In the battle against opioid addiction, most patients lack access to key treatment

Today, much of the conversation around opioid use focuses on ways to more tightly control access, including limits on usage and the mandatory use of databases that can alert physicians to patients’ opioid histories.

But for those suffering from Opioid Use Disorder (OUD), combatting addiction is a difficult feat, particularly due to treatment barriers, lack of qualified providers, and waitlists for evidence-based treatments.

Medication-Assisted Treatment (MAT) is an evidence-based treatment used to reduce OUD and overdose by decreasing opioid cravings and mitigating withdrawal. When combined with psychosocial intervention—a whole-health, evidence-based approach recommended by the National Institutes of Health—MAT empowers those suffering from OUD to recover from their addiction while rebuilding their lives.

However, access to MAT—which includes medications such as buprenorphine and naltrexone, both of which are approved by the U.S. Food and Drug Administration (FDA) for use in treating opioid addiction—is severely limited not due to a lack of supply, but a lack of certified MAT providers. As a result, many patients do not have access to this lifesaving treatment.

Barriers to MAT for Opioid Addiction

Prescribing MAT to those suffering from opioid addiction was a key solution recommended by the President’s Commission on Combating Drug Addiction and the Opioid Crisis this past November, following President Trump’s declaration of the opioid epidemic as a public health emergency. In order to be successful, it’s critical to recognize the numerous barriers to MAT access.

Much of the difficulty in treating patients suffering from OUD with MAT lies in the lack of physicians who are certified to administer this treatment. While more than 900,000 U.S. physicians can prescribe opioids, fewer than 32,000 physicians are licensed to prescribe buprenorphine. Many patients who do gain access to MAT often must visit private practice physicians who do not accept commercial insurance or Medicaid.

Becoming certified to prescribe buprenorphine requires physicians to take an eight-hour course, have certain specialty board certification, and then apply for a license. “What is a concern to me is that more physicians don’t feel the responsibility to step up [and get a license],” Melinda Campopiano, chief medical officer for the U.S. Department of Health and Human Services’ Center for Substance Abuse Treatment, told CBS News. But even among physicians who are licensed to prescribed buprenorphine, the majority do not prescribe it.

This suggests a high level of discomfort among physicians in prescribing evidence-based MAT and supportive psychosocial interventions. Some physicians do not believe their practices can support the needs of persons on MAT. Others may misunderstand the processes around starting MAT, and using it with treatments for other conditions like depression or PTSD. There is also the misconception among both medical providers and the public that use of buprenorphine and other types of MAT for OUD simply replaces one addiction with another.

Strategies for Increasing Access to MAT

It is clear that advancing access to MAT to support individuals in their recovery from OUD, in conjunction with psychosocial interventions such as individual therapies and peer recovery and support, is needed. Changing the perception of MAT will require leadership from physicians and healthcare organizations across the country, in addition to funding considerations.

For MAT to become a commonly recognized and prescribed form of treatment for opioid addiction, the following action steps are critical.

1. Expand networks of healthcare professionals and paraprofessionals who are trained in the use of MAT combined with psychosocial interventions. Research shows MAT combined with psychosocial interventions is superior to drug or psychosocial treatment on their own. Additionally, this approach significantly increases treatment adherence and reduces opioid misuse compared with nondrug approaches. By expanding and strengthening the professional workforce, including non-behavioral health providers, and the infrastructure for ensuring access to and availability of MAT, such treatment could be prescribed not only for patients who have been discharged from inpatient substance use treatment programs, but also for individuals receiving outpatient case management services.

2. Educate the healthcare community on MAT. In-depth education around evidence‐based MAT protocols is critical to addressing physicians’ pre‐conceived notions, which impact both access to treatment and recovery outcomes. By providing education with treatment and outcomes data for physician groups and hospital staff, such as through lunch-and-learn seminars, healthcare leaders not only will support improved outcomes for OUD patients, they will help to erase the stigma associated with prescribing such treatment. Presenting data that demonstrates the full impact of OUD in their communities is key to this education.

3. Use case managers to employ and support MAT protocols. This approach will reduce the possibility of relapse and/or readmission to a substance abuse inpatient or residential rehabilitation program.

4. Launch a community awareness campaign around opioid addiction and MAT. Use vehicles such as the hospital’s health and wellness magazine, posters in patient waiting rooms, and brochures in office lobbies to educate the community on how to spot the signs of addiction, the types of treatments available, and where to go for assistance. Elements of a community awareness campaign also could include:

• Information on the risks associated with opioids and step‐by‐step directions that minimize the chances of OUD or overdose
• Resources for individuals with OUD and other substance use disorders, including resources for patients who are uninsured or underinsured

5. Support the use of Certified Peer Recovery Specialists. Peer recovery may play a key role in ongoing support for persons with OUD. Health systems and health plans should employ certified peer recovery specialists and use these resources as part of the evidence-based approach to OUD treatment.

The Time for Action Is Now

Opioid misuse is a health crisis affecting communities all over the nation across a wide spectrum of social, racial and class boundaries, with opioid overdose standing as the leading cause of death in Americans under the age of 50. This is a public health emergency deserving of immediate and decisive action.

While public acknowledgment of the opioid crisis is an important step toward addressing the opioid epidemic and its impact, physician commitment to education and training around evidence-based MAT is critical to improving health, assisting patients in their recovery, and preventing relapse.

About the author
Dr. Caroline Carney is Chief Medical Officer, Magellan Healthcare.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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