Opioid addiction drugs severely underutilized, study finds

A study finds that despite the abili...

Posted: Jun 19, 2018 7:52 AM
Updated: Jun 19, 2018 7:52 AM

A study finds that despite the ability of medication-assisted treatment drugs like methadone and buprenorphine to save the lives of people who've overdosed on opioids, they continue to be underutilized.

The study, published Monday in the medical journal Annals of Internal Medicine, identified and tracked nearly 18,000 adults in Massachusetts who had gone to an emergency room because of a non-fatal drug overdose between 2012 and 2014. It found that only about 30% received any sort of Food and Drug Administration-approved medication-assisted treatment for opioid addiction.

Only three out of 10 people get some sort of FDA-approved drug for opioid addiction treatment

Drugs to treat opioid addiction can reduce risk of death by between 40% and 60%

Such treatment is considered the gold standard for opioid addiction and combines behavioral therapy with one of three approved drugs: methadone; buprenorphine, which is sold as Suboxone; and naltrexone, commonly sold as Vivitrol.

"We were shocked by the fact that so few people are getting medication," said Dr. Marc Larochelle, lead author of the study and an internist and researcher at Boston Medical Center's Grayken Center for Addiction.

Reducing risk of death

Larochelle and his colleagues found that when looking at the entire group a year after their overdoses, nearly 5% of the individuals had died, and about 2% of those deaths were due directly to opioids.

Overall, among those who received methadone, the one-year mortality rate dropped to 2.5%, and for those given buprenorphine, it dropped to 3% -- meaning, one year later, those who were treated with methadone or buprenorphine had reduced their risk of death by 60% and 40%, respectively.

There was no significant difference found in those patients who were treated with naltrexone. However, the study also cautioned that the number of patients using naltrexone was much more limited, which could have affected the finding.

Of the patients followed, researchers found that about 17% used buprenorphine, with median use of the drug around four months; 11% used methadone, with a median use of around five months; and just 6% used naltrexone, with a median use of about one month.

Caleb Banta-Green, who studies drug abuse epidemiology at the University of Washington's School of Public Health, said it's an important limitation, but he also noted that the limited use of just one month was still a noteworthy finding.

Dr. Sharon Stancliff agreed. "If you can't start a treatment, that says a lot about its effectiveness," said Stancliff, a practicing clinician in New York and a former adviser to the Harm Reduction Coalition. Neither she nor Banta-Green was involved in the new study.

There have been high dropout rates when it comes to naltrexone, possibly due to the fact that those starting the regimen cannot used any opioids for at least seven to 10 days. In contrast, methadone and buprenorphine can be started much sooner.

The hurdle in getting people to start naltrexone is also well-known. Randomized clinical trials have compared naltrexone to buprenorphine and found they were similarly effective in keeping people off opioids. But getting patients to start naltrexone has been difficult in these studies, as well.

Limited options when it comes to treatment

The latest study is the first side-by-side comparison in the United States of the impact these three drugs may have on mortality and accounts for how people actually use them.

"People chose to take these drugs out in the real world. And then this is what happened," Banta-Green said, calling it the real world apples-to-apples comparison that many clinicians have been hoping for.

Stancliff said, "this is a study that should be driving policy."

In recent years, Vivitrol, the long-acting injectable version of naltrexone, has become a popular treatment option in the criminal justice system -- and sometimes the only option.

"There's clearly no evidence it should be a preferred treatment, because it is clearly being pushed in some settings where people aren't being offered any other options," Larochelle said.

Fewer than half of all treatment programs prescribe one of the three FDA-approved medications, and only 3% provide all three. The FDA has taken additional steps to make these treatments more accessible. Most notably, in recent months, FDA Commissioner Dr. Scott Gottlieb has prioritized the development of new medication-assisted treatment option.

In the United States, the number of fatal opioid overdoses has continued to rise over the past two decades, and the most recent estimates have nearly 50,000 opioid-related overdoses in 2017. Opioid overdoses kill more people than breast cancer every year.

Larochelle and his colleagues also found that despite having had an overdose, 34% of people were prescribed opioids, and another 26% were prescribed benzodiazepines in the year after their overdoses.

What was clear from the study, Larochelle said, is that more people need to be accessing treatment. "We're not doing enough to reach enough people," he said.

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 733591

Reported Deaths: 13466
CountyCasesDeaths
Marion1003871748
Lake54020975
Allen40829679
St. Joseph35898552
Hamilton35735408
Elkhart28745442
Tippecanoe22432219
Vanderburgh22342397
Porter18871310
Johnson18028381
Hendricks17283315
Clark13015191
Madison12725339
Vigo12482248
LaPorte12011214
Monroe11928170
Delaware10726187
Howard9959218
Kosciusko9451117
Hancock8325142
Bartholomew8085156
Warrick7792155
Floyd7677178
Grant7080174
Wayne7064199
Boone6722101
Morgan6596139
Dubois6162117
Marshall6083112
Cass5839105
Dearborn582178
Henry5767104
Noble563684
Jackson502773
Shelby493696
Lawrence4571120
Harrison436372
Gibson436292
DeKalb429685
Clinton428153
Montgomery425389
Whitley397439
Huntington393380
Steuben390057
Miami382668
Knox372690
Jasper370148
Putnam362360
Wabash354980
Adams341955
Ripley340270
Jefferson331581
White315654
Daviess298299
Wells291981
Decatur285692
Fayette281662
Greene280085
Posey271933
LaGrange268370
Scott267254
Clay260647
Washington241832
Randolph241481
Spencer232631
Jennings230649
Starke217854
Fountain213246
Sullivan212142
Owen202156
Jay196730
Fulton195640
Carroll189620
Orange184154
Perry184037
Rush173725
Vermillion169743
Franklin168435
Tipton163045
Parke146616
Blackford135132
Pike135134
Pulaski117145
Newton108334
Brown102641
Crawford101315
Benton99014
Martin89515
Warren82415
Switzerland7938
Union71110
Ohio57111
Unassigned0417

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1089357

Reported Deaths: 19528
CountyCasesDeaths
Franklin1265611406
Cuyahoga1129542134
Hamilton803281211
Montgomery517261015
Summit47483955
Lucas42491792
Butler38487585
Stark32544909
Lorain25135486
Warren24359300
Mahoning21735588
Lake20791371
Clermont19844240
Delaware18582133
Licking16470212
Fairfield16284200
Trumbull16141468
Medina15341266
Greene15128244
Clark14062299
Wood13153189
Portage12930206
Allen11713232
Richland11414199
Miami10706220
Wayne8900214
Columbiana8859229
Muskingum8824133
Pickaway8589121
Marion8553136
Tuscarawas8500245
Erie7937155
Hancock6935128
Ashtabula6871172
Ross6871156
Geauga6724148
Scioto6431102
Belmont5960168
Union572948
Lawrence5583102
Jefferson5566151
Huron5453120
Darke5372126
Sandusky5369122
Seneca5305122
Washington5213109
Athens520458
Auglaize494586
Mercer481185
Shelby470193
Knox4506110
Madison438263
Putnam4297101
Fulton425969
Ashland425190
Defiance423997
Crawford3989107
Brown396657
Logan383076
Preble381098
Clinton373863
Ottawa368181
Highland356262
Williams342575
Champaign334658
Guernsey317353
Jackson313752
Perry295750
Morrow286839
Fayette282950
Hardin271564
Henry270266
Coshocton265657
Holmes2621101
Van Wert243963
Adams239553
Pike238034
Gallia236449
Wyandot232055
Hocking216062
Carroll192148
Paulding173940
Meigs145240
Noble133737
Monroe132542
Harrison109237
Morgan108523
Vinton84215
Unassigned02
Fort Wayne
Mostly Cloudy
69° wxIcon
Hi: 70° Lo: 44°
Feels Like: 69°
Angola
Cloudy
64° wxIcon
Hi: 70° Lo: 43°
Feels Like: 64°
Huntington
Cloudy
65° wxIcon
Hi: 70° Lo: 42°
Feels Like: 65°
Decatur
Cloudy
69° wxIcon
Hi: 71° Lo: 45°
Feels Like: 69°
Van Wert
Cloudy
68° wxIcon
Hi: 72° Lo: 45°
Feels Like: 68°
Isolated rain showers are possible late Saturday night into early Sunday morning. Most of Sunday will be dry and warm, but one or two pop-up showers possible Sunday afternoon.
WFFT Radar
WFFT Temperatures
WFFT National

Community Events