Less new opioid use, more treatment offer signs of hope in national survey

Last week's release of data from the 2017 National Survey on Drug Use and Health (NSDUH) offered some hope around progress in combating the opioid crisis, with decreases in several categories of use and increases in treatment episodes for opioid use disorders.

Still, the overall numbers indicate that the nation hasn't yet turned the corner on a staggering treatment gap for individuals with substance use disorders. Moreover, a presentation of the survey results from the Department of Health and Human Services' (HHS's) assistant secretary for mental health and substance use identified several populations about which there is growing concern, including pregnant women and youths transitioning to adulthood.

“We still have an epidemic,” Elinore McCance-Katz, MD, PhD, said in a taped video presentation released on Sept. 14.

A live press event that had been scheduled for that day to release the NSDUH results was canceled out of travel-related concerns resulting from Hurricane Florence, a spokesperson for the Substance Abuse and Mental Health Services Administration (SAMHSA) confirmed. McCance-Katz, who serves as SAMHSA's chief administrator, taped a presentstion in order to share information on the context for, and implications of, the latest data, according to SAMHSA.

Presenting much of the data in the form of a two-year comparison from 2015 to the new findings for 2017, McCance-Katz shared several encouraging developments regarding opioid use statistics:

• 11.4 million Americans reported past-year opioid misuse in 2017, down from 12.7 million reporting misuse in 2015. A total of around 11.1 million of these 11.4 million individuals reported misuse of prescription pain relievers.

• There was promising news in several indicators around prescription opioids. The 2017 survey showed a significant decline in hydrocodone misuse from 2016 levels. Also, the number of individuals with past-year prescription opioid use disorders has gradually declined since 2015.

• Past-year heroin use among all surveyed participants declined in 2017 after having increased in 2016, while the prevalence of past-year heroin use disorders is increasing. There has been a very steep decline in the number of new users of heroin, from 170,000 in 2016 to 81,000 in 2017. McCance-Katz said this speaks to public education efforts conducted within multiple agencies of the federal government and in partnership with states and communities.

Other data in the survey raise some red flags around opioids. With the numbers showing that more than half of individuals in their most recent episode of prescription opioid misuse received or took the medication from a friend or relative, “We still have a major problem in this country with prescribers overprescribing pain medications, to the point where people have enough of these drugs to share them,” McCance-Katz said in her presentation.

Also, when users of prescribed opioids were asked if they had ever used them in a way not directed by the prescriber in the past year, buprenorphine had the highest percentage of positive replies (31.7% of users).

The SAMHSA spokesperson this week clarified for Addiction Professional a comment in McCance-Katz's presentation that “people who have an opioid use disorder by definition cannot safely use these medications,” saying that the comment was intended to ensure that prescribers offer patients a proper dose of medications such as buprenorphine. The spokesperson reiterated SAMHSA's position that buprenorphine is useful and safe in the treatment of opioid use disorders.

More entering treatment

McCance-Katz reported that in 2017 the nation saw a significant increase in the number of individuals receiving treatment for an opioid use disorder, either in a specialty treatment setting or a physician's office. For individuals ages 12 and older with an opioid use disorder, 29.9% received treatment in 2017, compared with 22.5% in 2016 and 23.8% in 2015.

In fact, the two illegal drug categories for which the largest increases in the provision of treatment were seen were heroin and prescription opioids, McCance-Katz said.

Still, the overall percentages of people with substance use disorders who need treatment but don't receive it remain exceedingly high, and far above what is seen in the mental health community. The survey states that 92.3% of individuals ages 12 and older with a substance use disorder receive no treatment, compared with 57.4% of individuals with any mental illness and 33.3% of persons with a serious mental illness.

Other findings

Past-month substance use among pregnant women is rising considerably, the survey found. The prevelance of past-month alcohol use in this group in 2017 was 11.5%, compared with 8.3% in 2016. The prevalence of past-month illicit drug use in this population in 2017 was 8.5%, up from 6.3% in 2016. Marijuana is the most widely used illicit drug among pregnant women.

The 2017 NSDUH numbers also show some trends of concern around young people ages 18 to 25:

• This group saw a significant increase in alcohol use initiation, at the same time as the younger and older cohorts in the study experienced decreases.

• Past-month marijuana use among 18-to-25 year olds is increasing, with a 22.1% prevalence in 2017 vs. 19.8% in 2015.

• Increases in methamphetamine use are non-significant in most age groups but were significant in the 18-to-25 group in 2017.

• The prevalence of past-year suicidal thoughts, plans and attempts has continued to rise among young adults over the past decade.

The NSDUH is based on interviews with more than 60,000 adults and adolescents across the country. The data underestimate the prevalence of certain behavioral health problems to a degree, because the study sample does not include at-risk populations such as the incarcerated and homeless individuals not housed in shelters.