78% of Adults with OUD Go Without Access to Addiction Treatment

Only a fifth of the nearly 2.5 million adults with opioid use disorder received medication for the disease 2021, leaving millions without access to addiction treatment, according to new data from the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC).

The report, published as a research note in JAMA Network Open, also showed sociodemographic health disparities in opioid use disorder treatment access, with Black people, women, individuals who were unemployed, and those in non-metropolitan areas being less likely to receive treatment.

The study looked particularly at medication-assisted treatment, or MAT, which is considered the gold standard in OUD therapy. Drugs like buprenorphine, methadone, and naltrexone have all proven effective for OUD treatment.

However, those medications are often out-of-reach to many who need them.

"Medications for opioid use disorder are safe and effective. They help sustain recovery and prevent overdose deaths," Nora Volkow, MD, director of the National Institute on Drug Abuse, the NIH subdivision that contributed to the study, said in a statement.

Using data from the 2021 National Survey on Drug Use and Health (NSDUH), the researchers found that around 2.5 million people over age 18 had an opioid use disorder within the previous year. That’s a startling number, the researchers suggested, and it’s made worse given that 75 percent of the 107,000 drug overdose deaths in 2021 were opioid-related.

But despite this growing opioid crisis, people are going without the care they need, the research team said.

Only about a third of those with OUD in 2021 got some sort of treatment for it, and only 22 percent received MAT for their OUD. That’s a pretty considerable care gap, the research team indicated.

"Failing to use safe and lifesaving medications is devastating for people denied evidence-based care,” Volkow asserted. “What's more, it perpetuates opioid use disorder, prolongs the overdose crisis, and exacerbates health disparities in communities across the country."

There were also steep sociodemographic health disparities at play, the data added. Of those who did receive access to MAT, 59 percent were men, 62 percent were over age 35, 58 percent were White, and 58 percent lived in large metropolitan areas. Folks getting MAT were also five times more likely to have moderate to severe OUD, which the researchers said was probably due to MAT’s efficacy with people with more serious illnesses.

This left Black people, women, individuals who were unemployed, and those living in non-metropolitan areas having no access to MAT. Particularly, Black people were 14 times less likely to get access to MAT than White people, while men were six times more likely than their female counterparts.

Meanwhile, those with full-time employment were 14 times more likely to gain access to MAT than those who were unemployed, and those in metropolitan areas were three times more likely than those in non-metropolitan areas.

Closing these disparities is an essential part of the overall mission to address drug overdose deaths, Christopher M. Jones, PharmD, MPH, DrPH, the director of the National Center for Injury Prevention and Control at CDC, said.

“It is not a matter of whether we should address health disparities and inequities that many racial/ethnic minority groups face when trying to access substance use treatment. We must address these issues if we hope to reverse the trend of increasing drug overdose deaths,” Jones noted in a statement. “Everyone should have the opportunity to be as healthy as possible and our goal is to help reduce health disparities and save lives.”

Interestingly, mode of care access made a slight difference in access to opioid treatment. Specifically, those who received substance use disorder treatment over telehealth were 38 times more likely to receive access to MAT than those who accessed care over other media.

This shows just how powerful telehealth has been in supporting patient access to evidence-based treatment, according to Wilson Compton, MD, MPE, a deputy director of NIDA.

“More than 80,000 people are dying of a drug overdose involving an opioid every year, while safe and effective medicines to treat opioid use disorder are sitting on the shelf unused,” Compton, one of the senior authors of the study, said in a press release. “This study adds to the growing evidence that telehealth services are an important strategy that could help us bridge this gap, supporting the delivery of safe, effective, and lifesaving care for people with opioid use disorder.”