quality of care framework (Organizational
Structure>Clinical Process>Outcome) and from social ecology to examine prog...

## Key facts

- **NIH application ID:** 10823329
- **Project number:** 5R01DA057267-02
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** CHARLES J NEIGHBORS
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $726,809
- **Award type:** 5
- **Project period:** 2023-04-15 → 2028-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10823329

## Citation

> US National Institutes of Health, RePORTER application 10823329, Organizational factors associated with quality of care for opioid use disorders among transition-age adults in Medicaid (5R01DA057267-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10823329. Licensed CC0.

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