On Aug. 7, 2023, a National Institute of Health (NIH) supported study found that in 2021, an estimated 2.5 million people aged 18 years or older in the U.S. had opioid use disorder in the past year, yet only 1 in 5 of them (22%) received medications to treat it, according to the study. Some groups were substantially less likely to receive medication for opioid use disorder, including Black adults, women, those who were unemployed, and those in nonmetropolitan areas.

Published in JAMA Network Open, this study was a collaborative effort between researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the National Center for Injury Prevention and Control, a part of the Centers for Disease Control and Prevention (CDC). The findings highlight that evidence-based medications for people with opioid use disorder – including buprenorphine, methadone, and naltrexone – continue to be vastly underused.

In 2021, nearly 107,000 people died of a drug overdose, with 75% of those deaths involving an opioid. The overall rise in overdose deaths is largely attributable to the proliferation in the drug supply of illicit fentanyl, a highly potent synthetic opioid. Decades of research have shown the overwhelming benefit of three existing medications for opioid use disorder. During the COVID-19 pandemic, strategies to increase the availability of these medications were implemented, including expanded telehealth.

To provide updated estimates of how many people with opioid use disorder receive medications in the U.S., researchers analyzed data from the 2021 National Survey on Drug Use and Health (NSDUH). The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH provides nationally representative data on prescription opioid use and misuse, opioid use disorder, and related substance use treatments (including medications for opioid use disorder) among U.S. civilian, noninstitutionalized populations.

Researchers found that in 2021, an estimated 2.5 million people aged 18 and older had opioid use disorder in the past year, yet only 36% of them received any substance use treatment, and only 22% received medications for opioid use disorder. Among those who received medications for opioid use disorder, the researchers found that 59% were men, 62% were aged 35 or older, 58% were non-Hispanic white, and 58% lived in large metropolitan areas.

Medications for opioid use disorder are most often prescribed to patients with moderate-to-severe opioid use disorder. Consistently, this study found that adults with severe opioid use disorder were 5 times more likely to receive medications for opioid use disorder compared to those with mild opioid use disorder. However, adults with moderate opioid use disorder did not differ from those with mild opioid use disorder in their receipt of medications for opioid use disorder.

The researchers also found that those receiving substance use treatment via telehealth were approximately 38 times more likely to receive medications for opioid use disorder compared to those who did not receive treatment via telehealth, (including those who received any substance use treatment without telehealth as well as those who did not receive any substance use treatment).