Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis

Abstract

Objectives To determine treatment seeking behaviour in those with opioid use disorder (OUD) in the high-income countries. Methods Five databases were searched in November 2019 for quantitative studies that reported OUD treatment seeking behaviour. Data analysis involved determining an overall pooled proportion estimate of treatment seeking behaviour for the two base groups, lifetime treatment and past 12-month or less treatment using the IVhet effect model. Subgroup analysis included heroin OUD, prescription OUD and general OUD. The sensitivity analysis included removal of outliers, separating adults and adolescents and the metaXL sensitivity analysis (studies are excluded if outside the pooled proportion confidence interval of the base case). Systematic review Prospero database registration number [CRD42020159531]. Results There were 13 quantitative studies included in the systematic review, with all studies being from the United States of America (USA). IVhet models showed that 40% (95% CI: 23%, 58%) and 21% (95% CI: 16%, 26%) sought treatment in their lifetime and past 12 months respectively. Sub-group analysis found that lifetime treatment seeking for prescription OUD, 29% (95% CI: 27%, 31%), was less than for heroin plus combined OUD, 54% (95% CI: 26%, 82%). Most of the pooled results had high heterogeneity statistics except for results of lifetime treatment seeking for prescription OUD and past 12-month treatment seeking for prescription OUD. Conclusion All included studies in this meta-analysis were from the USA and indicate modest levels of treatment seeking for those with OUD. In particular, this review found that in the USA one in five people with OUD sought OUD treatment in the previous 12 months and two in five people with OUD sought OUD treatment in their lifetime. Further research is urgently required to explore the barriers and facilitators that can improve this low treatment seeking in those with OUD.

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

“…Table 1 outlines key input parameters for the base case and comparison strategies . We initialized the model with a cohort of individuals reflecting the age and gender of the US population who inject opioids (informed by the US Census and literature) .…”

“…Table 1 outlines key input parameters for the base case and comparison strategies. 27 , 51 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 We initialized the model with a cohort of individuals reflecting the age and gender of the US population who inject opioids (informed by the US Census and literature). 28 , 29 , 30 , 31 , 32 , 33 , 34 We chose the largest cohort size of 2.25 million to produce stable model runs.…”

“… 74 For the status quo strategy, we assumed that all patients with OUD would be referred to an offsite addiction specialist for buprenorphine. Each referred individual had a 21% weekly probability of presenting for care, 54 and those who presented to addiction care had a 30% probability of accepting buprenorphine. 27 For the BUP and BUP plus HR strategies, we assumed 100% of PCPs would offer buprenorphine at their visits, but patients had a 30% probability of accepting it.…”

Illegal synthetic opioids: Can Europe prevent a crisis?

“…Expand treatment capacity. Because opioid use produces pleasurable effects for the consumer, many longterm users are ambivalent about entering treatment (Hall et al, 2021a;Hall et al, 2021b;Roberts et al, 2011). If overdoses soar, that may motivate more to seek treatment.…”

Substance Use Disorder in Young Adults Across the United States

“…A metaanalysis study conducted in the U.S. shows only 3 in5 of those with OUD seek relief treatment (1 in5 in the first 12 months and 2 in5 during their lifetime). 51 In scenarios of a user experiencing withdrawal, irritation and emotional irregularities prove evident with significant rates of self harm notable in OUD patients (around 10/100). 52,53…”