Journal of Substance Abuse Treatment
January 31, 2019

As the nation grapples with the ongoing opioid crisis, the public health community had been working to expand access to much-needed treatment. But when opioid abuse coincides with mental illness -- as it often does -- less is known about the effect the dual diagnosis has on outcomes and what specialized treatment it might require.

Priscilla Novak and Jie Chen from the University of Maryland School of Public Health, along with researchers from Johns Hopkins University and the U.S. Department of Health and Human Services, investigated how the combination of mental illness and opioid use disorder affects the treatment of both issues. Their findings are published in the Journal of Substance Abuse Treatment.

The study found that many individuals suffering from both opioid use and mental health disorders receive treatment for neither, and that a significant proportion reported they needed mental health treatment but weren’t receiving it.

“Our study suggests that there are a lot of people who could benefit from treatment who aren’t getting it,” said Novak, who is a Management and Program Analyst at the U.S. Office of Personnel Management and a post-doctoral associate at the UMD School of Public Health.

Using data from a nationally representative survey, the researchers explored treatment utilization among those with opioid use disorder and different degrees of mental illness severity.

Nearly half — 47 percent — of those suffering from both opioid use disorder and mild-to-moderate mental illness were not receiving care for either issue. But as mental health problems increased in severity, patients were more likely to receive care. Among those with opioid use disorder and serious mental illness, just 21 percent received no treatment.

Though it’s encouraging that those with serious mental illness are more likely to receive treatment, “the results suggest that there is room for much improvement in coordination of substance use disorder and mental health treatment,” the study notes. This research is part of Associate Professor Jie Chen’s NIH-NIMH funded Hospital And Public health interdisciPlinarY research (HAPPY) Lab, which studies system-level care coordination among hospitals, communities, and public health agencies that can improve population mental health and reduce health disparities.

Many individuals reported an unmet need for mental health treatment, including sixty percent of those with serious mental illness.

The most common reason for forgoing treatment was affordability: more than half of patients reported it as a barrier to care, often because their insurance wouldn’t cover enough of the cost. Many patients also said they feared the stigma associated with treatment.

Among those receiving mental health care, the most popular form of treatment was prescription medication. Yet that medication can be problematic for those suffering from opioid use disorder, as existing research has found that certain medications can heighten the effects of opioid use, making lower doses more potent, the study reports.

Previous research has focused on behavioral health treatment among those with mental illness and substance use disorders more generally, but few have examined opioid abuse in particular.

The study, “Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey,” will be published in the Journal of Substance Abuse Treatment in March.

Novak and Chen authored the study alongside Kenneth A. Feder from the Johns Hopkins University Bloomberg School of Public Health and Mir M. Ali at the Office of the Assistant Secretary for Planning & Evaluation at the U.S. Department of Health & Human Services.

Related Links

Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness

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Priscilla Novak, Jie Chen