Barriers persist to accessing substance use disorder treatment despite greater need
Key takeaways:
- The prevalence of individuals who needed SUD treatment increased from 8.2% in 2013 to 17.1% in 2023.
- However, the percentage of individuals receiving treatment decreased from 9.3% in 2013 to 6.5% in 2020.
Although the prevalence of substance use disorder increased during the COVID-19 pandemic, the receipt of treatment declined before rebounding, according to a research letter published in JAMA Network Open.
Moreover, almost 6% of individuals who did not receive treatment perceived a need for such treatment, underscoring persistent barriers in accessing this care.
“Health care providers in both primary and specialty care need to be cognizant of the continuing substance use disorder (SUD) crisis and make the best possible efforts to address the critical barriers being faced by these individuals in receiving treatment themselves or by referrals,” Milap C. Nahata, PharmD, MS, director of the Institute of Therapeutic Innovations and Outcomes and professor emeritus of pharmacy, pediatrics and internal medicine at The Ohio State University Colleges of Pharmacy and Medicine, told Healio.
To describe SUD treatment needs, receipt and barriers between 2013 and 2023, Nahata and colleagues analyzed cross-sectional data from National Survey on Drug Use and Health (NSDUH) annual reports.
The analysis included 657,583 noninstitutionalized individuals in the U.S. aged 12 years or older.
Overall, the prevalence of individuals who needed SUD treatment increased from 8.2% in 2013 to 17.1% in 2023.
This increase corresponded with increased prevalence of AUD, from 6.6% to 10.2%; drug use disorder, from 2.6% to 9.6%; and OUD, from 0.8% in 2016 to 2% in 2023.
“These increases in prevalence since 2020 may partially reflect the shift from DSM-IV to DSM-5 criteria, known to increase prevalence estimates by 1.6- to 2.6-fold compared with DSM-IV,” Ligang Liu, PharmD, lead study author and postdoctoral scholar in the Institute of Therapeutic Innovations and Outcomes at The Ohio State University College of Pharmacy, told Healio. “Nevertheless, the continued increase in prevalence after 2020 still holds significance in highlighting the continuing public health crisis of SUD.”
However, the proportion of individuals receiving SUD treatment decreased from 9.3% in 2013 to 6.5% in 2020, rebounding to 14.9% in 2022 and stabilizing thereafter.
Specifically, AUD treatment decreased from 6.3% in 2013 to 4.3% in 2020, then increased to 7.6% in 2022. Similarly, drug use disorder treatment decreased from 13.4% in 2013 to 7.1% in 2020, then increased to 13.1% in 2022.
OUD treatment, on the other hand, increased from 11.2% in 2020 to 22.1% in 2021, but decreased to 18.3% in 2022.
According to Nahata and colleagues, no more than 5.7% of participants with SUD who did not receive treatment had a perceived need for treatment and 2.7% perceived a need for and made efforts in seeking treatment.
Participants indicated that the main reasons for not receiving treatment included reluctance to stop substance use, insufficient health care coverage, lack of awareness about treatment programs, negative impacts on employment and community perceptions, according to the researchers.
“We were very surprised to learn that while the need for treatment of substance use disorders more than doubled, less than 15% received the treatment,” Nahata told Healio. “Equally concerning was the fact that among those who did not receive the treatment, less than 6% perceived a need for treatment and less than 3% made efforts to seek treatment.”
The researchers acknowledged that limitations of the study included its reliance on self-reported data and methodological changes in the NSDUH, including the transition from DSM-IV to DSM-5 in 2020, the expanded OUD assessment in 2021, and revised definitions of treatment receipt and perceived need in 2022.
“There is an urgent need to conduct studies to determine which interventions would be most successful in removing existing treatment barriers and enhancing access and receipt of evidence-based treatment to achieve the desired outcomes,” Nahata said.
For more information:
Milap C. Nahata, PharmD, MS, can be reached at nahata.1@osu.edu.
Ligang Liu, PharmD, can be reached at liu.10645@osu.edu.