Despite strong evidence that medication is the most effective treatment for opioid use disorder (OUD), adolescents and most adults with OUD treatment need reported a lack of medication for OUD in the past year, according to a study at Columbia University Mailman School of Public Health. Among those who may have needed opioid use treatment, only 28 percent received medication for OUD. Until now, national studies on medication for OUD were lacking and little was known about individual-level characteristics. The findings are published in JAMA Network Open.
“Our nationally representative research revealed critical gaps in treatment engagement and use of medication for opioid use disorder (MOUD). Increased efforts to address barriers to care are critically needed,” said Pia Mauro, PhD, assistant professor of epidemiology at Columbia Mailman School of Public Health, and the study’s lead author. “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 US did not receive this gold standard treatment.“
The findings were based on data from the 2019 National Survey on Drug Use and Health in the U.S. Participants were community-based, and data excluded people who were institutionalized or homeless not in shelters. The researchers identified adolescents and adult respondents who may benefit from medication for OUD defined as: meeting criteria for a past-year opioid use disorder, reporting past-year medication for OUD, or receiving past-year specialty treatment for opioid use.
The data showed that 57 percent received no treatment for the disorder, and 15 percent received only services without medication. Notably, adolescents (aged 12-17 years) did not receive MOUD in the past year and only 13 percent of adults 50 years and older received medication for the disorder. “Our findings support calls for additional MOUD engagement and retention strategies tailored for both adolescents,” noted Mauro.
Among adults, the likelihood of past-year MOUD receipt compared to no treatment was also lower for people aged 50 years and older, versus for those 18 to 25 years of age. “Our finding that a minority of adults and no adolescents received MOUD indicates substantial gaps in access,” observed Mauro. “These results provide critical evidence to inform national efforts needed to increase equitable access to MOUD.”
Nearly one-third of non-Hispanic white people in need of OUD treatment received medication, compared with approximately 20 percent of people identifying as non-Hispanic Black or multiracial groups and 15 percent of Hispanic people. In contrast, roughly similar proportions of each racial and ethnic group received non-medication services, revealing significant disparities specifically for access to medication treatment among people of color.
Medication for OUD was lower among women, more likely among adults with at least some college, and less likely in small metropolitan areas versus large metropolitan areas. While contacts with the health care system (85 percent) and criminal legal system (60.5%) were common, most people encountering these systems did not report receiving MOUD (29.5 percent and 39 percent, respectively).
Starting in 2020, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act mandated that Medicaid cover all three U.S. Food and Drug Administration–approved medications for OUD, including methadone in certified opioid treatment programs.
“Policies that expand Medicaid coverage for these medications is an important population-level strategy to potentially increase access to effective opioid use disorder treatment in the publicly insured population,” said Hillary Samples, PhD, assistant professor at the Rutgers School of Public Health and study senior co-author. “In any case, our findings provide further evidence that investments are needed to increase MOUD prescribing and referrals in ambulatory settings.”
Co-authors are Sarah Gutkind and Erin Annunziato, Columbia Mailman School of Public Health.
The study was supported by the National Institute on Drug Abuse grant numbers K01DA045224, K01DA049950, and T32DA031099.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
Journal
JAMA Network Open