To ensure the provision of treatment based on evidence across the country, the National Institutes of Health and the Agency for Healthcare Research and Quality can support efforts to develop and deploy quality metrics across clinical programs. Technical assistance can increase the confidence of nonspecialist clinicians to offer addiction care 67, and may support clinicians across disciplines as they adopt quality metrics in their practices. In March 2019, the National Academies of Sciences, Engineering, and Medicine published Medications for Opioid Use Disorder Save Lives, a pivotal report on the importance of MOUD 5. The report highlighted barriers to greater use of medications, including stigma, inadequate education, and restrictive regulations.
Federal Laws Limiting Access to Buprenorphine
Removing stigma is a critical factor in the development of high-quality treatment services needed for reducing the burden of OUD. According to the CDC, only 1 in 12 non-Hispanic Black people who died of an opioid overdose had been engaged in substance use treatment, while non-Hispanic white people had been treated at nearly twice the rate. Even those who seek care are less likely to complete the program and have poorer outcomes — which studies have linked to implicit bias and a lack of diversity and empathy for Black patients among treatment providers. The FDA warns against using the injection intravenously as it can be life-threatening.
How can I help a loved one with opioid use disorder?
- The new tool can be used as an acceptable primary endpoint in studies of medications to treat adults with moderate to severe AUD.
- Of this total cost, 41 percent ($1.1 trillion) is attributed to deaths, 49 percent ($1.34 trillion) to lost quality of life, and 10 percent ($277 billion) to other costs such as healthcare, reduced labor productivity, and crime-related expenses.
- Finally, in recent years evidence has illuminated promising strategies to reduce the risk of opioid-related mortality for populations that are at high risk of overdose, such as people presenting to emergency departments after an overdose or people with OUD in detention.
- In 2008, only 12 medical schools reported a separate required SUD course and 45 schools offered an elective course 33.
- Rates of MOUD utilization have increased in the past few years, demonstrating a positive trend 11, but the continued toll of the opioid epidemic highlights the persistence of a concerning treatment gap.
In one compelling example, a study of rural family physicians cited lack of counseling availability as the top barrier to providing OUD treatment 67. In another recent study, approximately 10 percent of OTPs cited state regulations as barriers to expanding treatment 10. Finally, there is also insufficient coordination of care between clinicians and inadequate access to specialists such as mental health and substance use counselors trained in evidence-based opioid addiction treatment treatment. Studies show that the inability to refer to behavioral health and psychosocial services are major barriers for primary care clinicians wanting to treat SUD 66,67.
National Practice Guideline
— Purple flags, representing the nearly 300 Mecklenburg County residents who died of opioid overdose in 2023, fluttered in the humid breeze last August in recognition of International Overdose Awareness Day on the city’s Oxford House predominantly Black west side. Table 1 shows the distribution of Medicaid beneficiaries treated for OUD by eligibility category. Over half of the Medicaid beneficiaries treated for OUD were eligible due to Medicaid expansion, indicating that Medicaid expansion is playing a central role in directing treatment resources to low-income adults with OUDs. An additional 23.5% of those in treatment covered by Medicaid were non-disabled adults eligible through non-expansion pathways.
- Each person’s recovery journey is different, and a combination of therapies is often the most effective way to support long-term recovery.
- In its 2020 National Practice Guideline, the American Society of Addiction Medicine (ASAM) included treatment recommendations for OUD.
- Special efforts should be made to ensure that populations at high risk of overdose, especially incarcerated and recently incarcerated persons, have access to affordable medications.
- To facilitate the transition to higher quality care, technical assistance should be provided for key services, including offering MOUD in a variety of settings.
The accrediting body for medical residencies requires all programs to “provide instruction in pain management if applicable for the specialty including recognition of the signs of addiction,” but does not require training in the treatment of addiction 34. Most patients with opioid use disorder are candidates for primary care prescription of buprenorphine. Food and Drug Administration warned against prescribing buprenorphine to patients who used benzodiazepines or alcohol because of the elevated risk of overdose. You are living with your peers, and you can support each other to stay in recovery.
Additionally, as with emergency department visits, the total number of stays increased markedly during this period. To guide treatment, clinicians should ask about use of alcohol and other substances. (Recommendation 8 in the 2022 Clinical Practice Guideline) Alternatively, clinicians can arrange for a substance use disorder treatment specialist to assess for the presence of opioid and other substance use disorders. Feb. 25, 2025 – The FDA has approved a new treatment plan for a long-acting injection, making it easier for people with moderate to severe opioid use disorder (OUD) to start and keep up with their treatment.
- Medicaid’s role in financing OUD treatment has grown markedly in recent years, driven by Medicaid expansion.
- This guide is a useful tool for clinicians to provide to their patients and their families, along with a resource for pharmacies and patient groups looking to inform people about their options to treat the challenging disease of addiction involving opioid use.
- Methadone, buprenorphine, and extended-release naltrexone are safe and effective FDA-approved treatments for OUD.
- Nationally, Black people are half as likely as white people to be referred to or get treatment — even after a nonfatal overdose, according to the Centers for Disease Control and Prevention.
- Unfortunately, special privacy regulations impair data sharing for patient care.
- Future research efforts should endeavor to better understand those who do not utilize the treatment system and identify strategies that might engage them in care.
At least 2.1 million Americans 12 years and older had opioid use disorder in 2016, and approximately 47,000 Americans died from opioid overdoses in 2017. Opioid use disorder is a chronic relapsing condition, the treatment of which falls within the scope of practice of family physicians. With appropriate medication-assisted treatment, patients are more likely to enter full recovery. Methadone and buprenorphine are opioid agonists that reduce mortality, opioid use, and HIV and hepatitis C virus transmission while increasing treatment retention. Intramuscular naltrexone is not as well studied and is harder to initiate than opioid agonists because of the need to abstain for approximately one week before the first dose.
- Table 3 reports that Medicaid paid for 362,000 emergency department visits for opioid-related problems in 2021.
- Alarmingly, 93 percent of opioid deaths are caused by powerful synthetic opioids like fentanyl, which typically originate in China and are trafficked through Mexico.
- Treatment for OUD often requires continuing care to be effective, as OUD is a chronic condition with the potential for both recovery and relapse.
- When choosing a center, certain factors can help you find the best fit for your needs.
- Treatment may save a life and can help people struggling with opioid use disorder get their lives back on track by allowing them to counteract addiction’s powerful effects on their brain and behavior.
- Choosing the correct medication for a given patient depends on patient preference, local availability of opioid treatment programs, anticipated effectiveness, and adverse effects.
The rising toll of the opioid crisis makes this is an opportune time to catalyze and expand MOUD treatment within the health care system. These hypothesis-generating findings warrant confirmation but point to a potential role for work-related substance use and overdose prevention interventions. The WSR initiative also aims to address the determinants of substance use disorders and overdose through the reduction of work-related risk factors, including occupational injury and work-related stress (4). To maximize their potential benefit, WSR and other workplace-oriented interventions might need to tailor their approaches based on potential psychostimulant or cocaine use within a given occupation or industry. Nevertheless, increased access to harm reduction resources and evidence-based treatments for opioid use disorder and stimulant use disorder, both within and outside of a workplace setting, will be needed to address the current U.S. overdose crisis. Although clinicians can prescribe controlled substances such as fentanyl and morphine without mandatory training in substance use or pain management, agonist treatment medications have increased regulatory and logistic barriers.
