National outpatient medication utilization for opioid and alcohol use disorders from 2014 to 2016

Abstract

Background and aims: Research has recommended a combination of pharmacotherapy and behavioral therapy to treat opioid use disorder (OUD) or alcohol use disorder (AUD). The objective of this study was to estimate the prevalence of U.S. outpatient visits in which patients had a documented OUD or AUD and in what proportion of these visits the patient was receiving medication for OUD (MOUD) or AUD (MAUD), alone or in combination with behavioral therapy.

Design: Cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) from 2014 to 2016.

Setting: NAMCS provides national estimates based on the latest census data, for all U.S. outpatient medical visits.

Participants/cases: All visits involving patients aged ≥18 years with an OUD or AUD diagnosis.

Measurement: Medications for OUD included buprenorphine, buprenorphine/naloxone, or naltrexone; medications for AUD included acamprosate, disulfiram, or naltrexone. We defined behavioral therapy as provision of psychosocial therapy, mental health counseling, or stress management. We also compared annualized data between 2014 and 2016 using the Chi-square test.

Findings: From 2014 to 2016, NAMCS recorded nearly 2.3 billion adult outpatient visits, including 17.1 million and 21.7 million visits involving patients with an OUD or AUD diagnosis, respectively. From 2014 to 2016, a decreased prevalence of annual visits involved AUD (11.7 vs. 9.9/1000, P < 0.0001), while those for OUD increased (9.3 vs. 13.3/1000, P < 0.0001). Among office visits with an OUD diagnosis, a MOUD was documented in 14.2 million (83.1%) visits and behavioral therapy was provided in 4.4 million (25.6%). Among office visits with an AUD diagnosis, an MAUD was documented in approximately 800,000 (3.6%) and behavioral therapy in 5.4 million (24.8%).

Conclusion: These data highlight an opportunity to increase the use of MAUD and offer behavioral therapy to those with OUD and/or AUD.

Keywords: Alcohol use disorder; Behavioral therapy; National Ambulatory Medical Care Survey; Opioid use disorder; Pharmacotherapy.