A US study of more than a million Medicaid enrollees, newly diagnosed with opioid use disorder (OUD), finds most – nearly seven in 10 – are not receiving access to potentially life-saving drugs within six months.
The major gap in access to these medications – vital for those receiving free or low-cost healthcare and needing treatment for a dependency on heroin, painkillers and other opioids – is revealed ahead of looming Medicaid funding cuts, which threaten to further limit access to many various medications.
The research, published today in the peer-reviewed publication The American Journal of Drug and Alcohol Abuse , demonstrates that Black patients are substantially more likely than White patients to struggle in accessing treatment.
With OUD continuing to claim tens of thousands of lives a year, the study authors from Boston University School of Social Work, and the Institute for Health, Health Care Policy and Aging Research at Rutgers University, say the current access issues are particularly concerning as their findings also highlight just how vital a medication-based approach is to cut the odds of overdose.
In particular, their results indicate that methadone reduces overdose risk by 86% (the greatest reduction achieved by a prescription) when compared to receiving no medication at all.
Medicaid is the leading source of insurance coverage for addiction treatment in the US, but is currently under threat due to cuts imposed under the One Big Beautiful Bill Act .
The study authors suggest policymakers should continue supporting Medicaid to cut overdose deaths nationwide.
'Timely' access to medication is vital, they add. To reduce barriers to access, the authors are calling for reforms such as expansion of 'take-home' doses of methadone, which drug users self-administer while unsupervised.
"Results highlight the critical need for policies to ensure everyone can access treatment – regardless of where they live, their ability to pay, or other personal characteristics," states lead author Professor Peter Treitler from Boston University School of Social Work, who focuses on research aimed to improve wellbeing for people with substance use disorders and inform more-effective solutions to the nation's critical substance use challenges.
"Interventions should increase the use of medications for opioid use disorder and provide supports that reduce treatment dropout.
"Increasing access to methadone may be particularly important, given its large protective effect against overdose and the substantial policy and service delivery barriers to access."
The US opioid crisis remains a major public health issue with overdose deaths still at historically high levels. The study findings will fuel debates about Medicaid funding and coverage, including concerns over Medicaid that could limit access to addiction treatment.
Opioids include the illegal drug heroin and prescription pain relievers oxycodone, morphine, and fentanyl. Previous research shows medication treatment is highly effective in reducing the risk of opioid overdose.
The main medications currently approved for use in the US are the opioid substitutes methadone and buprenorphine which reduce cravings and withdrawal symptoms, and naltrexone, which blocks the effects of opioids.
This new study is among the first to analyze access to and effectiveness of all three of these medications in people newly diagnosed with OUD in the national Medicaid population.
A total of 1,172,200 participants with opioid use disorder aged 18 to 64 in 44 US states were included in the study. The majority (52%) were female and diagnosed between April 2016 and December 2019. Many of those included in the study also suffered from chronic pain, psychiatric disorders, and addictions to drugs other than opioids.
Results showed what the authors describe as a 'modest' improvement (27% to 34%) in the number of participants who received treatment within 180 days after diagnosis. This increase was observed over the four-year study period.
However, seven in ten (69%) did not receive medication within 180 days. Black participants were a third less likely than White drugs users to get methadone and other treatment within this timeframe, as were Hispanic participants although the difference was not as acute.
A small number of the 361,034 (31%) people who received medication to treat their addiction experienced an overdose within 180 days. Overdose was much less likely for those on methadone and buprenorphine than on naltrexone.
The authors highlight that recent changes to guidelines for opioid treatment programmes have reduced barriers to accessing methadone. However, most patients are still required to attend the clinic frequently, deterring many from initiating or continuing treatment. This issue needs to be addressed, the authors add.
