Only 20% of Americans with opioid misuse receive helpful medication.
Only 20% of Americans with opioid misuse receive helpful medication.
Access to Opioid Addiction Medications Remains Limited, Putting Lives at Risk
The U.S. continues to grapple with an opioid abuse epidemic that shows no signs of abating. Shockingly, a recent study has found that just 1 in 5 people with opioid addiction receive potentially lifesaving medication such as methadone, buprenorphine, or naltrexone. These medications have proven efficacy in treating prescription opioids like Vicodin and OxyContin, as well as street opioids such as fentanyl and heroin. Despite their availability, the vast majority of individuals with opioid use disorder are not utilizing these medications that could significantly help treat this serious health issue.
According to Dr. Wilson Compton, the deputy director of the U.S. National Institute on Drug Abuse, “These medications are effective for prescription opioids like hydrocodone [Vicodin] and oxycodone [OxyContin] and all those medications we rely on for pain, or street opioids such as fentanyl, heroin and a handful of others.”
To obtain these findings, researchers analyzed data from the 2021 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration. The survey revealed that approximately 2.5 million people aged 18 and older had opioid use disorder in the previous year, and nearly 107,000 people died of a drug overdose in 2021, with 75% of those deaths involving an opioid. Shockingly, only 36% of individuals received any substance use treatment, and a mere 22% received medications for opioid use disorder.
Certain groups face even greater barriers to accessing these medications. The study highlighted that Black adults, women, the unemployed, and individuals residing in nonmetropolitan areas were significantly less likely to receive medication for opioid use disorder. In particular, white adults were 14 times more likely to receive these medications than their Black counterparts, and men were six times more likely than women.
The study found that medications for opioid use disorder were predominantly prescribed to individuals with moderate-to-severe opioid use disorder. Adults with severe opioid use disorder were five times more likely to receive medication than those with mild opioid use disorder.
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It is crucial to address this issue promptly, as delayed or lack of treatment significantly increases the risk of fatal overdose. During the COVID-19 pandemic, the federal government relaxed regulations around telemedicine, which facilitated improved access to medications for opioid use disorder. Individuals receiving substance use treatment through telehealth were approximately 38 times more likely to receive these medications compared to those who did not utilize telehealth services.
“The good news is that telemedicine use is associated with greater access to these medications, and this data can be used to help guide telemedicine use of controlled substances,” explains Dr. Compton.
Beyond telemedicine, there are additional ways to diminish barriers to accessing prescription medications for opioid use disorder. Dr. Compton suggests that providing additional financing to states can significantly improve access to these medications. Another solution is the deployment of mobile methadone clinics, which bring these medications to areas where they are most needed and can enhance accessibility.
Moreover, recent regulatory changes now allow doctors to prescribe buprenorphine (Buprenex) to treat opioid use disorder without requiring the restrictive X-waiver. This change is expected to expand access to this medication.
Dr. Compton advises individuals with loved ones who have opioid use disorder to have naloxone (Narcan) on hand at all times to treat an overdose. Soon, naloxone will be available without a prescription, simplifying its accessibility.
Dr. Sarah Wakeman, the medical director for substance use disorder at Mass General Brigham in Boston, expressed her lack of surprise about the study’s findings. She emphasizes that despite having medications readily available for treating opioid addiction, far too few individuals are receiving them. Moreover, there are alarming disparities in who gains access to these medications.
There are multiple reasons why many individuals are not accessing these medications. Stigma surrounding their use, limited education and training among healthcare providers, and restrictive laws in certain states all contribute to the problem.
The key to expanding access to opioid addiction medications lies in employing a multi-pronged strategy. By removing the X-waiver and streamlining treatment availability, more people can access these life-saving medications as soon as they need them. Pregnant women, who raise specific concerns, stand to benefit significantly from accessing buprenorphine during their pregnancies. Unfortunately, some states report women to child abuse services if they are taking the medication when they deliver, which discourages women from seeking treatment.
To combat the devastating opioid abuse epidemic, it is essential to address the limited access to medications that can significantly improve individuals’ lives. By implementing various approaches, such as telemedicine, mobile clinics, and eliminating restrictive regulations, more lives can be saved, and greater progress can be made in battling opioid addiction.
Sources:
- Wilson Compton, MD, deputy director, U.S. National Institute on Drug Abuse, Bethesda, Md.
- Sarah Wakeman, MD, medical director, substance use disorder, Mass General Brigham, Boston
- JAMA Network Open, Aug. 7, 2023
