Despite the quadrupling of heroin overdose deaths over the past decade and a dramatic rise in deaths from prescription painkillers, the percentage of people getting treatment for their opioid abuse and dependence has remained the same, new Johns Hopkins Bloomberg School of Public Health research suggests.
Writing in the Oct. 13 Journal of the American Medical Association, the researchers say that while more money has been spent on treatment in recent years, the resources necessary to ensure wider access to treatment haven't kept up with the burgeoning demand.
"We found that 80 percent of people with an opioid addiction are not getting treatment," says study leader Brendan Saloner, PhD, an assistant professor in the Department of Health Policy and Management at the Bloomberg School. "This hasn't changed, despite the growing and more complicated problem of opioid abuse and dependence."
According to the Centers for Disease Control and Prevention, between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013. From 2001 to 2013, the rate of prescription drug-related overdose deaths more than doubled.
For the study, Saloner and Shankar Karthikeyan, a recent MPP graduate from the Bloomberg School, analyzed data from the National Survey of Drug Use and Health, a nationally representative survey of people ages 12 and older, to identify 6,770 people meeting clinical criteria for an opioid use disorder. Such individuals self-reported that they were either physically dependent on opioids or that their use of opioids caused personal, financial or legal problems. The researchers compared two time frames: From 2004 to 2008 and from 2009 to 2013.
After adjusting for demographic factors, they found that roughly 20 percent of those with a drug use disorder were in treatment during each time period. Since opioid use rose so dramatically during this period, the actual number of people in treatment increased from about 293,000 individuals in 2004 to 473,000 individuals in 2013, nearly a 50 percent increase, Saloner says.
The percentage of this population using heroin jumped dramatically from 24 percent in the first time period to 35 percent in the latter one. It is widely believed that many people addicted to prescription painkillers like oxycontin are switching to heroin, which is a cheaper alternative.
The researchers also found that there have been some important changes over time in the number and types of treatment settings that people with opioid addictions are visiting. The most common treatments, used by more than half of those in treatment during both time periods, were outpatient treatment (a setting where methadone is commonly distributed) and self-help groups. The use of inpatient services increased from 37.5 percent to 52 percent (some people were in multiple types of treatment). The percentage receiving care in a doctor's office went from 25 percent to 35 percent. Private physicians have increasingly prescribed a drug called buprenorphine, which helps individuals to manage cravings and reduce use of opioids.
There are many places where drug treatment programs are not available or programs are overcrowded. Another problem is access to evidence-based treatments. Many state Medicaid programs restrict access to buprenorphine and methadone, medications for managing addiction to opioids. Saloner says they work by preventing the body's physical withdrawal while also keeping users from becoming high and enabling them to function normally in society. They can also help prevent overdose in people who experience a relapse.
"The real challenge in this is getting more people into settings where they can get methadone or buprenorphine," he says. "We also need to think about changing the conversation about opioid addiction, which is a chronic relapsing illness, just like diabetes. Referring to drug users as junkies or criminals keeps people with addiction in the shadows and away from getting help. They may be open to treatment but they never seek it out because of the stigma associated with their addiction."
He says that getting more people health insurance through the Affordable Care Act may also improve access to affordable treatment.
"National Changes in 12-Month Substance Abuse Treatment Utilization Among Individuals with 2 Opioid Use Disorders, 2004-2013" was written by Brendan Saloner and Shankar Karthikeyan.