The opioid epidemic continues to cast a long shadow over public health, with its effects felt in every corner of society. Among Medicare enrollees, a vulnerable group often facing significant health challenges, the numbers highlight an alarming issue. According to a recent report from the Office of the Inspector General, Department of Health and Human Services, in 2023 alone, about 1.2 million Medicare enrollees were diagnosed with opioid use disorder (OUD). Yet strikingly, only 18.7% of them received medications to treat their condition. This reveals a persistent and troubling opioid treatment gap, despite incremental improvements in recent years.

Understanding the significance of the treatment gap

Opioid use disorder is a serious condition that can drastically affect an individual’s physical and mental health, relationships, and overall quality of life. Evidence strongly supports that medications like buprenorphine, methadone, and naltrexone constitute effective treatment options, often saving lives by preventing overdose and aiding recovery. However, with fewer than one in five Medicare enrollees receiving such medications in 2023, the scale of the opioid treatment gap is evident.

This low rate of treatment, which has seen only modest increases since 2020, highlights ongoing barriers to accessible care. Despite changes like the removal of the “X Waiver” in 2022—which had previously limited healthcare providers’ ability to prescribe buprenorphine to treat OUD—access to these vital medications remains worryingly limited for many.

Regional disparities in OUD treatment

Adding to the complexity of this issue are the stark regional disparities in access to medication for OUD. For example, states such as Florida, Texas, and Nevada are falling significantly short of the national average, with less than 10% of Medicare enrollees with OUD receiving medications.

Conversely, states in the Northeast, including Vermont (60%), Maine (51%), Massachusetts (50%), and New Hampshire (43%), are leading the way in addressing the treatment gap. These figures suggest notable differences in healthcare infrastructure, policies, and provider availability across states.

Why access remains a challenge

The persistent challenges to accessing medication for OUD are multi-faceted. Key issues include:

• Limited provider availability: Even with the removal of the X Waiver, a limited number of providers are available or willing to prescribe medications for OUD in some regions.
• Stigma and misconceptions: Many patients and providers still struggle with stigma surrounding opioid addiction and its treatment, discouraging open discussions and timely intervention.
• Geographic inequalities: Rural areas, in particular, often lack the necessary local treatment centres or qualified healthcare professionals to address OUD effectively.

What progress has been made

While the progress may be slow, there has been a noted increase in the percentage of Medicare enrollees receiving treatment over the last few years. The data shows a gradual rise from 15.9% in 2020 to 18.7% in 2023. More recently, federal initiatives to promote the use of overdose reversal drugs like naloxone have also gained traction, likely saving thousands of lives.

Nevertheless, this progress is not enough. The report underlines the ongoing need for proactive measures from the Centers for Medicare and Medicaid Services (CMS) to ensure equitable access to medications for OUD and overdose-reversal drugs nationwide.

Source: Friday Fact: Medicare Enrollees Struggle to Receive Treatment for Opioid Use Disorder