Only a fraction of Medicare patients who have opioid use disorder receive opioid agonist therapy (OAT) with buprenorphine-naloxone (multiple brands), say US researchers, who found that nonspecialist physicians are the least likely to prescribe the drug.
The Medicare population of 55 million patients has one of the largest and fastest growing rates of opioid use disorder in the United States. More than 6 in 1000 Medicare patients are diagnosed with the disorder; this translates to more than 300,000 affected individuals. Moreover, 211,200 Medicare patients require hospitalization for opioid overuse every year.
Because Medicare Part D, which covers prescription drugs, does not pay for methadone maintenance, buprenorphine-naloxone is the only OAT that is covered for Medicare patients. It is the most effective pharmacotherapy for opioid addiction that is available for Medicare patients with opioid use disorder.
However, an analysis of claims data revealed that only about 81,000 Medicare patients are receiving buprenorphine-naloxone therapy and that the drug is prescribed by just 1 in 40 family physicians who prescribe an opioid painkiller. Moreover, it is rarely used by pain specialists.
“We believe this reflects a significant treatment gap, although we are limited in providing precise estimates; not all patients with an opioid use disorder warrant OAT, but on the other hand, opioid disorders are systematically underdiagnosed and increasing in prevalence,” study investigators Anna Lembke, MD, and Jonathan H. Chen, MD, PhD, of Stanford University School of Medicine, in California, write.
“To combat the current prescription opioid epidemic, integration and promotion of OAT should be encouraged, and not just among addiction medicine specialists, who are far too few to meet the current and projected need,” they add.
The research was published online July 20 in JAMA Psychiatry.