Only 1 in 5 opioid addicts received medication, federal study finds

Just one in five adults addicted to opioids such as fentanyl received medications to treat their cravings, a federal study has found.

Researchers from the Centers for Disease Control and Prevention and the National Institutes of Health collaborated on the study, published Monday in JAMA Network Open.

They found that 22% of an estimated 2.5 million adults with opioid use disorder in 2021 received medical prescriptions for methadone, buprenorphine or extended-release naltrexone to ease their dependencies. Only 36% received any treatment at all.

“Failing to use safe and lifesaving medications is devastating for people denied evidence-based care,” said Dr. Nora Volkow, director of the NIH’s National Institute on Drug Abuse. “What’s more, it perpetuates opioid use disorder, prolongs the overdose crisis, and exacerbates health disparities in communities across the country.”

According to the CDC, nearly 107,000 people died of a drug overdose in 2021 and 75% of those deaths involved an opioid.

Fentanyl, a powerful synthetic opioid that depresses the central nervous system, has fueled a decade-long surge in drug overdose deaths that worsened during COVID restrictions.

In legal form, doctors prescribe fentanyl as a painkiller that is 50 to 100 times more potent than morphine. Counterfeit pills have increasingly flooded U.S. streets from China since 2013, along with illicit fentanyl powder manufactured in Chinese and Mexican drug labs with Chinese chemicals.

According to the study, those who received substance abuse treatment from a psychiatrist or another doctor by video or phone were about 38 times more likely to receive medications for opioid addictions than those who did not.

“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,” said Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse and senior author of the study.

The researchers also found that Black adults, women, the unemployed and residents of rural areas were less likely than others to receive medication for opioid addictions.

They reported that 59% of those who received medication were men, 62% were at least 35 years old, 58% were White and 58% lived in large metropolitan areas.

White adults were 14 times more likely to receive medications for opioid use disorder than Black adults. Men were six times more likely than women, people with full-time jobs were 14 times more likely than the unemployed, and those living in large metropolitan areas were three times more likely than those living in rural areas.

“Everyone should have the opportunity to be as healthy as possible and our goal is to help reduce health disparities and save lives,” said Christopher M. Jones, director of the CDC’s National Center for Injury Prevention and Control.

Officials not involved in the study said the findings confirm that doctors under-prescribed medication for opioid addicts, despite widespread bipartisan support.

“We have known that medication-assisted treatment is the standard of care for opioid use disorder for a number of years now,” said Katy Talento, an epidemiologist who served as President Trump’s top health advisor at the White House Domestic Policy Council before the pandemic.

“Policy makers need to take a hard look at why those dollars aren’t getting to our most vulnerable populations and take responsibility for preventing more unnecessary deaths,” she said.

Recovery is “attainable and sustainable” since the Food and Drug Administration has approved opioid addiction medications for use, said Christopher Garrett, a spokesperson for the Substance Abuse and Mental Health Services Administration, part of Health and Human Services.

“At a time of unprecedented overdose deaths, primarily related to illicitly manufactured fentanyl, medications for opioid use disorder save lives,” Mr. Garrett said in an email.

According to the study, doctors normally prescribe medication only for severe opioid addictions. The study found adults with severe opioid use disorder were five times more likely to receive medications than those with mild-to-moderate cases.

The study notes that Congress amended the Controlled Substances Act this year, eliminating red tape that prevents patients from receiving the drugs. Further research must show whether that step closes the treatment gap, the researchers noted.

There are “multiple reasons” why U.S. doctors have been slow to prescribe the drugs, said psychologist Keith Humphreys, a Stanford University addiction researcher who tracks the opioid crisis.

“Some addicted people live in rural areas where there are no doctors who prescribe these drugs,” Mr. Humphreys told The Times.

“Some doctors don’t prescribe because the reimbursement rate in their state is too low or because they do not want to interact with addicted people,” he said. “Some doctors would like to prescribe but do not feel confident doing so because they have no training in addiction medicine.”