prevent relapse in clients with opioid use disorder following medical withdrawal management from opioids. Extended-release injectable naltrexone may be prescribed by any individual who is licensed to prescribe medication (e.g., physician, physician assistant, nurse practitioner) or order administration by qualified staff. 

The National Survey of Substance Abuse Treatment Services (N-SSATS), an annual, national survey of all known substance abuse treatment facilities, both public and private, provides information on the numbers of facilities that provide medication-assisted treatment with methadone, buprenorphine, and/or naltrexone, as well as on the numbers of clients receiving these medications. This report updates the trends⁷ in the use of methadone and buprenorphine, and adds to those trends by including the use of extended-release, injectable naltrexone in the treatment of opioid use disorder in substance abuse treatment facilities. This report includes data from OTPs as well as facilities that did not have OTPs (hereafter referred to as “non-OTP facilities”). It does not include data from private physicians who are not affiliated with a substance abuse treatment program or facility.

With the introduction of buprenorphine at the end of 2002, OTPs and non-OTP facilities with a specially trained physician on staff began offering MAT for opioid use disorder with buprenorphine.  The number of OTPs offering buprenorphine increased from 11 percent of OTPs in 2003 (121 OTPs) to 58 percent of OTPs in 2015 (779 OTPs) (Figure 3).  Among non-OTP facilities, in 2003, about 5 percent (620 facilities) offered buprenorphine services; by 2015, the percentage of non-OTP facilities that offered buprenorphine services had increased to 21 percent (2,625 facilities) (Figure 4).

Likewise, the numbers of clients receiving buprenorphine at substance abuse treatment facilities on the survey reference date increased during this period. At OTPs, the number of clients increased from 727 clients in 2004, the first year N-SSATS collected buprenorphine client counts, to 21,236 clients in 2015; at non-OTPs, the number increased from 1,670 clients in 2004 to 54,488 clients in 2015 (Figure 5).  These buprenorphine numbers include only those clients who received their buprenorphine through a DATA 2000 waivered physician affiliated with a facility; it does not include any clients who received buprenorphine through an independent DATA 2000 waivered physician.

Extended-release injectable naltrexone for the use of relapse prevention in the treatment of opioid use disorder was approved in late 2010. In 2011, facilities were first asked in N-SSATS if they provided extended-release, injectable naltrexone services. A total of 11 percent (125) of facilities with OTPs and 8 percent (968) of facilities without OTPs offered extended-release, injectable naltrexone services in 2011, whereas 23 percent (315) of facilities with OTPs and 16 percent (1,959) of facilities without OTPs offered these services in 2015. 

N-SSATS first collected client counts for extended-release, injectable naltrexone usage in 2013. In 2013, 359 clients in facilities with OTPs and 3,422 clients in facilities without OTPs received extended-release, injectable naltrexone services, and in 2015, a total of 712 clients in facilities with OTPs and 6,323 clients in facilities without OTPs received these services (Figure 5). Again, these numbers include only those clients who received their naltrexone services through a treatment facility, not though an independent medical professional.

Opioid use disorder, whether to heroin or prescription pain relievers, is a serious, life-threatening medical condition.  Methadone and buprenorphine are medications that permit individuals with addiction to function normally within their families, jobs, and communities. While treatment with methadone is more established, it requires daily visits to an OTP. Not all individuals who could benefit from methadone treatment live within easy travelling distance of an OTP. Furthermore, the requirement for daily visits can interfere with jobs and other important activities. The use of buprenorphine for the treatment of opioid use disorder provides an alternative to methadone treatment for some individuals;

however, buprenorphine may not be appropriate for all persons with opioid addiction.  The dramatic increase in the number of clients receiving buprenorphine through treatment facilities is an indication of the demand for safe and effective medications for the treatment of opioid use disorder in the context of a broader treatment program. Furthermore, the introduction of extended-release, injectable naltrexone further increases the opportunities for those with opioid use disorder on their paths towards recovery.

1. Substance Abuse and Mental Health Services Administration. (2015).  National Survey on Drug Use and Health. Unpublished table. Rockville, MD.

2. Mental Health and Drug & Alcohol Office, New South Wales Department of Health. (2008). NSW drug and alcohol withdrawal clinical practice guidelines (SHPN [MHDAO] 070083).  Retrieved from http://www0.health.nsw.gov.au/policies/gl/2008/pdf/gl2008)011.pdf

3. An opioid agonist is a drug that activates the opioid (mu) receptors on nerve cells in the brain.  A full agonist (methadone) continues to produce effects on the receptors until all receptors are fully activated or until the maximum effect is reached resulting in a relief of cravings, blocking of the euphoric effects associated with heroin and other opioids, and preventing withdrawal.  A partial agonist (such as buprenorphine) activates the mu receptors, but not to the same extent as a full agonist; the effects increase until a plateau is reached.  Once a plateau is reached and maintained, those with opioid addiction will not experience withdrawal symptoms.  An opioid antagonist (such as naltrexone) binds to the opioid receptors with greater affinity than agonists, but does not activate the receptors; they block the receptor; therefore, preventing the neurons from responding to opioids, effectively blocking the effects of opioids.  The result is a reversal of the effects of opioids and is used in the management of opioid use disorder to aid in the prevention of relapse.

4. Center for Substance Abuse Treatment. (2005). Medication-assisted treatment for opioid addiction in opioid treatment programs. Treatment Improvement Protocol (TIP) Series 43 (Rev. ed.; HHS Publication No. SMA 12-4214). Rockville, MD: Substance Abuse and Mental Health Services Administration.

5. Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—Tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063–2066.

6. Maintenance treatment involves the substitution of a long-acting orally administered opioid, such as methadone, for the shorter-acting opioids, such as heroin, that are usually injected.  Because methadone is long-acting, it may be taken once a day.  It eliminates withdrawal symptoms for 24 to36 hours.

7. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.  (April 23, 2013). The N-SSATS Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003-2011. Rockville, MD.

8. The increase in the number of OTPs reporting to the N-SSATS appears to be a combination of an actual increase in OTPs coupled with better identification of OTPs in the survey and response to the survey.  As N-SSATS is a voluntary survey, not all OTPs respond to the N-SSATS; numbers reported in this report include only those OTPs that responded to the N-SSATS.  The actual number of OTPs on December 17, 2016 (1,482 OTPs) was obtained from the master list of certified OTPs maintained by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.

9. The number of clients receiving methadone, buprenorphine, or injectable naltrexone on the survey reference date refers to the number of clients receiving methadone, buprenorphine, or extended-release, injectable naltrexone at a residential or hospital inpatient facility on the date of the last weekday in March and the number of clients who received methadone, buprenorphine, or extended release naltrexone at an outpatient facility during the month of March and who were still enrolled in treatment on the last weekday of March.

Alderks, C.E., Trends in the Use of Methadone, Buprenorphine, and Extended-release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update). The CBHSQ Report: August 22, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.