Evidence-Based Medications for Opioid Use Disorder Underutilized in the US

In 2021, an estimated 2.5 million adults aged 18 years or older in the US experienced opioid disorder (OUD) within the previous year. However, only 22% of them received medications to treat their OUD, according to a recent study conducted by investigators at the National Institute on Drug Abuse and the National Center for Injury Prevention and Control, part of the CDC.¹

In the study, Christopher Jones, PharmD, DrPH, MPH, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and a team of investigators showed evidence-based medications for OUD, such as buprenorphine, methadone, and naltrexone, are vastly underused.

“Medications for opioid use disorder are safe and effective. They help sustain recovery and prevent overdose deaths,” Nora Volkow, MD, director of the National Institute on Drug Abuse said in a statement. “Failing to use safe and lifesaving medications is devastating for people denied evidence-based care. What’s more, it perpetuates opioid use disorder, prolongs the overdose crisis, and exacerbates health disparities in communities across the country.”²

That year, nearly 107,000 people died from a drug overdose, with 75% of those deaths involving an opioid. The increase in overdose deaths is largely attributed to the proliferation of illicit fentanyl, a highly potent synthetic opioid.

Despite decades of research exhibiting the benefits of existing medications for OUD, the utilization of these medications remains low.¹

Investigators analyzed data from the 2021 National Survey on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration, to estimate how many people with OUD receive medications in the US.

Findings showed that among the estimated 2.5 million adults with OUD, only 36% received any substance use treatment, and only 22% received medications for OUD. The study further revealed that medications for OUD are most commonly prescribed to patients with moderate-to-severe OUD.

Adults with severe OUD were 5 times more likely to receive medications compared with those who had mild OUD. However, there was no significant difference in medication receipt between adults with moderate and mild OUD.

One finding demonstrated that individuals receiving substance use treatment via telehealth were approximately 38 times more likely to receive medications for OUD when compared with those who did not receive treatment via telehealth.

Certain demographic groups were found to be less likely to receive medications for OUD. Black adults, women, those who were unemployed, and those in nonmetropolitan areas had lower odds of receiving these medications compared with other groups.

Additionally, the study found non-Hispanic White adults were 14 times more likely to receive medications for OUD than non-Hispanic Black adults; men were 6 times more likely than women; those with full-time employment were 14 times more likely than the unemployed; and those living in large metropolitan areas were 3 times more likely than those in nonmetropolitan areas.

While the findings may not be generalizable to groups excluded from the survey, the findings underscore the importance of addressing health disparities and inequities faced by racial/ethnic minority groups when accessing substance use treatment. Investigators called for efforts to reduce these disparities to reverse the trend of increasing drug overdose deaths.

References

1. Jones CM, Han B, Baldwin GT, Einstein EB, Compton WM. Use of medication for opioid use disorder among adults with past-year opioid use disorder in the US, 2021. JAMA Netw Open. 2023;6(8):e2327488. doi:10.1001/jamanetworkopen.2023.27488

2. Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021. News release. National Institute on Drug Abuse. August 7, 2023. Accessed August 7, 2023. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021