番茄社区

Only about a quarter of adults who needed treatment for opioid use disorder (OUD) received recommended medications, survey data showed.

In 2022, the National Survey on Drug Use and Health (NSDUH) found that 3.7% of U.S. adults -- approximately 9.4 million people -- needed OUD treatment. Of those, 55.2% received any treatment, and 25.1% of adults received medications for opioid use disorder (MOUD), reported Deborah Dowell, MD, of the CDC's National Center for Injury Prevention and Control in Rockville, Maryland, and co-authors in (MMWR).

Many adults who needed OUD treatment by clinical criteria didn't perceive the need for it (42.7%) or obtained treatment that did not include medication (30%), the authors noted.

A higher share of white adults received any OUD treatment than Black/African American or Latino adults (60.3%, 43.8%, and 45.7%, respectively). Women were less likely to receive medication (51.0% vs 39.5% among men). More adults ages 35-49 years (68.4%) received medication than those ages 18-34 or ≥50 (range 19.9%-44.1%).

"These findings underscore disparities in treatment and a need to increase use of medications for OUD," wrote Dowell and team.

Medications to treat opioid addiction can reduce the risk of overdose deaths but are vastly underused, Dowell and colleagues noted. The year studied -- 2022 -- was the most deadly ever for opioid overdoses, with 81,806 deaths in the U.S. alone, they pointed out.

"Given the high burden, morbidity, and mortality of OUD, it is important that all clinicians become familiar with the medications to treat OUD and that these medications become a routine part of medical practice," wrote the CDC's M. Allison Arwady, MD, MPH, and co-authors in a article that cited the MMWR study. Arwady was not affiliated with the study, although one co-author was.

For a range of reasons, some clinicians who see patients seeking care for OUD may encourage detoxification without helping patients receive approved OUD medications, which include methadone, buprenorphine, and extended-release naltrexone, Arwady and colleagues noted. This approach has a higher treatment failure rate and is associated with increased mortality compared with MOUD, they observed.

"Given the dramatic rise of illegally made fentanyl and fentanyl analogs, and increases in deaths involving more than one substance, all prescribers, not just those in addiction-centric specialties, can play a more active role in treating individuals with OUD," they added.

By implementing a "cascade of care" framework outlined in the JAMA article,"[w]e can work to ensure that all patients with OUD know their diagnosis, are connected to harm reduction approaches including naloxone, and can access evidence-based treatments that include medications for OUD and recovery support," Arwady's group wrote.

The NSDUH study was based on 2022 survey data and included in-person and online interviews with 56,610 community-dwelling adults.

The need for OUD treatment was defined by meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for either mild or moderate OUD (two to five symptoms), severe OUD (six or more symptoms), or by receiving OUD treatment during the prior year.

Groups with a greater need for OUD treatment included those who did not attend college, weren't employed, or had ever been arrested. The need for treatment was higher among poorer adults, and in people who in the prior year had a mental illness (9.0%), used illicit drugs apart from opioids (7.6%) or marijuana (7.0%), misused stimulants (20.7%) or opioids (35.9%), or had a non-opioid substance use disorder (10.4%).

Compared with the general adult population, the percentage of adults who received any OUD treatment was higher among those with jobs (63.1%), who had ever been arrested and booked (66.3%), and who had used illicit drugs apart from opioids (61.2%). The percentage of adults who received OUD treatment was also greater among adults with severe OUD versus mild/moderate OUD (53.0% vs 20.5%).

The number of people needing OUD treatment was likely an underestimate because the survey was done in households, the researchers acknowledged. The only unhoused individuals included in the study were those in shelters; adults in jails or other institutions were excluded.

In addition, survey response rates were lower in 2021 and 2022 than in prior years, which may have influenced results.

Comment