Drugs for opioid addiction widely underused

Despite a record number of drug overdose deaths in the United States and a large body of evidence supporting the effectiveness of drugs to treat opioid use disorder (OUD), these drugs remain largely underused, according to new research.

Based on data from the National Survey of Drug Use and Health (NSDUH), investigators found that only one in four people with OUD received drug treatment.

In addition, receipt of medication for OUD (MOUD) was lowest among women, uninsured black or Hispanic people, low-income people, and people over age 50. Teenagers with OUD had the lowest rate of drug use among all. demographic groups — zero.

The study is the first to estimate MOUD use in the past year in a nationally representative community sample of individuals who may have needed OUD treatment.

Dr. Pia Mauro

“The overdose crisis in the United States unfortunately continues unabated, and access to medication is an important tool for targeting and reducing overdose deaths,” said lead author Pia Mauro, PhD, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University, New York. City, says Medscape Medical News. “It’s important to put a number on the breakdown of people who receive medication, because it shows that what we are doing is not enough.”

The study was published online March 23 in Open JAMA Network.

Overdose deaths at record high

Drug overdose deaths in the United States have reached an all-time high, with 100,306 American deaths between April 2020 and April 2021, an increase of nearly 30% from the previous year. Almost three-quarters of those deaths involved opioids.

There are currently three medications approved by the Food and Drug Administration (FDA) to treat OUD: methadone, buprenorphine, or naltrexone, all of which are very effective. Buprenorphine is the only drug approved for use in adolescents, and only in those 16 and older.

Prior to 2019, information on MOUD treatment use was not collected in the NSDUH, an annual survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Based on responses to the new question about MOUD use, Mauro and colleagues identified participants who may have needed MOUD in the past year, including those who reported having a disorder. related to heroin or opioid use, receiving medication for their disorder, or undergoing non-drug treatment. OUD treatment, including cognitive behavioral therapy and self-help.

Only 27.8% of those eligible for OUD treatment received MOUD treatment in the past year; 57.0% received no treatment; and 15.3% received non-MOUD services.

People aged 18 to 25 were most likely to receive MOUD, with only 13.2% of people over 50 and no one under 18 receiving medication.

“This study indicates extremely low drug use for people who may need it and given the continued increase in drug-related overdose deaths, the majority of which involve opioids, the need to increase access to medication is more important than ever,” said Mauro. .

MOUD use was significantly lower among non-Hispanic blacks (adjusted relative risk [aRRR], 0.82; 95% CI, 0.27-2.46), Hispanics (aRRR, 0.57; 95% CI, (0.14-2.28) and Asians, Native Americans or Native Americans Alaskan, Hawaiian, Pacific Islander, or multiracial (aRRR, 0.28; 95% CI, 0.08-0.92) compared to White.

Medication use was less likely in women than in men (aRRR, 0.52; 95% CI, 0.29-0.95) and more likely in people who had both a to prescription opioid and heroin use compared to those who abused only one of the substances (aRRR, 5.07; 95% CI, 1.50-17.12).

MOUD was more common among people with public insurance than among those with private insurance or no insurance, but overall use remained very low regardless of insurance status.

“Public insurance has always been positively associated with access to MOUD, so our study builds on this to show the importance of public insurance in increasing access to medicines,” Mauro said. “But even among those with public insurance, only 35% received medication. That’s only one in three.”

About 85% of participants likely to have needed treatment for OUD had at least one contact with a healthcare provider in the past year and more than half had contact with the system criminal justice. Only about a third of those people received MOUD, which Mauro lamented as a missed opportunity for treatment.

Persistent Barriers to Treatment

The findings highlight continuing barriers to drug therapy for OUD, said Alan Leshner, PhD, chief executive emeritus of the American Association for the Advancement of Science and former director of the National Institute on Drug Abuse.

Dr Alan Leshner

“These kinds of data are critical to increasing our understanding of the nature of the opioid epidemic and what to do about it,” Leshner said. “Understanding who has and who does not have access to life-saving medicines is particularly important, but also where to focus efforts to address the problem.”

In 2019, Leshner co-authored a report on the underuse of medications to treat OUD. As previously reported by Medscape Medical Newsthis report argued that stigma, burdensome regulations, unfounded concerns about misappropriation of MOUDs, lack of insurance coverage, and inadequate professional training of healthcare providers, law enforcement, and officials of criminal justice all acted as barriers separating people with a medical condition from desperately needed and effective treatment.

“The hurdles are the same and haven’t been vigorously addressed,” Leshner said. However, recent steps taken by government leaders could signal a positive trend towards expanded treatment, he added.

Earlier this month, Leshner chaired a workshop on ways to improve access to methadone, one of the drugs approved to treat OUD. Officials from SAMHSA, the Drug Enforcement Administration, and the FDA attended, as did Rahul Gupta, MD, director of the Office of National Drug Control Policy and senior national drug policy official.

“I am optimistic that there can be a renewed commitment to working on this outbreak using a health-centered approach that takes into account the range of social issues that surround the problem as well as criminal justice issues,” he said. Leshner said.

The study was funded by the National Institute on Drug Abuse grant. Mauro and Leshner reported no conflict. Full disclosures are reported in the original article.

JAMA network open. Published online March 23, 2022. Article.

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