Only One in Four People Needing Treatment for Opioid Use Disorder Received Medication
Despite strong evidence that medication is the most effective treatment for opioid use disorder (OUD), adolescents and most adults with a need for OUD treatment reported a lack of medication for OUD in the past year, according to a study by researchers at Columbia University Mailman School of Public Health. Among those who may have needed opioid use treatment, only 28 percent received medication for OUD. Until now, national studies on medication for OUD were lacking. The findings are published in JAMA Network Open.
“Our nationally representative research revealed critical gaps in treatment engagement and use of medication for opioid use disorder. Increased efforts to address barriers to care are critically needed,” said Pia Mauro, PhD, assistant professor of epidemiology at Columbia Mailman School and the study’s lead author. “Evidence supporting the effectiveness of medication for opioid use disorder such as methadone, buprenorphine, or naltrexone is unequivocal, but most people who needed OUD treatment in the U.S did not receive this gold standard treatment.“
The findings were based on data from the 2019 National Survey on Drug Use and Health. Participants were community-based, and data excluded people who were institutionalized or homeless not in shelters. The researchers identified adolescents and adult respondents who may benefit from medication for OUD defined as meeting criteria for a past-year opioid use disorder, reporting past-year medication for OUD, or receiving past-year specialty treatment for opioid use.
The data showed that 57 percent received no treatment for the disorder, and 15 percent received only services without medication. Notably, adolescents (aged 12-17 years) did not receive (medication for opioid use disorder) MOUD in the past year and only 13 percent of adults 50 years and older received medication for the disorder. “Our findings support calls for additional MOUD engagement and retention strategies tailored for both adolescents,” noted Mauro.
Among adults, the likelihood of past-year MOUD receipt compared to no treatment was also lower for people aged 50 years and older, versus for those 18 to 25 years of age. “Our finding that a minority of adults and no adolescents received MOUD indicates substantial gaps in access,” observed Mauro. “These results provide critical evidence to inform national efforts needed to increase equitable access to MOUD.”
Nearly one-third of non-Hispanic white people in need of OUD treatment received medication, compared with approximately 20 percent of people identifying as non-Hispanic Black or multiracial groups and 15 percent of Hispanic people. In contrast, roughly similar proportions of each racial and ethnic group received non-medication services, revealing significant disparities specifically for access to medication treatment among people of color.
MOUD was lower among women, more likely among adults with at least some college, and less likely in small metropolitan areas versus large metropolitan areas. While contacts with the health care system (85 percent) and criminal legal system (61 percent) were common, most people encountering these systems did not report receiving MOUD (30 percent and 39 percent, respectively).
Starting in 2020, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act mandated that Medicaid cover all three U.S. Food and Drug Administration–approved medications for OUD, including methadone in certified opioid treatment programs.
“Policies that expand Medicaid coverage for these medications is an important population-level strategy to potentially increase access to effective opioid use disorder treatment in the publicly insured population,” said Hillary Samples, PhD, assistant professor at the Rutgers School of Public Health and study senior co-author. “In any case, our findings provide further evidence that investments are needed to increase MOUD prescribing and referrals in ambulatory settings.”
Co-authors are Sarah Gutkind and Erin Annunziato, Columbia Mailman School of Public Health.
The study was supported by the National Institute on Drug Abuse (grant numbers DA045224, DA049950, DA031099).