Few patients who may benefit from opioid use disorder treatment receive it

About one in four people who may have needed treatment for opioid use disorder received it in 2019, according to findings published in JAMA Network Open.

“Our study findings of low medication uptake occurred in the context of a worsening drug overdose epidemic,” Pia Mauro, PhD, an assistant professor of epidemiology at Columbia Mailman School of Public Health, told Healio. “Drug overdose deaths are preventable, and treating opioid use disorder (OUD) is a crucial way to reduce overdose risk.”

Medication for opioid use disorder (MOUD) is a gold standard for treatment, and efforts to increase access to medication are needed in the U.S., she added.

In a separate study, researchers found that most patients who received MOUD in the ED do not remain on treatment, highlighting a need to improve the transition of OUD care.

Pia Mauro

‘Substantial gaps’ in MOUD

In the first study, Mauro and colleagues estimated MOUD use based on data from the 2019 National Survey on Drug Use and Health. Adult and adolescent respondents were included if they were identified as individuals who may benefit from MOUD; for example, if they met criteria for past-year OUD, reported past-year MOUD use or received past-year specialty treatment for opioid use in the last or current treatment episode.

In total, data from 2,206,169 people were included in the study. Among them, 55.5% were men or boys, 74.6% were white and 9.9% were Black. Also, a majority of participants were aged 35 years or older (55.1%), publicly insured (53.7%), had a past-year prescription OUD (56.8%) and had one or more cooccurring substance use disorders (80%).

Only 27.8% of participants who needed MOUD received it in 2019, according to Mauro and colleagues. Meanwhile, 57% of participants received no treatment and 15.3% received non-MOUD services (eg, connected with treatment but not medication). No adolescents received MOUD, and few (13.2%) adults aged 50 years or older reported using it.

Previous research has shown that adolescents are less likely to receive MOUD. This may be explained in part by “substantial stigma around medication use,” Mauro said. In the current study, most adolescents did not receive nonpharmacological treatment either (88%), indicating “a substantial unmet treatment need in this population,” Mauro said.

The odds of receiving treatment were also lower for respondents who earned an annual income of $50,000 to $74,999 compared with those who earned $19,999 or less (adjusted RR [aRR] = 0.18; 95% CI, 0.07-0.44) and for women compared with men (aRR = 0.52; 95% CI, 0.29-0.95), according to the researchers. In addition, participants who received MOUD were more likely to have had some college education (aRR = 2.94; 95% CI, 1.33-6.51) and less likely to live in small vs. large metropolitan areas (aRR = 0.41; 95% CI, 0.19-0.93).

Past-year contact with the health care system (85%) and criminal legal system (60.5%) was common among participants, according to Mauro and colleagues. However, only 29.5% of participants with past-year health care contact and 39.1% of those with past-year criminal legal system contact reported receiving MOUD.

“Most people who needed OUD treatment encountered the health care system in the past year but did not receive medication,” Mauro said. “These health care encounters are an opportunity to engage people in evidence-based OUD treatment through appropriate screening and intervention when clinically indicated. By meeting people where they are likely to seek services, primary care physicians can be a critical part of increasing access to medication for OUD.”

Transition to care from ED

The second study, published in Annals of Emergency Medicine, suggests that even when medication is prescribed for OUD, most patients do not continue receiving it.

Researchers at the nonprofit RAND Health Care conducted a statistical analysis of 92% of prescriptions written by emergency physicians in the U.S. for opioid-related ED visits from Feb. 1, 2019, to Nov. 30, 2020.

Bradley D. Stein, MD, PhD, a senior physician researcher at RAND, and colleagues identified 22,846 buprenorphine prescriptions written and filled during the study period. Overall, 71.5% of patients who filled an initial buprenorphine prescription from an emergency physician did not fill subsequent prescriptions from other clinicians. Moreover, rates of filled prescriptions decreased 3.5% after the COVID-19 public health emergency was declared.

While the American College of Emergency Physicians recommends a direct referral with a prescriber after a buprenorphine prescription is given in an ED, this strategy is only effective if local clinicians are accepting new patients on buprenorphine treatment, according to a RAND press release. However, research suggests that many buprenorphine-prescribing clinicians do not treat many patients or are not accepting new ones.

“There is substantial room for improvement to create a system of care that seamlessly transitions patients from the emergency setting to community treatment providers who can continue treatment,” Stein said in the release.

References:

Mauro PM, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.3821.

Most people who receive medication in emergency departments to treat opioid use disorder do not sustain the treatment. https://www.rand.org/news/press/2022/03/21.html. Published March 21, 2022. Accessed march 23, 2022.

Only 1 in 4 people needing treatment received medication for opioid use disorder in past year. https://www.publichealth.columbia.edu/public-health-now/news/only-1-4-people-needing-treatment-received-medication-opioid-use-disorder-past-year. Published March 23, 2022. Accessed March 23, 2022.

Stein BD, et al. Ann Emerg Med. 2022;doi:10.1016/j.annemergmed.2022.01.042.