"Most people with OUD in the United States do not receive any treatment at all, and those who do receive any type of treatment may wait years to do so. Of the small proportion of people who do receive treatment, just a fraction receive medication. Access to evidence-based treatment is poor across the board, but it is starkly inequitable among certain generational, racial, ethnic, social, and economic groups.
medication assisted treatment
"Treatment with a combination of medication and evidence-based behavioral interventions (e.g., contingency management approaches, cognitive behavioral therapy, and structured family therapy) can be effective for many people with OUD. However, little is known about which combinations of medication and behavioral interventions are most effective, which patients are most likely to benefit from behavioral interventions, and which patients may do well with medications and appropriate medical management alone.
"Evidence demonstrates that patients who receive longer-term treatment with medication for OUD have better treatment outcomes; they are also less likely to die from overdose if they return to use while on medication. In fact, people with OUD are up to 50 percent less likely to die when they are being treated long term with methadone or buprenorphine. Further research is needed to define an optimal treatment regimen for each of the available medications and to directly compare the effects of the three medications’ long-term use.
"Recent trials with extended-release formulations and higher dosages of PPs, particularly prescription amphetamines, have shown promising results promoting abstinence from cocaine and reducing drug use. PPs’ potential as an “agonist-type” treatment seems to be better explored with higher dosage regimens and at clinical settings that have direct observed dosing available.
"Our finding that MOUD [Medication for Opioid Use Disorder] treatment with naltrexone was not protective against overdose or serious opioid-related acute care use is consistent with other studies15,35 that found naltrexone to be less effective than MOUD treatment with buprenorphine. The mean (SD) treatment duration for naltrexone in this cohort was longer than prior observational studies at 74.41 (70.15) days.
"Our results demonstrate the importance of treatment retention with MOUD [Medication for Opioid Use Disorder]. Individuals who received methadone or buprenorphine for longer than 6 months experienced fewer overdose events and serious opioid-related acute care use compared with those who received shorter durations of treatment or no treatment. These findings are consistent with prior research11,15,27-29 demonstrating high rates of recurrent opioid use if MOUD treatment is discontinued prematurely. Despite the benefit of MOUD in our study, treatment duration was relatively short.
"In a national cohort of 40,885 insured individuals between 2015 and 2017, MOUD [Medication for Opioid Use Disorder] treatment with buprenorphine or methadone was associated with a 76% reduction in overdose at 3 months and a 59% reduction in overdose at 12 months. To our knowledge, this was the largest cohort of commercially insured or MA individuals with OUD [Opioid Use Disorder] studied in a real-world environment with complete medical, pharmacy, and behavioral health administrative claims.
"Virtually all drug courts (98%) reported that at least some of their participants were opioid-dependent in 2010. Prescription opioids were more frequently cited as the primary opioid problem than heroin (66% vs. 26%). This trend is particularly apparent in less densely populated areas: prescription versus heroin rates across the three population areas were: rural (76% vs. 12%), suburban (67% vs. 33%), and urban (prescription opioids less likely to be selected than heroin as the primary opioid; 38% vs. 50%); p < .01.
According to a census of courts in the US:
Substance abuse treatment services are provided to clients in 86.8% of all courts overall, 95.5% of all drug courts, and 77.1% of all mental health courts.
Integrated substance abuse and mental health treatment services are provided to clients in 60.4% of all courts overall, 62.5% of all drug courts, and 85.5% of all mental health courts. Medication as a treatment strategy is available in 28.1% of all courts overall, only 22.5% of all drug courts, and 59.9% of all mental health courts.