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The U.S. opioid abuse epidemic wages on, and overdose deaths continue to rise, yet just 1 in 5 people receives potentially lifesaving medication such as methadone, buprenorphine or naltrexone to treat their addiction, a new study finds.
“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,” said study author Dr. Wilson Compton.
“Despite the availability of medication, the vast majority of people with opioid use disorder are not using medications that could help treat this serious health disorder," added Compton, deputy director of the U.S. National Institute on Drug Abuse.
About 2.5 million people aged 18 and older had opioid use disorder in the prior year, and nearly 107,000 people died of a drug overdose in 2021, with 75% of those deaths involving an opioid. Despite these statistics, only 36% received any substance use treatment, and only 22% received medications for opioid use disorder, the survey showed.
Some groups were much less likely to receive medication for opioid use disorder, including Black adults, women, unemployed people, and those who lived in nonmetropolitan areas.
Specifically, white adults were 14 times more likely to receive medications for opioid use disorder than Black adults, and men were six times more likely than women.
Medications for opioid use disorder are most often prescribed to people with moderate-to-severe opioid use disorder. Adults with severe opioid use disorder were five times more likely to receive medications for opioid use disorder compared to those with mild opioid use disorder, the survey showed.
There's always the risk of a fatal overdose if folks don't get help in time.
During the COVID-19 pandemic, the federal government relaxed some of the regulations around telemedicine, and it improved access to medications for opioid use disorder. Folks receiving substance use treatment via telehealth were approximately 38 times more likely to receive medications for opioid use disorder compared to those who did not receive treatment via telehealth.
“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,” Compton said.
There are other ways to remove barriers to these medications, he noted. “Providing additional financing to states is a very important tool to improve access to medication,” he said. Mobile methadone clinics bring these medications to where they are needed most and can also boost access.
Doctors no longer need a specific waiver, known as the X-waiver, to prescribe buprenorphine (Buprenex) to treat opioid use disorder, which should also result in greater access to this medication, Compton said.
“If you have a loved one with opioid use disorder, make sure you always have naloxone [Narcan] on hand to treat an overdose,” he said. This will soon be available without a prescription.
The study is published in the Aug. 7 issue of JAMA Network Open.
Unfortunately, the new findings don't surprise Dr. Sarah Wakeman. She is the medical director for substance use disorder at Mass General Brigham in Boston.
“Despite this being the worst overdose epidemic in history and having medications readily available to treat opioid addiction, too few people receive medications for opioid use disorder, and there are ongoing and worsening disparities in who receives them,” said Wakeman. She wasn't involved in the new study.
There are many reasons that people aren't receiving these medications, including the stigma associated with their use, lack of education and training among health care providers, and laws in some states, Wakeman said.
How can more people access these medications? “Removing the X-waiver is a wonderful thing, but our efforts need to be multi-pronged,” she said. “We need to make treatment available and ready the moment a person comes in the door.”
Pregnant women may pose special concerns. Buprenorphine is considered safe for women during pregnancy, but some states will report women to child abuse services if they are taking the medication when they deliver.
“It is the best treatment during pregnancy, but these laws have a chilling effect,” Wakeman said.
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
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