Most People in the US With Opioid Use Disorder Do Not Receive Medication for Its Treatment

A significant gap in care between opioid use disorder (OUD) and access to medications for opioid use disorder (MOUD) persists in the United States, according to results of a study published in the International Journal of Drug Policy.

Investigators at the NYU Grossman School of Medicine sourced OUD data from the US National Survey on Drug Use and Health (NSDUH) and MOUD data from the National Survey of Substance Abuse Treatment Services (NSSATS) and the IQVIA LRx database.

The rates of past-year OUD among individuals aged 12 years and older were 830.3 per 100,000 in 2010, 855.9 per 100,000 in 2014, 901.1 per 100,000 in 2015, and 618.0 per 100,000 in 2019.

From 2010 to 2019, the rate of receipt of MOUD increased by 105.6%. From 2018 to 2019, the rate of receipt of MOUD increased by 4.9%. The rate of MOUD dispensed in opioid treatment programs or from pharmacies increased from 177.8 per 100,000 in 2010 to 365.4 per 100,000 in 2019.

Comparing past-year OUD with past-year MOUD receipt, 95.1% of individuals with OUD did not receive MOUD in 2010 compared with 86.6% in 2019.

At the state level, the prevalence of past-year OUD in 2019 was highest in Washington, DC (adjusted rate, 8100 per 100,000) and lowest in Minnesota (adjusted rate, 751.8 per 100,000). The rate of receipt of MOUD in 2019 was lowest in South Dakota (66.1 per 100,000) and highest in Vermont (1342.6 per 100,000).

Using a multiplier-adjusted OUD prevalence estimation approach, the largest gap in care between OUD and receipt of MOUD was observed in Iowa in which 97.3% of individuals with OUD did not receive MOUD, followed by North Dakota (96.1%) and Washington DC (95.1%); the smallest gap in care was observed in Connecticut (53.9%), Maryland (58.1%), and Rhode Island (58.6%).

In sensitivity analyses, the trends tended to lie between the adjusted and unadjusted rates found in the main analysis.

The main limitation of this study was the inherent difficulty in estimating the true prevalence of OUD and MOUD, as the surveys used tend to miss important populations.

Study authors concluded that although there has been a large increase in the use of MOUD in the United States, a significant gap in care remains. The COVID-19 pandemic has led to policy changes that have allowed individuals to have more flexible access to MOUD and may be an initial step in expanding access to these treatments. However, “[O]ur research and health systems have a long way to go in addressing the needs of people with OUD to support retention in treatment and services to effectively reduce overdose and improve long-term health and well-being.”