Caution Is Necessary When Estimating Treatment Need for Opioid Use Disorder Using National Surveys

ABSTRACT

Heroin use in particular is thought to be severely underestimated by NSDUH largely because heroin use is a rare and particularly stigmatized behavior concentrated in hard-to-reach populations, whereas NSDUH aims to assess drug use trends in the general population.6 NSDUH also does not include certain populations in its sampling frame that may be more likely to experience OUD, including unstably housed individuals not living in shelters and incarcerated individuals.6,7 In addition, as noted by Saini et al., NSDUH does not ask questions about illicitly manufactured fentanyl use- intentional use or unintentional use via exposure as an adulterant or contaminant in substances such as cocaine and methamphetamine.8 The exclusion of fentanyl, its analogs, and other new synthetic opioids (e.g., U-47700) from NSDUH is particularly troubling given the shifting overdose epidemic, with rapidly increasing fentanyl-involved fatal overdoses and declining nonprescription opioid- and heroin-involved fatal overdoses.8,9 The absence of measures of fentanyl and novel opioids might affect prevalence estimates of opioid use and OUD in the general population. [...]prevalence estimates of past-year opioid (mis)use may be underestimated in NSDUH, potentially biasing population estimates of OUD and associated treatment needs. Physicians in outpatient nonspecialty settings were authorized to prescribe buprenorphine after receipt of training and a waiver issued by the Substance Abuse and Mental Health Services Administration with limits on the types of providers eligible to prescribe buprenorphine and the number of patients at a time to whom a provider could prescribe buprenorphine.10 Some of these strictures have been loosened to prevent coronavirus disease 2019 transmission (e.g., buprenorphine initiation via telehealth for new patients, 28-day medication supplies for established patients), but implementation of these policies across municipalities has been inconsistent.11 Understanding the prevalence of individual structural barriers to treatment access could have important implications for policy planning and expanded delivery of OUD treatment services. ACKNOWLEDGMENTS Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers R01DA044207, R01DA045872, and K01DA049900.