By Monica E. Oss, Chief Executive Officer, OPEN MINDS
New data provides some useful context to the current opioid epidemic. Of U.S. adults, almost 11% reported nonprescription opioid use within the past 12 months, according to Estimates Of Illicit Opioid Use In The US. This includes 7.5% of the population reporting using illicitly manufactured fentanyl (IMF) in the past 12 months. Illicit opioid use was higher among men, Black respondents, and younger age groups.
These findings suggest that illicit opioid use and, in particular, fentanyl use are more prevalent than previously estimated. There are many analyses of the National Survey on Drug Use and Health. One analysis found that in 2022, 3.7% of U.S. adults used opioids and needed opioid use disorder (OUD) treatment. Another analysis found that the prevalence of heroin use increased from 0.17% in 2002 to 0.32% in 2018.
Among those adults reporting nonprescription opioid use within the past 12 months, 39% reported that their first opioid use involved opioids prescribed to them, and 36% reported their first use involved prescription opioids not prescribed to them. Only 25% reported their first exposure involved illicit opioids. Of those using illicit opioids, almost 8% reported intentional use and a little over 3% reported unintentional use. For IMF, 4.95% reported intentional use and 2.57% reported unintentional use. Almost 5% of respondents reported it was very likely they would have an overdose due to opioid use. But this rate increased to 33% among those who had used fentanyl in the past 12 months.
The study authors noted, “This study underscores the importance of improved data collection methods to effectively address the opioid crisis because national estimates of rates of illicit opioid use are typically released with a considerable lag time and may be underreported… As the opioid crisis has evolved, attention to the role of prescription opioids has waned, even though overdose deaths from prescription opioids remain high and prescription opioids may operate as critical pathways to illicit opioid use.”
The findings have significant implications for health and human service provider organizations. Essentially, one in ten adults in any group of consumers have used opioids in the past year—and one in twenty are at high risk of overdose. And given the data on the total health care costs of consumers using opioids, addressing opioid use is important for success with any value-based contract. The data also points to the importance of opioid prescribing practices—with 75% of opioid users reporting that their first use was with prescription opioids.
As the health and human service system continues looking for ways to address both the need and the costs of OUD, Dr. Buttlaire notes that MAT is the “gold standard” of opioid treatment and a critical element of most clinical service lines. Dr. Buttlaire’s advice: consider offering full-spectrum MAT options, including buprenorphine, methadone, and naltrexone, and explore long-acting injectable innovations. He commented, “Integrated MAT across residential, partial hospitalization, and outpatient settings will become a key differentiator of clinical and financial success as payers move toward continuum-of-care reimbursement.”
Executives should also consider leveraging technology to integrate hybrid elements in service delivery—blending virtual, in-clinic, community-based, and in-home services. He commented that hybrid models increase convenience for consumers and clinical staff, reduce unit costs, and most importantly, improve access to services for both existing and new consumer groups. “The window is now for scaling virtual/hybrid substance use disorder programs with high-engagement digital tools, especially for rural or justice-involved populations,” Dr. Buttlaire said.
Finally, the increasing focus on whole person care models of care—particularly capitated behaviorally-led primary care models—requires attention to OUD. “Co-occurring medical and psychiatric complexity is the rule, not the exception,” said Dr. Buttlaire. “While the overall goal of these models is to provide comprehensive care that addresses physical, mental, and social well-being, it’s critical to target specific populations and then include enhanced screening, care coordination, and consumer engagement… Programs that combine SUD, behavioral health, and medical care—especially for pregnant women, transition-aged youth, and reentry populations—will see increased demand and funding… And with recent regulatory changes making buprenorphine prescribing more accessible, there’s an opportunity to rapidly scale MAT through primary care integration and training partnerships.”
I spoke to my colleague, OPEN MINDS Vice President of Clinical Excellence and Leadership, Stuart Buttlaire, Ph.D., about options for addressing consumers with opioid addiction problems. He outlined three strategic opportunities for provider organizations—medication-assisted treatment (MAT) for opioid use disorder (OUD), hybrid care models, and integrated care initiatives.
As the focus on integrated care and more value-based contracting continues to grow, Dr. Buttlaire had advice for specialty provider organization growth strategies—understand the potential value in partnerships, with both payers and other provider organizations, when seeking service solutions. “When it comes to market positioning, consider acquiring or partnering with programs that have payer-aligned models, strong medical/psychiatric integration, and proven outcomes in MAT delivery. The systems with the ability to measure engagement, retention, and functional outcomes—like return to work and reduced ED use—will be best positioned for success.”