Self-Reported Treatment Need and Barriers to Care for Adults With Opioid Use Disorder: The US National Survey on Drug Use and Health, 2015 to 2019

Abstract

Objectives. To explore barriers to care and characteristics associated with respondent-reported perceived need for opioid use disorder (OUD) treatment and National Survey on Drug Use and Health (NSDUH)‒defined OUD treatment gap. Methods. We performed a cross-sectional study using descriptive and multivariable logistic regression analyses to examine 2015-2019 NSDUH data. We included respondents aged 18 years or older with past-year OUD. Results. Of 1 987 961 adults, 10.5% reported a perceived OUD treatment need, and 71% had a NSDUH-defined treatment gap. There were significant differences in age distribution, health insurance coverage, and past-year mental illness between those with and without a perceived OUD treatment need. Older adults (aged ≥ 50 years) and non-White adults were more likely to have a treatment gap compared with younger adults (aged 18-49 years) and White adults, respectively. Conclusions. Fewer than 30% of adults with OUD receive treatment, and only 1 in 10 report a need for treatment, reflecting persistent structural barriers to care and differences in perceived care needs between patients with OUD and the NSDUH-defined treatment gap measure. Public Health Implications. Public health efforts aimed at broadening access to all forms of OUD treatment and harm reduction should be proactively undertaken. (Am J Public Health. 2022;112(2):284-295. https://doi.org/10.2105/AJPH.2021.306577).

FIGURE 1—

Flow Chart of Study Sample Selection: National Survey on Drug Use and Health (NSDUH), United States, 2015‒2019 Note. OUD = opioid use disorder. Weighted frequencies reported in figure; total number of NSDUH respondents, 2015–2019, unweighted n = 282 768; adults with past-year OUD, unweighted n = 2183; adults with OUD and past-year treatment gap, unweighted n = 1497; adults with OUD and no past-year treatment gap, unweighted n = 686; adults with OUD and past-year treatment need, unweighted n = 252; adults with OUD and no past-year treatment need, unweighted n = 1931; adults with past-year treatment gap and treatment need, unweighted n = 205; adults with past-year treatment gap and no treatment need, unweighted n = 1292; adults with no past-year treatment gap and with treatment need, unweighted n = 47; adults with no past-year treatment gap and no treatment need, unweighted n = 639; all adults classified as having OUD by NSDUH are also classified as needing treatment.