May 12, 2022 - Health

Opioid abuse treatments don't reach those most at risk

Estimated number of U.S. drug overdose deaths
Data: CDC; Chart: Erin Davis/Axios Visuals

Drugs for treating opioid abuse aren’t reaching most high-risk patients, potentially widening gaps in care as overdose deaths hit record highs.

The big picture: New provisional data show a 15% surge in overdose deaths during the pandemic, rekindling a debate over whether enough Americans in the throes of the addiction crisis have access to potentially life-saving treatments.

Driving the news: Nearly 53% of patients with opioid use disorder were not prescribed buprenorphine, which reduces the risk of future overdoses, according to a new analysis of insurance claims from about 180,000 people.

  • More than 70% of opioid users who also misuse other substances, such as alcohol or methamphetamine, weren’t prescribed the drug, per the analysis in JAMA Network Open, which was based on data that predated the pandemic.
  • The analysis also found buprenorphine was better at helping prevent future overdoses than another commonly used addiction treatment, naltrexone.

What they’re saying: “This is equivalent to giving those with advanced cancer a less aggressive treatment,” said co-author Laura Bierut, a professor of psychiatry at Washington University.

  • “It seems obvious to many of us that we should be giving the most aggressive and effective treatments to those who are most seriously ill.”

Many doctors remain reluctant to prescribe buprenorphine for use at home without supervision. Some experts say there’s also a lack of data about the drug’s effectiveness in those who misuse multiple substances.

  • A 2020 VA study of veterans found a lower likelihood of buprenorphine treatment for patients with multiple substance use disorders.
  • The American Medical Association recommends other strategies, such as making the easy-to-use opioid overdose antidote naloxone available over-the-counter and legalizing the use of strips that test drugs for the synthetic opioid fentanyl, which remain illegal in about half the states.

Where it stands: The National Center for Health Statistics said at least 107,622 people died from overdoses in 2021 -- more than in any other year on record and a major increase from the estimated 93,655 deaths in 2020.

  • A growing number of deaths involve fentanyl, which is often mixed with other drugs, and the stimulant methamphetamine.
  • The Biden administration last month sent Congress its first national drug control strategy, which emphasizes addressing untreated addiction through harm reduction strategies and evidence-based treatments and clamping down on drug trafficking.
  • Harm reduction, which includes steps like expanded access to needle exchanges, has drawn controversy, as well as skepticism from health experts who say it won't make a major dent in overdose deaths.

The big question: It remains to be seen if the worsening addiction crisis leads to more prescribing of buprenorphine -- or a broader reevaluation of treatment strategies.

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