California County Fact Sheets: Treatment Gaps in Opioid-Agonist Medication Assisted Therapy (OA-MAT) and Estimates of How Many Additional Prescribers Are Needed

Lisa Clemans-Cope, Douglas A. WissokerMarni Epstein, and Joshua Aarons
Last updated November 11, 2019

This analysis presents county-level estimates of opioid use disorder (OUD) and treatment needs in California counties. The OUD rates are averages of two estimates derived from the National Survey on Drug Use and Health (NSDUH). The first estimate uses California and national estimates from the NSDUH, and the second estimate multiplies these NSDUH-based numbers by a ratio representing the relationship between an NSDUH-based OUD rate, known to be biased downward, and an OUD rate for Massachusetts based on a capture-recapture analysis of seven administrative databases linked at the person level. To calculate treatment capacity, we use a lower bound of the current number of patients receiving buprenorphine and methadone treatment and an upper bound that assumes buprenorphine-waivered prescribers treat more patients.

We estimate each county’s opioid-agonist treatment capacity based on data from the Drug Enforcement Administration and the California Controlled Substance Utilization Review and Evaluation System prescription drug monitoring database, as well as opioid treatment program data from the state. Using a range of treatment capacity estimates, we estimate the number of additional prescribers needed per county to fill the estimated treatment gap. We present strategies to meet demand for treatment, showing a range based on lower and upper estimates of the treatment gap and treatment capacity.

Fact sheets can be downloaded individually or as one document, and a separate methodological appendix describes the data, assumptions, and methodology. To view data on all counties, download the California state fact sheet.

These fact sheets cannot be compared with our previously published estimates because our methodology for 2019 differs significantly from our previous methodology. Our earlier estimates and methodology are available here.