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In 2019, only 27.8% of American adolescents and adults who could potentially stand to benefit from treatment for opioid use disorder (OUD) reported receiving medication in the prior year, a cross-sectional study found.

In a weighted, nationally representative sample of more than 2 million people with OUD, medication uptake for OUD was relatively slow and unbalanced across ages and sociodemographic groups, Pia M. Mauro, PhD, of Columbia University Mailman School of Public Health in New York City, and colleagues reported in .

Compared with adults ages 18 to 25, people 50 and older were 86% less likely to receive OUD medication (adjusted relative risk ratio [aRRR] 0.14, 95% CI 0.05-0.41). The highest use observed was among adults ages 26 to 34 (42.3%), while only 13.2% of adults 50 and over with OUD reported receiving medication in the past year.

At the other end of the age spectrum, no adolescents (ages 12 to 17) received such medication, despite the approval of buprenorphine for those 16 years and older.

"Hesitancy about off-label prescribing for ages 12 to 15 years could contribute to underuse of MOUD [medication for OUD] in this population," the researchers noted. "Gaps in access could be worsened by specialty facilities with adolescent treatment programs being less likely to provide MOUD than facilities serving adults."

Interestingly, some people on the higher end of the income spectrum were less likely to receive such medication. Compared to individuals with an income of up to $19,999 per year, those whose income fell between $50,000 and $74,999 per year were 82% less likely to receive a potentially helpful treatment for OUD (aRRR 0.18, 95% CI 0.07-0.44), the researchers reported.

On top of that, people with at least some college (versus those with no more than a high school education) were more likely to receive medication for OUD rather than non-medication services and support. On the other hand, medication-based treatment for OUD was less likely to be given to people living in small metropolitan areas versus those in large metropolitan areas.

Of note, only 29.5% of individuals with past-year contact with healthcare (85% of the study population) received medication for OUD. Similarly, 39.1% of those who had contact with the criminal legal system received medication (60.5% of the study population).

"Our nationally representative research revealed critical gaps in treatment engagement and use of medication for opioid use disorder," Mauro explained in a statement, adding that this underscores the need for increased efforts to address barriers to care.

"Evidence supporting the effectiveness of medication for opioid use disorder such as methadone, buprenorphine, or naltrexone is unequivocal, but most people who needed OUD treatment in the U.S. did not receive this gold standard treatment," she added.

Her group pointed out that these medications for OUD have all been associated with reductions in OUD, longer treatment retention, as well as significantly reduced opioid-related death.

"Policies that expand Medicaid coverage for these medications [are] an important population-level strategy to potentially increase access to effective opioid use disorder treatment in the publicly insured population," suggested study co-author Hillary Samples, PhD, MHS, of the Rutgers School of Public Health in New Brunswick, New Jersey, in a statement.

"In any case, our findings provide further evidence that investments are needed to increase MOUD prescribing and referrals in ambulatory settings," she added.

Data for the analysis came from the 2019 National Survey on Drug Use and Health in the U.S., including 2,206,169 community-based, noninstitutionalized adolescent and adults deemed as possibly benefiting from medication for OUD. This was defined as either meeting the criteria for a past-year OUD, reporting past-year medication for OUD use, or receiving past-year specialty treatment for opioid use in the last or current treatment episode.

Of the sample, 55.5% were male, 8% were Hispanic, 9.9% were Black, and 74.6% were white. A total of 56.8% had past-year prescription OUD and 80.0% had one or more co-occurring substance use disorders.

One limitation to the study, the researchers said, was an inability to differentiate between the types of OUD medications people did receive, such as who received methadone versus buprenorphine.

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