Rates of substance abuse treatment remain low for opioid use disorders despite their rapidly rising incidence
While the greatest increases occurred in inpatient treatment and at physicians' offices, medication-assisted treatments were often unavailable in inpatient settings.
Treatment rates remained low for individuals with opioid use disorders from 2004 to 2013, even as nonmedical use of opioid analgesics and heroin increased substantially during the same span, according to a study.
Researchers used data from the National Survey of Drug Use and Health, a nationally representative annual survey of individuals age 12 years or older, and in-person interviews to identify individuals with opioid abuse or dependence symptoms and to determine whether they received treatment for opioid use disorders in the prior 12 months. The sample was divided into two 5-year periods (2004-2008 and 2009-2013). 2008 marked the passage of the Mental Health Parity and Addiction Equity Act, which required group health plans and health insurers to ensure that financial requirements (such as co-pays or deductibles) and treatment limitations (such as visit limits) for mental health or substance use disorders were no more restrictive than those applied to other medical benefits.
The study results appeared in a research letter in the Oct. 13 JAMA.
There were 6,770 respondents with opioid use disorders. In an unadjusted analysis, the percentage of individuals with opioid use disorders receiving treatment was 16.6% in 2004-2008 and 21.5% in 2009-2013 (difference, 5.0 percentage points; 95% CI, 1.5 to 8.4 percentage points; P=0.005). Regression-adjusted rates were similar (18.8% in 2004-2008 vs. 19.7% in 2009-2013), and the difference was not statistically significant (0.8 percentage point; 95% CI, −2.3 to 4.0 percentage points; P=0.59).
The mean number of settings visited for treatment (such as a hospital, inpatient or outpatient clinic, emergency department, doctor's office, or jail) increased from 2.8 in 2004-2008 to 3.3 in 2009-2013 (difference, 0.5; 95% CI, 0.1 to 0.8; P=0.007). The most common setting in both periods was self-help groups, which did not significantly change.
Use of inpatient treatment increased from 37.5% in 2004-2008 to 51.9% in 2009-2013 (difference, 14.4 percentage points; 95% CI, 4.4 to 24.5 percentage points; P=0.005), and office-based treatment increased from 25.1% to 34.8% (difference, 9.7 percentage points; 95% CI, 0.5% to 18.8 percentage points; P=0.04). Adjusted treatment setting differences were consistent with unadjusted differences.
“Individuals in treatment received care in more settings, with the greatest increases in inpatient treatment and at physician's offices. Although physician's offices may provide access to buprenorphine, medication-assisted treatments are often unavailable in inpatient settings, which could hinder patient recovery,” the authors wrote.