More Addictions Treated with Drug Therapy
Opioid abuse continues to rise, but more patients may be receiving drug treatment for their condition, researchers said.
Ambulatory visits for opioid use disorders rose six-fold between 2001-2003 and 2007-2009 (P=0.004), but treatment with pharmacotherapy rose at a similar rate (P<0.001), Joseph Frank, MD, of Brigham & Women’s Hospital, and colleagues wrote in a research letter in the Archives of Internal Medicine.
That increase was driven largely by greater use of buprenorphine (Subutex, Suboxone) to treat opioid addiction, they wrote.
Over the last decade, more treatment options for drug and alcohol abuse have become available, but the extent to which these agents have been used in traditional ambulatory care settings isn’t known.
So Frank and colleagues scanned the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2001 to 2009 for visits that included a diagnosis or complaint of alcohol or drug use disorder. They also assessed the use of pharmacotherapy with any of the five drugs indicated for alcohol or opioid use treatment—buprenorphine, methadone, acamprosate, disulfiram, and naltrexone—as well as the use of psychotherapy and counseling. In total, they reviewed 8,930 visits representing an estimated 42.2 million visits. They found that overall visits for substance abuse rose 70% during that time, from 10.6 million in 2001-2003 to 18 million in 2007-2009 (P=0.006). Specifically, visits for opioid abuse rose six-fold, from 772,000 to 4.4 million. In the beginning of that time period, opioid abuse accounted for 7% of all substance use disorder visits, but by the end of the study period, it accounted for a quarter (P=0.004). But the study “provides reason for optimism,” the researchers wrote, given that rates of physician prescribing of pharmacotherapy rose more than six-fold, from 643,000 visits in 2001-2003 to 3.9 million visits in 2007-2009 (P<0.001). That rise appears largely driven by greater clinician use of buprenorphine to treat opioid addiction, they reported, with scripts for buprenorphine or methadone written during 4.8 million visits, compared with 1.5 million visits ending in scripts for acamprosate, disulfiram, or naltrexone. Still, the overall use of pharmacotherapy accounted for only 15% of visits, they reported. Psychotherapy, on the other hand, was used in 59% of all visits. And neither therapy was provided in 36% of visits, they found. Andrew Kolodny, MD, chair of psychiatry at Maimonides Medical Center in New York, said treatment with buprenorphine is "still falling far short" of targets. "It's easier now to find doctors who can treat patients with buprenorphine," Kolodny told MedPage Today. "But it's still hard to find a doctor willing to take people's insurance." Although insurance companies will cover drug costs, reimbursement issues have made psychiatrists - who do the vast majority of buprenorphine prescribing, though it can be done in a primary care physician's office - hesitant to work with insurers. Thus, patients may have to pay out of pocket for clinic visits when they go to receive their drug treatment, he said.