Only 1 in 4 Adults Who Need Opioid Use Disorder Treatment Get Medication

In 2022, 81,806 opioid-involved overdose deaths were reported in the United States — more than in any year before. Medications for opioid use disorder (OUD) — buprenorphine, methadone and extended-release naltrexone — are proven to help; buprenorphine and methadone in particular substantially reduce both overdose deaths and deaths overall. Yet they are markedly underused. This report, from CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Drug Abuse, measured the gap.

Image from CDC's report on treatment for opioid use disorder.

How it was measured

The authors used the 2022 National Survey on Drug Use and Health — interviews with 56,610 adults — and a "cascade of care" borrowed from HIV care: who needs treatment, who perceives that need, who receives any treatment, and who receives medication. Needing treatment meant meeting the DSM-5 criteria for OUD ("a problematic pattern of opioid use leading to clinically significant impairment or distress") in the past year, or being in OUD treatment.

The cascade

• 3.7% of U.S. adults — about 9,367,000 people — needed OUD treatment.
• Of them, 42.7% didn't think they needed it.
• 30.0% got treatment, but without medication.
• Only 25.1% received medication for OUD.

Who needed treatment

Need was higher among people who:

Adults aged 18–25 were less likely to need treatment (2.2%) than older adults (3.7%–4.3%).

Who got treatment — and medication

Any treatment reached:

• 60.3% of White adults who needed it, compared with 43.8% of Black and 45.7% of Hispanic adults;
• 44.9% of adults 50 and older, compared with 58.9%–67.8% of younger adults.

Medication, among adults who got any treatment, reached fewer than half (45.5%):

People with other drug use or who had been arrested were more likely to get medication, perhaps because they had more contact with systems that link people to care. Even among adults with severe OUD, fewer than half received medication, since only 53.0% received any treatment.

Why so few

• Not seeing the need. People who take opioids only as prescribed — the majority of those meeting OUD criteria — may be especially unlikely to think they need treatment. Clinicians who suspect OUD in patients on prescribed opioids should raise it, invite the patient to share concerns, and assess against DSM-5 criteria; nonjudgmental support and harm reduction can build trust with people not ready for treatment.
• Attitudes. Some clinicians prefer treatment without medication, and some equate these medications with illegal drug use.
• Methadone access. It can be dispensed only by SAMHSA-certified opioid treatment programs, and many counties have none.
• Buprenorphine and naltrexone barriers. Many treatment facilities don't offer them, some won't accept clients who use them, many pharmacies don't stock buprenorphine, and payers — including many state Medicaid programs — impose restrictions such as prior authorization.
• The old waiver. Until 2023, prescribing buprenorphine for OUD required a waiver, which fewer than 10% of physicians obtained; primary care doctors cited inexperience, fear of being inundated with requests, lack of specialist backup and the training required.

Limitations

• The survey covers households, so it misses people in jails and homeless people outside shelters; need is likely underestimated.
• Response rates in 2021 and 2022 were lower than before.
• Sample sizes limited some comparisons, including by insurance and by mild versus moderate OUD.
• OUD was inferred from answers to diagnostic questions, not from a clinical diagnosis.

What needs to happen

The shift from heroin to illegally made fentanyl has made overdoses more likely to be fatal, adding urgency — especially for Black and Hispanic adults, women, and younger and older adults. The authors call for:

• wider communication that medications for OUD work, aimed at people who use drugs and those close to them;
• clinicians and treatment providers offering or arranging evidence-based treatment, including medication;
• use of the change since 2023: any clinician with a current Drug Enforcement Administration registration that includes Schedule III authority may now prescribe buprenorphine for OUD, where state law allows;
• pharmacists and payers making these life-saving medications available without delay.

Sources

Based on Dowell D, Brown S, Gyawali S, et al., "Treatment for Opioid Use Disorder: Population Estimates — United States, 2022," Morbidity and Mortality Weekly Report 73(25), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.