Addiction Treatment Eludes More Than Half of Americans in Need

The News

Roughly three in 10 adults have been addicted to opioids or have a family member who has been, and less than half of those with a substance use disorder have received treatment, according to a new survey conducted by KFF, a health policy research group.

The survey, which polled more than 1,300 adults in July, underscores the broad and often harmful influence of opioid addiction across the nation, which recorded around 110,000 fatal drug overdoses last year alone.

And the findings suggest that some proven medications for helping curb drug cravings, such as buprenorphine and methadone, are still not getting to those who need them. Only 25 percent of participants in the poll who said they or someone in their family had an opioid addiction reported receiving medication for themselves or family members.

Mollyann Brodie, the executive director of KFF’s polling program, said that the numbers might be an undercount, as some survey participants might have been hesitant to share histories of opioid addiction.

It was also possible, she added, that some people had their own ideas about what qualified as addiction. “It’s our best estimate based on people’s willingness to self-report,” she said.

Why It Matters: Opioid addiction affects every part of American society.

Addiction cuts across class, race and geography, the KFF researchers found. Rural and white Americans were the likeliest to report personal or family opioid addiction, but significant percentages of Black, Hispanic, urban and suburban families did, as well.

White families were more likely than Black or Hispanic families to say that they had received treatment. Overdose fatality rates among Black Americans have climbed substantially in recent years, the Centers for Disease Control and Prevention found in a study last year.

Low household income levels also appear to influence experience with addiction, KFF found. A higher percentage of households making less than $40,000 annually reported possible prescription painkiller, illegal drug and alcohol addiction, compared with households with higher incomes.

Addiction has also weighed on the psyche of families, the study found. A third of Americans fear that someone in their family will die of an opioid overdose, researchers discovered. Roughly four in 10 adults said that they were concerned a family member would unintentionally ingest fentanyl, a potent and deadly synthetic opioid that is often mixed into other drugs or counterfeit pills and that can go undetected.

Background: Recent efforts to make treatment more accessible have had limited success.

In December, Congress scrapped a special licensing requirement for health providers who want to prescribe buprenorphine, a medication that dulls cravings and prevents withdrawal, expanding the number of places drug users can seek treatment. But this year researchers found that less restrictive training requirements for health workers had not led to greater prescribing of the medication.

Federal researchers this month found that in 2021, only about 20 percent of the roughly 2.5 million people with opioid use disorder had received medication treatment, a problem that especially affects Black adults, women and the unemployed.

The reasons may be cultural and financial. KFF researchers published some anonymous responses from survey participants who were asked why they or a family member did not get treated. “We are not raised that way,” a 22-year-old Black woman in Georgia said.

“Lack of funding, no insurance coverage — turned away for treatment,” a 50-year-old white woman in South Carolina said.

More than 80 percent of the respondents said that naloxone, a medicine that can reverse an opioid overdose, should be readily available in places like bars and fire stations.

What’s Next: Getting treatment into more medical practices.

Dr. David Fiellin, an addiction physician at the Yale School of Medicine, said the survey showed the need for a stronger federal response to substance use disorders, akin to the one for AIDS. Primary care practices are especially critical to treating Americans, he noted.

“There’s often a misunderstanding of what treatment actually looks like and what it is — people often look to a quick fix,” he said, referring to a detox strategy. “Effective treatment tends to be much more long term and requires addressing the denial that can be part of the condition.”

President Biden this month requested $350 million from Congress to fund addiction treatment and other drug-related services across the country. The Biden administration and federal lawmakers also continue to search for ways to loosen restrictions on treatment.

Methadone, another opioid addiction medication that alleviates cravings, is heavily regulated and often difficult for drug users to access and use continuously, prompting repeated calls from addiction physicians and public health experts for easing restrictions.