Vast Majority of Opioid Addictions Go Untreated

Federal survey data show treatment rates below 20%

If we had this low treatment rates on any other chronic disease… would that be just malpractice or a EPIDEMIC of irresponsible professional negligence  ?  How many pts would die if their chronic disease(s) left  untreated ? Is this another example of “the system” failing pts and the pts being blamed for the failures ?

http://www.medpagetoday.com/Psychiatry/Addictions/54186?xid=nl_mpt_DHE_2015-10-21&eun=g578717d0r

While rates of opioid use disorders in the U.S. over the last decade have jolted skyward, treatment levels have remained low, according to a research letter appearing in the Journal of the American Medical Association reporting that one-sixth of people with an opioid addiction received treatment.

Experts are calling the prescription drug problem an epidemic, which puts the low treatment rates into perspective: Prevalence rates of opiate use disorders rose from 11.9% in 2003 to 17.8% in 2013. Data capturing opioid misuse prevalence appeared in an accompanying article in JAMA by Beth Han, MD, PhD, MPH, who analyzed data from 6,770 respondents to the National Survey of Drug Use and Health (NSDUH) from 2004 to 2013.

Emergency visits for nonmedical use of prescription opioids more than doubled between 2004 and 2011, according to an accompanying editorial citing data from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network, accounting for an estimated 488,000 ER visits in 2011. Deaths due to nonmedical use of opioid medications have tripled since 1999, translating to an estimated 16,235 deaths in 2013.

Just 16.6% of those with opiate use disorders received any treatment between 2004 and 2008, according to Brendan Saloner, PhD, who is assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health and a co-author on the study. That rate rose to 21.5% in 2009-2013.

Saloner and colleague Shankar Karthikeyan, MPP, analyzed NSDUH data that included responses to a question asking respondents if they had received treatment for an opiate use disorder in the past year. The authors divided the sample into two 5-year periods for reliable estimates. Saloner noted that the 2008 cut point was also the year that the Mental Health Parity and Addiction Equity Act of 2008 became law.

Although the analysis did not delve into the factors driving low treatment rates, Saloner told MedPage Today that “stigma surrounding addiction is pervasive, and many individuals do not want to be identified as having an opioid use disorder. Second, cost of care is an important impediment to getting treated, especially as many opioid treatment programs do not accept Medicaid or other forms of public insurance.”

Saloner also said that locating treatment programs is very difficult in many areas of the country, and there are rural counties where people have to travel very far distances to go to a specialty treatment program.

In the accompanying editorial, Lewis Nelson, MD, of New York University School of Medicine, and two colleagues wrote that prescription of opioid analgesics for chronic pain factors into most nonmedical use of these drugs, and that more than 10% of patients who initiate treatment with opioids progress to chronic use.

“Nobody can reliably predict who will develop an opioid use disorder, or addiction, following short term use of opioids,” Nelson told MedPage Today. “But we know that even if the risk is small to an individual, when spread over a country the actual number of new initiates to nonmedical use is magnified.”

He noted that one way to control the increase in opioid and heroin abuse is to reduce the number of new opioid users where possible: “Before every prescription for an opioid analgesic is written, the healthcare provider and the patient have to rationally examine the known risks and potential benefits of such therapy and both be comfortable that it is the right decision,” said Nelson. “In studies and clinical practice, when patients are provided with information regarding the risks versus the benefits of opioids, many opt to forego the opioid.”

Nelson noted that most chronic pain does not respond optimally to opioids, and many patients can use better alternatives for chronic pain. “We have learned this the hard way over the past 20 years,” he said.

“There is virtually no data for safety or efficacy in chronic non-end-of-life pain, but patients are convinced that they need [opiate medications],” Nelson added. “These same patients often cannot stop due to the development of opioid withdrawal, which is associated with or interpreted as worsening of the underlying pain syndrome. This situation is very complicated and the debate will not likely be settled easily, but by scaling back the number of new initiates dramatically, the use of opioids in the U.S. will fall in line with the rest of the developed world.”

Limitations to the study reported in the research letter included the time frame of the analysis — therefore not reflecting any improvements brought on by the Mental Health Parity Act — as well as its reliance on self-reported data from survey respondents.

Filed under: General Problems