20% of people with opioid use disorder get medication, study shows

Another study found cost is a major continuation factor

Key takeaways:

• In 2021, 35.6% of adults with opioid use disorder received any treatment and 22.3% received medication.
• For those who did get medication, higher out-of-pocket costs were linked to higher discontinuation rates.

In the United States, about one in five adults with opioid use disorder received medication as treatment in 2021, according to the results of research published in JAMA Network Open.

“OUD is a chronic but treatable condition,” David Broder, DO, an osteopathic physician specializing in internal medicine and member of the American Osteopathic Association who was not affiliated with the study, told Healio. “Yet, despite guidelines recommending medication for OUD, 80% of affected people in the year studied remained untreated. This number was even higher for certain demographic groups such as women, Black adults and people in nonurban areas.”

Meanwhile, another study published in JAMA Internal Medicine found that out-of-pocket (OOP) costs can be a factor in receiving medication for opioid use disorder (MOUD), with higher costs being linked to a higher risk for discontinuation.

Estimated MOUD prevalence in 2021

Christopher M. Jones, PharmD, DrPH, MPH, director of the National Center for Injury Prevention and Control at the CDC, and colleagues wrote that many patients who have opioid use disorder (OUD) do not receive MOUD like buprenorphine, extended-release naltrexone and methadone.

“Data on the national prevalence of MOUD receipt among persons with OUD in the U.S. are limited,” they wrote. “One study using 2019 data among individuals with OUD based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria found 27.8% received MOUD in the past year.”

However, strategies like expanding telehealth were implemented during the COVID-19 pandemic to increase the availability of MOUD. So, Jones and colleagues sought to “provide the latest estimates of MOUD receipt” among adults with OUD in the U.S. To do so, they conducted a cross-sectional study using data from 47,291 adults who participated in the 2021 National Survey on Drug Use and Health.

The researchers found that approximately 2.5 million adults (95% CI, 2-2.9 million) had past-year OUD. Among them:

• 67.4% (95% CI, 60.1-73.9) were aged 35 years or older;
• 60.6% (95% CI, 51.8-68.9) were white;
• 52.5% (95% CI, 43.5-61.4) were men; and
• 52% (95% CI, 42.6-61.3) lived in large metropolitan areas.

Of those who had past-year OUD, 35.6% of adults (95% CI, 27.6-44.4) received any past-year treatment, and just 22.3% (95% CI, 15.2-31.5) received MOUD. In the latter group, the researchers reported that 61.7% (95% CI, 43.1-77.4) were aged 35 years or older, 67.1% (41.3-85.6) were white, 58.5% (95% CI, 38.3-76.3) were men and 57.7% (95% CI, 34.3-78) lived in large metropolitan areas.

The odds for receiving MOUD were lower among Black adults (adjusted OR = 0.07; 95% CI, 0.02-0.22), those who were unemployed (aOR = 0.07; 95% CI, 0.01-0.58), women (aOR = 0.17; 95% CI, 0.04-0.71), those who had past-year cannabis use disorder (aOR = 0.17; 95% CI, 0.04-0.76) and those living in nonmetropolitan areas (aOR = 0.31; 95% CI, 0.1-0.99).

In contrast, the odds for receiving MOUD were greater in patients who received substance use treatment through telehealth in the past year (aOR = 37.78; 95% CI, 7.61-187.6).

“Consistent with prior research, receipt of telehealth treatment for substance use was associated with increased likelihood of MOUD receipt. This finding underscores the growing role telehealth can play in connecting patients with OUD to care,” Jones and colleagues concluded. “Our findings suggest that MOUD remains substantially underused. Future research should examine whether removal of the X-waiver in the U.S. in 2023, along with other efforts to expand MOUD, will help close the treatment gap.”

To date, Broder said that “it remains to be seen” whether the X-waiver removal will increase the rate of OUD treatment.

“Substance abuse disorders cause serious physical and mental morbidity and mortality as well as significant economic costs to society,” he said. “America needs to approach OUD from multiple medical, legislative and educational perspectives.”

Out-of-pocket costs

Ashley A. Leech, PhD, MS, an assistant professor at Vanderbilt University School of Medicine’s Department of Health Policy, and colleagues investigated the connections between OOP costs for a patient’s initial buprenorphine prescription and buprenorphine discontinuation within 1 year among adults in the U.S. who were commercially insured.

The cohort study included data from the MarketScan Commercial Claims Database on 40,035 people aged 18 to 64 years who initiated buprenorphine between April 1, 2013, and Dec. 31, 2020.

The researchers found that 22% of patients continuously used buprenorphine during the yearlong follow-up period and 6% swapped to naltrexone.

Each quartile of higher costs was linked to an increasingly higher risk for buprenorphine discontinuation compared with the lowest quartile of OOP costs, which ranged from $0 to $0.71. The second quartile, ranging from $0.72 to $1.84, had an adjusted HR of 1.09 (95% CI, 1.06-1.13). The third quartile, ranging from $1.85 to $4.27, had an aHR of 1.18 (95% CI, 1.13-1.22), and the fourth, ranging from $4.28 to $97.5 had an aHR of 1.34 (95% CI, 1.29-1.39).

Additional risk factors the researchers observed were having physical comorbidities, having other substance use diagnoses, younger age, living in the Western region rather than the North Central region and starting medication in any month besides January.

The researchers noted that “the findings might not generalize to other insured or uninsured populations.” However, they concluded that policies that address “patient-level hurdles within the OUD cascade of care may prevent lasting impact on adverse health outcomes associated with OUD.”

“The Patient Protection and Affordable Care Act’s preventive drug list mandates private insurance plans cover recommended preventive services without patient cost-sharing,” they wrote. “Adding OUD medications to this list could alleviate lasting consequences of the opioid crisis. This approach alongside other state-level, supply-side initiatives (eg, relaxing clinician scope of practice limits and caps on refills) could optimize benefits of sustained OUD therapy.”

References:

• Jones CM, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.27488.
• Leech AA, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.2826.