Receiving medication-assisted treatment, even for as short as several months, is likely to save the lives of Veterans with opioid use disorder, according to a new Stanford-led study.
More than 1.6 million people suffer from opioid use disorder (OUD) in the United States, yet more than 80% of people with OUD do not receive medication-assisted treatment for a condition that claims tens of thousands of lives each year. The epidemic continues to climb, with overdose deaths rising from 21,088 in 2010 to 49,860 deaths in 2019.
“Individuals with OUD have up to 20 times greater risk of dying early from overdose, trauma or suicide — and face significant burdens of co-morbid mental health disorders, other substance use disorders, and infectious diseases compared to individuals without OUD,” writes Jack Ching, lead author of a study published May 17 in the journal Addiction.
The largest provider of treatment for substance use disorder in the United States is the Veterans Health Administration (VA), with the prevalence of opioid use disorder among VA enrollees steadily increasing. In 2017, an estimated 69,230 veterans with diagnosed OUD received care at the VA — or about 1.2% of all veterans who got VA care that year.
The researchers modeled the mortality outcomes for veterans with OUD receiving varying durations of treatment. They found that veterans receiving medications approved to treat addiction for 2 to 4 months had up to 65 fewer deaths over 12 months than those veterans who received no medication-assisted treatment.
“Because of the potential mortality risks associated with starting and stopping OUD treatment, it is important to understand how long someone needs to remain in treatment for the benefits to outweigh the risks,” said Ching, a PhD student at Stanford Health Policy who focuses on health systems design, health-care delivery and implementation science.
These findings were consistent for a non-VA population, the researchers said, as well as across a range of different assumptions about the effectiveness of treatment.
Ching, a PhD student at Stanford Health Policy, published his findings with SHP Director Douglas K. Owens, Ching’s thesis advisor, and SHP faculty members Jeremy Goldhaber-Fiebert and senior author Joshua Salomon, both of whom are on Ching’s dissertation committee. Their other co-author was Jodie A. Trafton, an assistant clinical professor (affiliated) in the Stanford Department of Psychiatry and Behavior Sciences, who is also the director of the Program Evaluation and Resource Center at the Office of Mental Health and Suicide Prevention with the VA.
The Addiction study is part of an effort by a team of decision scientists at Stanford to develop scientific models to inform health policy decisions that could combat the epidemic. Owens and colleagues at the VA recently led a project, for example, which found that expanding access to a treatment that combines medication and counseling for opioid addiction would generate significant cost savings while also saving many lives.
The team for the Addiction study noted that even though medication-assisted treatment of opioid use disorder is highly effective and endorsed by clinical practice guidelines, many social stigmas and prescription restrictions prevent treatment from being widely accessible to those with OUD in the general population.
“These hurdles, which include restrictive eligibility criteria, mandatory reporting to law enforcement, lack of supervised dosing and mandatory urine drug screening — all create barriers for treatment access and retention,” the author write.
“Our results suggest that initiating MAT among individuals with OUD remains an important way to reduce mortality in this population even if treatment durations are relatively modest,” the authors wrote. Because the treatments are so effective, even fairly short durations of treatment — such as six months — are likely to save lives.
The opioid epidemic is threatening the hard-fought gains in the prevention and control of HIV and hepatitis C virus (HCV). Stanford Health Policy's Douglas K. Owens leads a team of decision scientists who received a highly prestigious NIH MERIT award to tackle the issue.