PHILADELPHIA— Methadone treatment for opioid use – which cuts the risk of death by overdose in half -- among individuals insured by Medicaid-insured increased substantially after 2010, according to a new Penn Medicine analysis.. But researchers say that since as few as a quarter of people with opioid use disorder receive medication treatment, the study highlights a need for expanded access.The research was published in JAMA Health Forum.
“These medications allow people to focus on rebuilding their lives: Finding housing, reconnecting with family, working, and managing other health conditions,” said the study’s co-author, Ashish Thakrar, MD, an assistant professor of General Internal Medicine in Penn’s Perelman School of Medicine. “In other words, these medications are not just symptom relief, but they are cornerstones to recovery. They are saving lives.”
In addition to significantly reducing the chance of death by opioid use disorder, treatment with medications like methadone and the related buprenorphine—which stabilize withdrawal symptoms and opioid cravings—have also been found to increase the likelihood that people will stick with their treatment plans.
In addition to the gains in methadone, buprenorphine prescriptions were also found to increase, though at a higher rate, likely due to ease of access.
Tracking the treatments
Analyzing de-identified national data from 1999 to 2020 on methadone and buprenorphine prescriptions from the Medicaid program, which covers nearly 40 percent of Americans living with opioid use disorder, the researchers found very little use of methadone in 1999. Buprenorphine was not approved for opioid use disorder until 2002.
By 2010, use of methadone and buprenorphine had increased modestly. Methadone use increased from 0.7 to 1.9 prescriptions per 1,000 Medicaid enrollees, and buprenorphine increased to 2.3 prescriptions per 1,000 enrollees through the decade.
A much larger increase in the use of both treatments was seen beginning around 2011, with buprenorphine taking off more than methadone. Methadone prescriptions rose steadily to 6.2 prescriptions per 1,000 enrollees by 2020, roughly tripling its number from 10 years prior. The researchers saw roughly five times more people using buprenorphine for opioid use disorder in 2020 compared to 2010, with the rate standing at 12 people having prescriptions for it per 1,000 Medicaid enrollees.
“Potential explanations for these increases include both the worsening of the opioid epidemic and efforts to increase access to the treatments because of their significant impact on saving lives,” said senior author Sean Hennessy, PharmD, PhD, a professor of Epidemiology.
An issue of access
Buprenorphine outpacing methadone’s increased use was not a surprising finding because it is much more easily accessed by the populations that need it: The medication can be prescribed by doctors in outpatient settings, including primary care.
Methadone, according to federal law, can only be dispensed and taken at certified opioid treatment programs.
“The regulation limits access to methadone, particularly in rural areas or urban spaces that lack adequate public transportation, and for people who might have some inflexible barriers like work or child care responsibilities,” said Thakrar said.
While both buprenorphine and methadone are effective treatments, people who start methadone are more likely to remain in treatment for at least six months, the minimum amount of time required to see benefits from these medications.
“It is also a more attractive treatment option for some patients with opioid addiction who fear the withdrawal that can occur when starting buprenorphine,” Thakrar explained.
In recent years, there have been signs of increased in government interest in expanding methadone access for opioid treatment. The Substance Abuse and Mental Health Services Administration (SAMSHA), an agency within the U.S. Department of Health and Human Services, recently allowed for more take-home methadone use. And legislation allowing for methadone to be prescribed by addiction specialists from outpatient clinics, the Modernizing Opioid Treatment Access Act, was introduced in both chambers of Congress in 2023.
The Senate version of the bill is on the legislative calendar, and the House of Representatives version was referred to the House Energy and Commerce Subcommittee on Health.
“This legislation could greatly expand access to methadone for opioid addiction because patients could access treatment from any clinical setting with an addiction specialist, not solely from licensed opioid treatment programs which have limited hours and space.” Thakrar said.
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Trends in Methadone Use for Pain and Opioid Use Disorder Among Medicaid Enrollees
PHILADELPHIA—Use of medications for mental health and behavioral conditions among children and young adults increased steadily for two decades, and about one in four young people taking these medicines were prescribed a combination that carries a risk of serious drug interactions, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. They published their findings in the Journal of the American Academy of Child & Adolescent Psychiatry.
The combinations of these medications—most commonly involving antidepressants and antipsychotics—can lead to dangerous conditions that include abnormal heart rhythms, excessive sedation, or dangerously elevated serotonin levels.
“While these medicines can be helpful, our research highlights the need for careful monitoring when multiple medications are used, more research on long-term safety, and better access to non-drug treatments like therapy,” said senior author Sean Hennessy, PharmD, PhD, a professor of Epidemiology, Systems Pharmacology, and Translational Therapeutics. “Families should have open dialogue with their clinicians to help weigh the benefits and risks of these prescriptions and ensure regular follow-up to keep treatment safe and effective.”
Greatest increases seen in youngest and oldest studied
Psychotropic medications include antidepressants, stimulants used for ADHD, antipsychotics, and medications for anxiety or mood disorders. Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) that was collected between 2001 and March 2020 to evaluate psychotropic medication use in children age 6 through young adults age 24.
Overall, use increased from 5.3 percent in the 2001-2004 time period to 8.3 percent in 2017-2020. The greatest increases were among children 6-11 years old and young adults 20-24 years old. Use among adolescents (12-19 years old) was relatively stable.
Use of stimulant medications, which typically treat attention deficit hyperactivity disorder (ADHD), nearly doubled —from 2.7 to 5.4 percent—over the study period. All medication categories examined saw an increase.
A rise in combinations with serious interaction risks
During the study period, the rate of people who were taking at least one psychotropic medication in combination with another medication almost doubled, climbing from 1.8 to 3.3 percent. Researchers discovered that 26 percent of the population surveyed were taking multiple medications associated with major drug to drug interactions, meaning these combinations are classified as having the potential to cause serious harm and typically require close monitoring, dose adjustment, or avoidance in the first place.
While there are systems in place designed to catch these cases, including regular medication checks at clinician visits and electronic prescribing systems that flag potential issues, the findings show that the “complexity of real-world care like when patients switch providers or get care from different clinics” remains difficult to manage and cause dangerous combinations to be missed, said lead author Lin-Chieh Meng, MS, a doctoral student in Epidemiology.
Half of those taking an antipsychotic medication, which treats conditions such as bipolar disorder or schizophrenia, were identified as being at risk of a potentially dangerous major interaction as a result of taking another medicine. And just under half of those taking antidepressants were also identified as having at least one major interaction.
At the same time, prescribing some combinations may be intentional, reflecting the need to adjust medication in the goal to provide patients relief. “Some of what we observed may be the most recent episode of a long line of unsuccessful treatment attempts,” said co-author David Mandell, ScD, a professor of Psychiatry and director of the Penn Center for Mental Health. “All medicine has tradeoffs and, as a mentor of mine says, ‘The brain doesn’t know the DSM. ’ In some cases, the risks associated with this may be worth the benefit, though it still should undergo a very high level of scrutiny.”
A potential solution and challenges ahead
The researchers noted that health insurers may be uniquely positioned to help identify high‑risk combinations.
“Insurers are in a unique position to address these concerns because they have access to all prescription fills and can track patients across transitions in care,” said co-author Molly Candon, PhD, an assistant professor in Psychiatry and an assistant professor of Health Care Management in the Wharton School.
Journal
Journal of the American Academy of Child & Adolescent Psychiatry
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Trends in Psychotropic Medication Use, Polypharmacy, and Potential Major Drug–Drug Interactions Among US Youth
