Associations Between Polysubstance Use Patterns and Receipt of Medications for Opioid Use Disorder Among Adults in Treatment for Opioid Use Disorder

Source:

Ford, B. R., Bart, G., Grahan, B., Shearer, R. D., & Winkelman, T. N. (2020). Associations Between Polysubstance Use Patterns and Receipt of Medications for Opioid Use Disorder Among Adults in Treatment for Opioid Use Disorder. Journal of Addiction Medicine.

Abstract

Objective: 

To examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD).

Methods: 

We conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (N = 9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine).

Results: 

Between 1992 and 2017, treatment admissions involving opioid/cocaine (−17.2 percentage points [PP]) and opioid/alcohol co-use (−12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4–38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6–35.9), methamphetamine (23.9%; 95% CI 23.7–24.2), alcohol (25.0%; 95% CI 24.8–25.2), or benzodiazepines (34.6%; 95% CI 34.3–34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017.

Conclusions: 

Opioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.