When the coronavirus pandemic arrived in the U.S. in February 2020, most people were unsure what that would mean for their daily behavior. When COVID-19 spread nationwide and rats of infection and death increased, federal, state, and local governments enacted a series of public safety measures that disrupted daily life for millions of people.
At the time, addiction professionals predicted negative consequences for people in substance use disorder (SUD) treatment if the more restrictive rules and regulations around treatment receipt and delivery were changed or eased to accommodate the new, default status quo. They were particularly concerned about people with opioid use disorder (OUD) in medication-assisted treatment (MAT) programs required to access medication for opioid use disorder (MOUD) and treatment in-person. The emergency public health guidelines created a situation where some patients would be unable to access medication and treatment, which, experts predicted, could increase chances of relapse and fatal overdose.
Thankfully, the authorities listened. They changed important rules and regulations in order to keep people in treatment and remove barriers to treatment with new SUD diagnoses, and specifically eased rules on initiating and accessing MOUD for people with OUD in MAT programs.
- Expanding telehealth services
- Changing prescribing rules for MOUD
- Allowing more take-home doses of MOUDs
- Allowing initiation of MAT via virtual/telehealth
To read more about the federal response to COVID-19 with regards to MAT and MOUD for people with OUD, please navigate to the blog section of our website and read this article:
Critics of these changes argued that increased access to MOUDs would increase diversion of MOUDs for illicit purposes, and drive up misuse and overdose fatalities. However, this didn’t happen. We document this in an article here:
Spoiler alert: increasing access to buprenorphine did not result in an increase in buprenorphine-related overdose or overdose fatalities. On the contrary, increasing access to MOUD for people in MAT programs saves lives, rather than puts them at risk, and increases overall community safety by reducing criminal behavior associated with OUD.
To learn more about the benefits of medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD), please read our MAT treatment page here:
That article will tell you how we approach MAT for OUD in our nationwide network of treatment centers. This article will discuss findings published in a recent study that examined the impact of the COVID-19 era rules on treatment with medications for opioid use disorder (MOUD).
Substance Use Disorder (SUD), Opioid Use Disorder (OUD), and MAT with MOUD in 2021
Released in August 2023, the paper “Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021” used data from the 2021 National Survey on Drug Use and Health (2021 NSDUH) to assess the use of MOUDs in the context of the regulations in place at the time. That year – 2021 – was novel because it included the period during the pandemic but before the release of the vaccine.
Since most of 2021 occurred during the height of the crisis, researchers wanted to know – given the special circumstances – how many people engaged in treatment with MOUD, and what factors may have impacted their treatment during that time of heightened anxiety, uncertainty, and worry over the ultimate outcome and resolution of the pandemic.
To that end, they analyzed data from 47,291 adults age 18+ with opioid use disorder (OUD) to determine:
- Receipt of MOUD/MAT for opioid use disorder
- Impact of substance use
- Impact of mental health/mental illness variables
- Effect of sociodemographic characteristics
Before we look at that data, let’s look at the big-picture numbers for 2021, in order to understand where MAT and MOUD fit in the general, nationwide SUD and SUD treatment situation.
SUD in 2021: Adults 18+
- SUD, past-year diagnosis: 1 million
- Needed SUD treatment: 41 million
- Received any SUD Treatment: 4.03 million
- The treatment gap for SUD: 91% of people with SUD did not get SUD treatment
That’s the big picture for adults 18+. Note the significant treatment gap, or the difference between the number of people who needed SUD treatment and the number of people who received SUD treatment. Data shows an enormous gap of 91 percent: that’s a problem we need to address.
Now let’s look at opioid use disorder (OUD) and treatment for OUD among people age 12+ and learn whether there’s a similar treatment gap for people with OUD.
Medication-Assisted Treatment for OUD, Total Age 12+
- Past-year OUD diagnosis: 5.6 million
- Receipt of any OUD treatment: 1.2 million (21%)
- Received MAT for OUD: 533,000 (9%)
- Received MAT for opioid use, with no OUD diagnosis: 1.1 million (19.6%)
- Receipt of MAT for opioid misuse: 887,000 (15%)
Those figures reveal another significant – and troubling – treatment gap: close to 80-85 percent for people with OUD for treatment overall and over 90 percent for people with OUD for MAT with MOUD. That sets the scenario for the information we’ll share below, from the study we introduce above.
MAT with MOUD Among Adults 18+
First, let’s look at the data researchers collected on adults with opioid use disorder (OUD):
- 5 million adults reported OUD in the past year
- 52% male
- 48% female
- Age groups:
- 67% age 35+
- 61% White
- 39% Non-White Hispanic or Black
- 58% large metropolitan areas
- 42% rural/small metropolitan areas
Now let’s look at the rates of treatment for OUD among adults with past-year OUD:
- Any past-year SUD treatment: 35.6%
- Past year MOUD treatment: 22.3%
- Among those who received MOUD:
- Males: 58.5%
- Age 35+: 61.7%
- 1% White
- 9% Non-White Hispanic or Black
- Environment: 57.7% large metropolitan areas
Next, let’s look at factors the researchers identified as either increasing or decreasing likelihood of receiving MOUD for OUD in MAT programs:
- Severe OUD diagnosis: 29% increased likelihood of receiving MOUD compared to mild OUD
- Moderate OUD diagnosis: 445% increased likelihood of receiving MOUD compared to mild OUD
- Past-year co-occurring cannabis use disorder and past year co-occurring alcohol use disorder: decreased likelihood of receiving MOUD for OUD by 76% and 83%, respectively
- Past-year other illicit drug use disorder: 48% increased likelihood of receiving MOUD
- Female gender: 83% decreased likelihood of receiving MOUD
- Non-Hispanic Black: 93% decreased likelihood of receiving MOUD
- Employment status: compared to people with full employment, data showed a 93% decreased likelihood for unemployed people and a 78% decreased likelihood for people employed part-time
- Environment: compared to people living in large metropolitan areas, data showed a 38% decreased likelihood for people living in small metropolitan areas, and a 69% decreased likelihood for people living in a rural/non-metropolitan area
We saved one finding for last:
Patients with OUD who engaged in SUD treatment via telehealth showed a 3,678% increased likelihood of receiving MOUD, compared to people who did not receive SUD treatment via telehealth.
We interpret that as a positive: expanded telehealth use during COVID-19 was associated with a significantly higher rate of treatment with MOUD.
How This Data Helps Us Help Our Patients With OUD
The study authors state the primary takeaway from this research clearly:
“Despite the well-documented effectiveness of MOUD, our findings suggest that MOUD remains substantially underused.”
By “well-documented effectiveness,” they mean decades of evidence show medication-assisted treatment (MAT) with MOUDs is the gold standard treatment for opioid use disorder (OUD). The benefits of MAT with MOUD include:
- Decreased opioid use
- Increased time-in-treatment
- Decreased risk of relapse
- Increased psychosocial functioning
- Decreased risk of fatal overdose
- Increased ability to seek and secure employment
- Decreased criminal behavior associated with opioid seeking/opioid use
- Decreased premature mortality
We’ve known about these benefits for literally decades, yet these medications still go underused. To reiterate, this study showed that close to 80 percent of adults over age 18 received MOUD for MAT. That treatment gap is unacceptable when we know about the benefits, especially the benefit we identify in the final bullet point above: people with OUD who engage in MAT with MOUD are more likely to stay alive than people who don’t.
That’s why experts call MAT and MOUD lifesaving approaches to OUD treatment.
In addition to the large treatment gap, we’ll also note that several groups are at decreased risk of receiving MOUD:
- Women receive MOUD at lower rates than men
- Black and Hispanic people receive MOUD at lower rates White people
- Unemployed people receive MOUD at lower rates employed people
- People in rural areas receive MOUD at lower rates than people in large metropolitan areas
We’ll close this article with more insight from the study authors:
“Addressing disparities in MOUD uptake should be prioritized in program, policy, and clinical initiatives… Future research should examine whether removal of the X-waiver in the US in 2023, along with other efforts to expand MOUD, will help close the treatment gap.”
We can add one more thing. This data teaches us that we, as clinicians and treatment providers, should redouble our efforts to examine any unconscious or implicit bias in our OUD treatment efforts. We work every day to ensure we treat everyone equitably. We hope to lead the way for other treatment providers, and demonstrate that it’s possible to meet people where they are, offer the treatment they need in the way they’ll accept it, and provide the gold-standard treatment – MAT with MOUD – to anyone with OUD who decides to commit to long-term, sustainable recovery.