Despite the significant rise in deaths from prescription painkillers and heroin over the past decade, only about 20 percent of people who suffer from opioid dependence and addiction are receiving treatment, according to a new study by Johns Hopkins Bloomberg School of Public Health.
Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled — more than 8,200 people died in 2013 alone, according to the Centers for Disease Control and Prevention. From 2001 to 2013, the rate of prescription drug-related overdose deaths more than doubled.
And while more money has been spent on treatment in recent years, the resources necessary to ensure wider access to treatment haven’t kept up with the explosive demand, say the researchers.
“We found that 80 percent of people with an opioid addiction are not getting treatment,” says study leader Brendan Saloner, Ph.D., an assistant professor in the Department of Health Policy and Management at the Bloomberg School. “This hasn’t changed, despite the growing and more complicated problem of opioid abuse and dependence.”
For the study, Saloner and Shankar Karthikeyan, a recent Master of Public Policy (MPP) graduate from the Bloomberg School, analyzed data from the National Survey of Drug Use and Health, a nationally representative survey of people ages 12 and older, to identify 6,770 people meeting clinical criteria for an opioid use disorder.
Participants self-reported that they were either physically dependent on opioids or that their use of opioids caused personal, financial, or legal problems. The researchers compared two time frames: From 2004 to 2008 and from 2009 to 2013.
The findings showed that approximately 20 percent of those with a drug use disorder were in treatment during each time period. Since opioid use rose so dramatically during this period, the actual number of people in treatment increased from about 293,000 individuals in 2004 to 473,000 individuals in 2013, nearly a 50 percent increase, Saloner says.
The percentage of this population using heroin jumped dramatically from 24 percent in the first time period to 35 percent in the latter one. It is widely believed that many people addicted to prescription painkillers like oxycontin are switching to heroin, which is a cheaper alternative.
One pressing problem is that some people do not have access to a drug treatment program in their area. Also, many state Medicaid programs restrict access to buprenorphine and methadone, medications for managing addiction to opioids. Saloner says they work by preventing the body’s physical withdrawal while also keeping users from becoming high. They can also help prevent overdose in people who experience a relapse.
“The real challenge in this is getting more people into settings where they can get methadone or buprenorphine,” says Saloner.
“We also need to think about changing the conversation about opioid addiction, which is a chronic relapsing illness, just like diabetes. Referring to drug users as junkies or criminals keeps people with addiction in the shadows and away from getting help. They may be open to treatment but they never seek it out because of the stigma associated with their addiction.”
He says that getting more people health insurance through the Affordable Care Act may also improve access to affordable treatment.
The findings are published in the Journal of the American Medical Association.