As drug overdose deaths rise, far too few get life-saving medications, study warns

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New research warns that 9 out of 10 people with opioid use disorder fail to get life-saving medication. Photo courtesy of the U.S. Department of Agriculture

With U.S. drug overdose deaths continuing a dramatic rise, a new study warns that fully 90% of people with opioid use disorder fail to get life-saving medication.

While medications such as methadone, buprenorphine and extended-release naltrexone are proven to reduce opioid overdoses by more than 50%, the investigators said their new research indicates the vast majority — 86.6% — of people who have opioid use disorder are not receiving these evidence-based medicines.

And, the study points out, this is occurring even though the use of such medications has increased by more than 100% over the past decade.

That’s because the rise in treatment isn’t keeping pace with opioid abuse and overdose death rates, which are largely driven by fentanyl, a synthetic opioid up to 100 times stronger than morphine.

Findings from the study, led by researchers at New York University Grossman School of Medicine, were published Thursday in the International Journal of Drug Policy.

Even in states like Connecticut, Maryland and Rhode Island, which have the smallest gap between people with opioid use disorder and those who receive treatment for it, at least 50% of the people who could benefit from medications are still not getting them, researchers said.

The largest treatment gaps were found in Iowa, North Dakota and Washington, D.C.

The findings highlight the urgent need to remove barriers to getting these medications to the people who need them, said Noa Krawczyk, the study’s lead author.

Unfortunately, healthcare providers, as well as regulators, have been “resistant to change,” Krawczyk, assistant professor at the Department of Population Health’s Center for Opioid Epidemiology and Policy at NYU Langone, told UPI in an email.

This partially stems from stigma around addiction and medications to treat addiction, she said, explaining that “unfounded fears of methadone and buprenorphine diversion are often prioritized over making the medications more accessible, which is a huge disservice in light of the deadly illicit opioid supply that is out there.”

Also, Krawczyk maintained that for-profit treatment providers are looking to protect profits by limiting who can provide treatment and what treatment is provided.

For their analysis of opioid treatment gaps at the national and state levels from 2010 through 2019, the researchers used two databases, including one that tracks medications for opioid use disorder dispensed by licensed methadone clinics.

The second database, using outpatient pharmacy claims, tracks prescriptions filled for buprenorphine and extended-release naltrexone, which can be prescribed from a doctor’s office.

Krawczyk said she sees hopeful signs, including an increase in the use of medications for opioid use disorder over the past decade, essentially driven almost entirely by buprenorphine.

Between 2010 and 2019, methadone utilization, only available via opioid treatment programs, rose 39% in the United States, she said. But there was a 222% rise in buprenorphine utilization, which can be prescribed in office-based settings.

“What this tells us is that expanding [these medications] to office-based settings is effective at getting more people into treatment, although we have a lot more work to do of course to make such a system even more available and accessible than it currently is,” Krawczyk said.

Nationwide, more than 70% of residential treatment programs do not offer medications for opioid use disorder, she noted.

Krawczyk said access to treatment could be expanded by removing “special waiver requirements” so that more physicians can prescribe buprenorphine, as well as more widely disseminating the medicines via mobile health clinics and community-based organizations — and also within the criminal justice system.

Another long overdue step is making methadone more accessible, and not limiting its to distribution to highly regulated opioid treatment programs, she said.

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