Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

Abstract

Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

“…Although the number of buprenorphine prescribers has increased across the United States, disparities in access to buprenorphine are a major problem. 47,48 Most prescribers are located in urban areas while rural areas encompass 97% of the nation's land area and contain 20% of the US population. 49 Additionally, fewer percentages of nurse practitioners obtained waivers in more restrictive states where nurse practitioners needed physician oversight to prescribe medication.…”

“…58,59 Educating the entire healthcare workforce about the benefits of medication treatment, reducing stigma around treatmentseeking, and improving health insurance coverage of medication treatment are ways to expand availability and accessibility of treatment. 48 Identifying and encouraging providers to obtain buprenorphine waivers in high-need areas with low waivered providers can also increase access to treatment. 13 Recruiting students with rural backgrounds, offering curricula and rotations on rural practice, and providing financial incentives such as federal loan repayment programs may help retain providers in rural communities.…”

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

“…Unfortunately, even if desired by a significant portion of the target treatment population, several SUD treatment center characteristics suggested by study participants may have limited feasibility without broader policy changes. Even though participants highlighted the need for SUD treatment centers to offer a range of evidence-based treatments, only 36% of specialty SUD treatment centers in the United States offer any form of MOUD (Abraham et al, 2020). Several factors likely affect the limited offering of MOUD, including stigma and availability of trained staff (Madras et al, 2020).…”

Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

“…Women of childbearing age who misuse opioids are a particularly vulnerable population as they juggle their own substance dependence, pregnancy, and motherhood. To address the rising rates of overdose morbidity and mortality, there has been a shift toward medication-assisted treatment (MAT) for opioid dependence ( Scholl et al, 2019 ; Abraham et al, 2020 ; Adams and Volkow, 2020 ). MAT has become the gold standard for opioid dependence in pregnant women ( Timmermans and Berg, 2010 ; Klaman et al, 2017 ; Reddy et al, 2017 ; Verduin, 2017 ).…”