Utilization of Medications for Opioid Use Disorder Across US States: Relationship to Treatment Availability and Overdose Mortality

Abstract

Objective: Availability of medications for opioid use disorder (MOUD) remains sparse. To date, there has been no national, state-by-state comparison of patient MOUD utilization relative to treatment availability and burden of overdose deaths. We aimed to quantify, for each state, the number of MOUD patients relative to (1) office-based buprenorphine providers and opioid treatment programs (OTPs) and (2) overdose deaths. Methods: We conducted a spatial analysis of patients receiving MOUD from OTPs or buprenorphine providers in March 2017 across all 50 states and Washington, DC. For each state, we calculated the number of patients receiving MOUD from OTPs and buprenorphine prescriptions, relative to available OTPs and buprenorphine providers; as well as ratios of number of patients receiving MOUD relative to overdose deaths. Results: In March 2017, 942,368 patients attended an OTP (410,288) or received a buprenorphine prescription (486,318). Patient to OTP ratio was highest in West Virginia, Delaware, Washington, DC, New Jersey, New Hampshire, Connecticut and Ohio, ranging from 91 to 193 patients per OTP in the first quintile to 430 to 648 in the fifth. Patient to buprenorphine provider ratio was highest in Kentucky and West Virginia, ranging from 3 to 7 patients per provider in the first quintile to 19 to 28 in the fifth. Median MOUD patients per overdose death was 21 (IQR:14.9-28.2). Of high overdose states, Washington, DC, New Jersey, and Ohio had the smallest number of patients on MOUD relative to deaths.Conclusions: High patient volume relative to treatment availability in overdose-burdened areas may indicate strain on MOUD providers and OTPs. Promoting greater utilization while expanding MOUD providers and programs is critical.

A randomized, sham-controlled, quintuple-blinded trial to evaluate the NET device as an alternative to medication for promoting opioid abstinence

“…The trial design was predicated on observations that, despite the established efficacy of MOUDs, some patients choose to discontinue medication [ [26] , [27] , [28] , [29] , [30] , 58 ] and many treatment facilities under-utilize MOUD treatment [ 59 ]. Also, some patients seek non-pharmacological treatment options [ [23] , [24] , [25] ], and there is growing scientific interest in the potential value of developing medical devices for treating OUD [ 60 ]. To provide alternative options to patients, ethically-responsible controlled trials are needed to evaluate the efficacy of medical devices while allowing use of medications (e.g.…”

“…Despite these enormous problems, OUD treatment participation is unacceptably low: fewer than 15% of persons with OUD in the US currently receive treatment [ [16] , [17] , [18] ]. Food and Drug Administration (FDA)-approved medications for OUD (MOUD) are effective for promoting retention and abstinence among many but not all persons seeking pharmacotherapy; however, due to several barriers [ [19] , [20] , [21] , [22] ], rates of MOUD utilization are low [ [23] , [24] , [25] ]. Furthermore, a non-trivial proportion of patients entering OUD treatment express reservations about MOUD (e.g.…”

History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder

“…These data suggest that approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it ( Krawczyk et al., 2022 ). Many factors may contribute to suboptimal MOUD use including shortage of MOUD treatment providers and programs, especially in remote and rural areas ( Haffajee et al., 2019 ; Langabeer et al., 2019 ), waivered providers not prescribing at all or to their maximum capacity ( Duncan et al., 2020 ; Krawczyk et al., 2021 ), stigma harbored and communicated by providers that undermines patients’ engagement in treatment, and lack of integrated systems of care ( Jones et al., 2021 ).…”

Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program

“…1,2 Yet opioid agonist treatment (OAT) for OUD is underutilized in the United States. [2][3][4][5][6][7] Moreover, many individuals who enter MTD experience difficulty achieving or maintaining opioid abstinence. Although abstinence is not always the primary goal of treatment, some clinic policies can result in patients being involuntarily discharged from care, a clinical decision that contrasts with managing other chronic conditions (eg, diabetes).…”