Associate Professor Ferris State University Big Rapids, United States
Background: The opioid overdose epidemic has emerged as one of the most pressing public health crises of the 21st century, with devastating consequences for individuals, families, and communities worldwide. Medications play an essential role in the management of opioid use disorder, offering evidence-based approaches to reduce cravings, alleviate withdrawal symptoms, and facilitate recovery. However, it has been reported that access to MOUD is limited for those in need.
Objectives: To determine the rate of MOUD prescribing in ambulatory care settings in the US between 2014 and 2019. Patient demographics and prescriber specialty are described.
Methods: This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) from 2014 to 2019 (5-year combined; 2017 data is unavailable). The data includes patient-physician encounters in office-based ambulatory care settings in the US. The study dataset included encounters resulting in one or more MOUD prescriptions to patients aged at least 18 years. Naltrexone, buprenorphine, and buprenorphine-naloxone were included as MOUD. Sampling weights were applied to estimate national rates and 95% confidence intervals (95% CIs). The prescribing rate, patient demographics, and physician specialty were examined.
Results: Between 2014 and 2019, 0.8 out of 100 office visits included a MOUD prescription (95% CI 0.6 – 1.1 per 100). The rates fluctuated annually without displaying any discernible trends of either increase or decrease. Nearly 92% of all MOUD prescriptions were buprenorphine or buprenorphine-naloxone (95% CI 87 - 95%). Non-Hispanic White patients took up 88% of all MOUD prescribing visits, followed by Hispanic (8%), non-Hispanic Black (3%), and non-Hispanic other (1%). The average age of MOUD-receiving patients was 41.4 years (95% CI 38.8 – 44.1). Most were male patients (61%); however, when stratified by race/ethnicity, Hispanic females outnumbered Hispanic males (57% vs. 43%). Internal medicine (31%), psychiatry (24%), and general/family practice (23%) were the most common MOUD-prescribing physician specialties.
Conclusions: According to the CDC, the number of overdose deaths involving opioids rose from 28,647 in 2014 to 49,860 in 2019 (74% increase). However, our analysis suggests that the rate of MOUD distribution did not increase during the period. Also, there appeared to be variations in MOUD receipt based on race and sex. Despite the alarming surge in opioid-related deaths, our findings underscore the critical need for access to MOUD to effectively address the devastating impact of the opioid crisis across diverse demographics.
