With more than 6 million people in the U.S. suffering from opioid use disorder, methods to treat addiction and its fallout are sorely needed.
But the most evidence-based treatment method—medication for opioid use disorder—is significantly underused. A new study led by researchers at Yale School of Medicine (YSM) and published Nov. 13 in the journal JAMA Network Open found that fewer than half of psychiatric hospitals in the U.S. have such medications available for their patients.
That’s important because there is a significant overlap between patients with opioid use disorder and psychiatric disorders. For example, research has shown that more than a third of treatment-seeking patients with opioid use disorder have a psychiatric disorder as well, such as depression, anxiety, or bipolar disorder. This means that patients at psychiatric hospitals are even more likely to need opioid addiction treatment than the general population.
The FDA-approved medications for treating opioid use disorder are buprenorphine, methadone, and naltrexone. Studies have shown that buprenorphine and methadone reduce risk of death from overdose by 50% or more, and the medications are generally safe and help patients reduce their use of opioids. Buprenorphine and methadone are themselves opioids and act on the brain’s opioid receptors, reducing cravings and protecting people from overdose and death. Naltrexone acts by blocking the receptors’ action, preventing reward-associated feelings that can occur when taking opioids.
“These are incredible, lifesaving medications for opioid use disorder,” said Shawn Cohen, MD, an assistant professor of medicine at YSM and addiction medicine specialist who co-led the study. “Our goal is that people should be able to access these evidence-based treatments wherever they interact with the medical system.”
Cohen, a consulting doctor for Yale New Haven Hospital’s Yale Addiction Medicine Consult Service, teamed up with Srinivas Muvvala, MD, associate professor of psychiatry; David Fiellin, MD, professor of medicine and director of the program in addiction medicine; and Tamara Beetham, a doctoral student at the Yale School of Public Health, to explore the subject.
The researchers used data from a national survey of substance use and mental health treatment facilities. Of the 1,021 psychiatric hospitals that responded to the survey and reported whether they use medications for opioid use disorder, only 490 reported having these treatments available. Cohen pointed out that the survey only asked whether any of the three medications are available at the facility, not how regularly they are offered to patients, so the actual use of these treatments at psychiatric hospitals could be even lower.
The survey results don’t capture why these medications are so commonly unavailable at psychiatric hospitals, but the researchers postulated that a combination of stigma and lack of provider education might be at fault. Although methadone and buprenorphine are highly regulated (naltrexone has fewer regulations), these medications are easier to prescribe in hospitals than in outpatient settings, which not all providers may realize. And outdated perceptions that addiction must be overcome through willpower alone may prevent providers from offering these medications.
Although medications for opioid use disorder are also available in outpatient clinics, making them more available in psychiatric hospitals could give access to patients who are hospitalized for other reasons and may not seek out these medications. Research also shows that if these medications are started in the hospital setting, patients are more likely to connect with outpatient care, Muvvala said.
“We are missing an opportunity to intervene and change the course of the illness by initiating treatment when patients are in the hospital,” Muvvala said. “This discussion doesn’t happen with other treatments. We don’t discuss whether we should start diabetes or hypertension medications for patients, but when it comes to addiction treatment, stigma and bias can prevent providers from recognizing that this is a condition that can be treated.”