March 20, 2019
WASHINGTON – Although three U.S. Food and Drug Administration-approved medications to treat opioid use disorder (OUD) are safe and effective, most people who could benefit from these treatments do not receive them, and access is inequitable, especially among certain subpopulations, says a new report from the National Academies of Sciences, Engineering, and Medicine. Medications for Opioid Use Disorder Save Lives says that withholding or failing to have available these medications for the treatment of OUD in any care or criminal justice setting is denying appropriate medical treatment.
Treating a Chronic Brain Disease
More than 2 million people in the United States are estimated to have OUD, a treatable chronic brain disease resulting from changes in neural structure and function that are caused over time by repeated use of prescription opioids, heroin, or other illicit opioids, the report says. OUD is a life-threatening condition associated with a twentyfold greater risk of death due to overdose, infectious diseases, trauma, and suicide. In 2017, 47,000 people in the United States died as a result of opioid overdoses.
Stopping opioid misuse is extremely difficult. Medications help normalize brain structure and function. Methadone, buprenorphine, and extended-release naltrexone – approved by the FDA to treat OUD – work by alleviating withdrawal symptoms, reducing opioid cravings, or decreasing the response to future drug use. Patients who receive these medications are less likely to die from overdose or other causes related to their addiction, have higher treatment retention rates and better long-term outcomes, or are also less likely to inject drugs and transmit or contract infectious diseases. In addition, risk of death is cut in half for people with OUD who are treated long term with methadone or buprenorphine, the report says.
Confronting Barriers to Treatment
As the number of people with OUD surges, the need for treatment far exceeds current use rates. Major barriers to the use of medications to treat opioid use disorder include:
Broadening Access to Treatment
Access to medications for OUD is inequitable among subpopulations, for example, adolescents and young adults, people in rural areas, and racial and ethnic minority groups. However, evidence supports the effectiveness of medication for treating OUD in all groups, including adolescents, pregnant women, and people with comorbidities.
In the U.S., methadone can only be administered through specialty facilities known as opioid treatment programs, even though the available evidence shows that delivering it through an office-based medical practice setting is also effective. Most residential treatment facilities do not offer medications, and if they do, they rarely offer all three medications. Pharmacies, mobile medication units, community health centers, emergency departments, and other care settings provide opportunities to engage people with OUD and connect them with effective care, the report says.
Despite the large and increasing numbers of people with OUD entering the criminal justice system in the U.S., medications are often withheld or only provided on a limited basis for medically supervised withdrawal. As a result, few people with OUD receive medication while incarcerated or under the supervision of drug courts, and often those who do receive medication for OUD are not connected with care upon their release, leading to treatment discontinuation and the associated risks of overdose and death.
“The United States is experiencing a public health crisis of almost unprecedented scale — an epidemic of opioid use disorder and related overdose deaths,” said Alan Leshner, chief executive officer emeritus of the American Association for the Advancement of Science, and chair of the committee that conducted the study. “The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment. Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — health care, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.”
To more widely address the opioid crisis, additional research will be needed on differences in the nature of OUD in subgroups, as well as on the potential need for specific medication-based treatment guidelines for subpopulations. Research should also be expanded on new and better medications to treat OUD, determining behavioral therapies that can help maximize outcomes, and refining the most appropriate protocols for their effective use.
The study — undertaken by the Committee on Medication-Assisted Treatment for Opioid Use Disorder — was sponsored the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse of the National Institutes of Health. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit nationalacademies.org.
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Dana Korsen, Senior Media Relations Officer
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