Increase in Methadone Treatment Episodes With Co-occurring Mental Health Disorders between 2013 and 2023

Objectives To compare US methadone treatment episodes with co-occurring mental health disorders in 2013 and 2023. Methods We analyzed 2013 and 2023 Treatment Episode Data Set-Discharges records for 75,338 episodes with methadone use, a co-occurring mental health disorder, valid sex or gender information, and discharge because treatment was completed, dropped out, or terminated by the facility. We compared demographics, substance use, treatment, and discharge characteristics. Results Eligible episodes increased from 18,935 in 2013 to 56,403 in 2023. Compared with 2013, 2023 episodes involved older clients (mean age, 39.72 vs 36.16 years), fewer female clients (40.2% vs 49.8%), more methamphetamine/speed use (14.7% vs 3.2%), more cocaine/crack use (38.8% vs 29.9%), less injection drug use (37.1% vs 55.3%), more Medicaid payment (22.9% vs 7.7%), and more homelessness (19.3% vs 12.7%). Conclusions The profile of methadone treatment episodes with psychiatric comorbidity changed markedly. Public Health Implications: Treatment systems may need greater capacity for stimulant co-use, aging-related needs, Medicaid-financed integrated care, and housing support.