Opioid use disorder treatment is not consistent around the nation

© M.Rode-Foto - stock.adobe.com

As opioid overdose deaths climbed in in recent years, treatment was not consistent around the nation.

Fewer than half the people diagnosed with opioid use disorder (OUD) received medications to treat it, according to a new national study of Medicaid, which covers health care for more than 90 million people in the United States.

The original investigation, “State- and County-Level Geographic Variation in Opioid Use Disorder, Medication Treatment, and Opioid-Related Overdose Among Medicaid Enrollees,” was published in JAMA Health Forum. The study covered adults in 46 states, Washington, D.C., and Puerto Rico for 2016, 2017, and 2018.

“We fail people by not providing adequate treatment to people with opioid use disorder enrolled in Medicaid,” lead author Stephan Lindner, PhD, said in a news release. Lindner is associate professor in the Oregon Health & Science University (OHSU) Center for Health Systems Effectiveness.

About 10 million people misused opioids in 2019 and deaths climbed from 51,000 that year to 81,000 in 2021. The authors noted “opioid use remains an urgent public health problem,” but “the severity of the crisis has varied substantially across the country.”

Medicaid provides health care coverage to more than 90 million Americans covers an estimated 40% of people with opioid use disorder, but research on treatment has been limited, the study said.

Now, evidence strongly suggests that medication should be the nearly universal treatment for people with opioid use disorder, coauthor Dennis McCarty, PhD, said in the news release. McCarty is professor emeritus of public health in the OHSU School of Medicine and the OHSU-Portland State University School of Public Health.

The researchers found wide variability in access to medication for opioid use disorder.

The medication treatment prevalence for Medicaid enrollees was 55.2%.

Regionally, in some Northeast states, up to 75% of patients covered by Medicaid and diagnosed with opioid use disorder received buprenorphine, methadone, or naltrexone, the three medications approved by the U.S. Food and Drug Administration for treatment. In contrast, among Medicaid recipients living in the Midwest and the South, fewer than 25% of individuals diagnosed with opioid use disorder received one of the treatment medications.

At the state level, medication treatment rates ranged from 17.7% in Kansas to 82.8% in Maine. Oregon, the researchers’ home state, fell roughly in the middle, with a rate of 61%.

Regarding treatment options and availability, the researchers noted patients may have personal barriers, such as stigma, shame, or lack of trust in the health care system, that prevent them from seeking treatment. There also may be structural barriers, such as lack of personnel or training, to assist them.

State policies also may influence rates of opioid use disorder, treatment, and overdose. Medicaid reimbursement rates are one such policy, but the researchers also cited educational outreach should emphasized the importance of diagnosing OUD and the effectiveness of medication to primary care physicians, psychologists, nurses, and other clinicians.

Four states – Alabama, Utah, Rhode Island, and Wyoming – were excluded due to data quality concerns, according to the study.