Several effective medications are now available for treating opioid use disorder but many patients who could benefit do not receive them. Some patients who receive the medications face challenges to staying in treatment. For more information, please visit the NIDA Notes website: https://www.drugabuse.gov/news-events/nida-notes/2018/07/opioid-use-disorders-increased-prescriptions-treatment-did-not-keep-pace You can view NIDA's Comment Policy here: https://www.drugabuse.gov/comment-policy

1. DRUGABUSE.GOV
A study found that:
• Among more than 100 million Americans with
commercial health insurance, the prevalence of
opioid use disorder (OUD) diagnoses quadrupled
from 2010 to 2014.
• The number of prescriptions for medications to treat
OUD (MOUD) in this population also increased but
did not keep up with the rise in diagnoses.
• Patients continued taking sublingual and oral-
mucosal buprenorphine/naloxone longer than they
continued taking other MOUDs.
As Opioid Use Disorders Increased,
Prescriptions for Treatment Did Not Keep Pace

2. DRUGABUSE.GOV
Dr. Jake R. Morgan and colleagues at Boston
Medical Center analyzed medical records in a
nationally representative database of people with
employer-sponsored commercial health insurance.
Of 100 million individuals in the database, 340,000
spent some time living with a diagnosis of OUD
during the years 2010 to 2014. The proportion of
the population with an OUD diagnosis increased
from year to year and was four times higher in
2014 compared with 2010.
Diagnoses of OUD Quadrupled From 2010 to 2014
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

3. DRUGABUSE.GOV
Of the more than 340,000 patients who carried an OUD
diagnosis during some or all of the time during the period
from 2010 to 2014, only 11 percent were prescribed an
MOUD.
From 2010 to 2014, Only 11 Percent of Patients
With OUD Were Prescribed an MOUD
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

4. DRUGABUSE.GOV
For each year, the researchers computed the total number of
months that patients spent with an OUD diagnosis (OUD months).
They compared the OUD months with the total number of months
that were covered by prescriptions for OUD medications (MOUD
months). Both OUD months and MOUD months increased from
year to year, but OUD months increased faster than MOUD
months. Physicians’ MOUD prescriptions covered 25 percent of
OUD months in 2010, and only 16 percent in 2014.
Dr. Morgan says that several factors may have contributed to the
widening gap, including:
• Increases in OUD prevalence and rising awareness among
health care providers and patients may lead to more
diagnoses.
• Barriers may limit treatment with MOUD. For example, health
care providers need a waiver to prescribe buprenorphine and
can only treat a certain number of patients with the
medication. The requirement to become abstinent as a
precondition for initiating treatment initiation with naltrexone
may pose a barrier to wider use of that medication.
Increases in MOUD Prescriptions Did Not Keep Pace With Increased
Treatment Need
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

5. DRUGABUSE.GOV
Doctors were most likely to prescribe
buprenorphine/naloxone in sublingual or oral-
mucosal formulation (S/O BUP/NAL; Suboxone® and
generic), followed by sublingual buprenorphine
(BUP; generic) and oral naltrexone (oral NTX;
ReVia®). Extended-release naltrexone (XR-NTX;
Vivitrol®) and transdermal buprenorphine were
introduced during this period. Although they added
to patients’ treatment choices, doctors did not
prescribe them often enough to prevent the
widening gap between OUD and MOUD.
Newly Introduced MOUDs Accounted for a Small Proportion of Prescriptions
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

6. DRUGABUSE.GOV
Many patients who received MOUD prescriptions
stopped taking the medication within the first 30 days.
Patients were least likely to stop taking S/O BUP/NAL
(31 percent) and most likely to stop taking oral NTX
(70 percent).
Dr. Morgan cites several reasons why patients might be
more likely to discontinue some medications than others:
• Patients who stop taking NTX do not experience
withdrawal symptoms, making it easier to discontinue
that medication. In contrast, stopping opioid agonists,
such as BUP, leads to withdrawal symptoms.
• Opioid agonists, such as BUP, may have greater
rewarding effects.
• The logistics of treatment (e.g., frequency of
administration, oral administration vs. injection) may
influence medication compliance.
Patients Are More Likely To Stop Taking Certain Medications
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

7. DRUGABUSE.GOV
Patients discontinued sublingual and oral-
mucosal buprenorphine at lower rates than
other MOUDs over the longer term, as well.
However, other factors, such as patient
demographics (e.g., age) and treatment settings
(e.g., inpatient or office-based), also played a
role in long-term quit rates.
Most OUD Patients Stop Treatment Within 2 Years
Adapted from Morgan et al. 2017; permission for use of data provided by Dr. J.R. Morgan

8. DRUGABUSE.GOV
• These findings suggest that
clinicians underutilize available
OUD medications.
• Clinicians have a greater menu
of OUD medication options than
ever before.
• Some patients still face
significant barriers to staying in
treatment, jeopardizing
successful outcomes.

9. DRUGABUSE.GOV
Dr. Morgan says, “The findings from this study suggest that in the current opioid crisis, clinicians underutilize the
available OUD medications.”
He adds, “We have made important strides in treating opioid use disorder. Doctors and patients can now choose among
several highly efficacious medications. However, even a highly efficacious medication is only effective for those who
take it. Our real-world analysis indicates that significant barriers to staying on treatment remain, even in a commercially
insured population that was able to initiate injectable naltrexone treatment.”
Dr. Morgan notes that his study did not include people on Medicaid. He comments, “While we are unable to directly
compare our prevalence estimates to the Medicaid population, we believe that the central message of our research—
that treatment rates and retention are low and threaten the benefits of highly efficacious medications—is generalizable
to this population.”
The study was supported by NIH grants DA040500 and DA031059.
Source:
Morgan J.R., Schackman, B.R., Leff, J.A., et al. Injectable naltrexone, oral naltrexone, and buprenorphine utilization and
discontinuation among individuals treated for opioid use disorder in a United States commercially insured population. J
Subst Abuse Treat 85:90-96, 2018.