Those with opioid use disorder, polysubstance use less likely to initiate MOUD treatment
Click Here to Manage Email Alerts
Individuals with opioid use disorder and polysubstance use were less likely to initiate treatment with buprenorphine and naltrexone than those without polysubstance use, according to a study published in JAMA Network Open.
“Despite a higher likelihood of treatment discontinuation and overdose, polysubstance use in individuals with opioid use disorder is understudied and undertreated,” Kevin Y. Xu, MD, MPH, of the health and behavior research center in the department of psychiatry at Washington University School of Medicine, and colleagues wrote.
Researchers sought to examine buprenorphine and naltrexone initiation among those diagnosed with opioid use disorder (OUD), with and without concurrent substance use disorder (SUD).
The observational comparative effectiveness study utilized insurance claims between 2011 and 2016 from United States IBM databases to find instances of medication initiation for OUD in 179,280 treatment-seeking individuals (50.5% male), aged 12 to 64 years, with a primary diagnosis of OUD.
Concurrent SUD was defined as being diagnosed concurrent with, or in the 6 months before OUD treatment initiation. Treatment was classified as psychosocial treatment without medications for opioid use disorder (MOUD), or initiation, buprenorphine or both extended-release and oral naltrexone. Data were analyzed from Feb. 3-26, 2021.
Results showed that 102,930 (57.4%) individuals received psychosocial treatment without MOUD. Among 47,488 individuals with concurrent SUDs, 33,449 (70.4%) did not receive MOUD, whereas in 131,792 individuals without concurrent SUDs, 69,481 (52.7%) did not receive MOUD.
Concurrent SUD was associated with diminished odds of initiating buprenorphine (RR, 0.55; 95% CI, 0.54-0.56) but increased odds of initiating naltrexone (extended release RR, 1.12; 95% CI, 1.05-1.20; oral RR, 1.95; 95% CI, 1.86-2.03).
“Targeted efforts are needed to expand access to MOUD in individuals with polysubstance use,” Xu and colleagues wrote.