The United States is facing an epidemic of drug overdose deaths, with more people dying from overdose deaths in 2014 than in any year on record, according to the Centers for Disease Control and Prevention. And more than 60 percent of the country’s drug overdose deaths involve an opioid, including both prescription opioids and heroin.
Scientific research and physicians agree, Medication-Assisted-Treatment (MAT), or the use of medications in combination with counseling and behavioral therapies, is key to tackling the country’s opioid epidemic. Yet as overdose deaths rise, MAT remains severely underutilized.
Many roadblocks stand in the way of MAT including limited availability of the treatment and stigma. Fewer than 4 percent of practicing physicians have licenses to prescribe buprenorphine (often sold under the brand name Suboxone), which is one of three drugs approved by the FDA for the treatment of opioid dependence. And the number of prescriptions a physician can write is restricted by the federal government.
Although the U.S. Health and Human Services lifted the patient cap on the number of patients an individual physician can treat for opioid dependence with buprenorphine, from 100 patients to 275 in September, this effective weapon for fighting opioid addiction is not being used to its full potential.
A study released in the Journal of the American Medical Association last month found that physicians authorized to prescribe buprenorphine tend to prescribe the drug to significantly fewer patients than they are authorized to treat. More than 20 percent of buprenorphine-prescribing physicians treated 3 or fewer patients per month, which was significantly below the 100-patient cap at the time of the study, and fewer than 10 percent of physicians treated more than 75 patients per month.
A common refrain among some communities is the seemingly counterintuitive notion of treating drug addiction with another drug. Most treatment programs for substance use disorders in the U.S. do not offer evidence-based care, including MAT, and many favor abstinence-only approaches to addiction based on outdated ideologies. Curbing the nation’s opioid epidemic will require overcoming a history of abstinence-only treatment for addiction and adopting new models of care.
Limited coverage is another barrier to MAT. Only 28 states cover all three FDA-approved medications for the treatment of opioid dependence under Medicaid, and the vast majority of states require prior authorization in order to obtain buprenorphine to treat opioid dependence. Private insurers, likewise, often require patients and physicians to jump through hoops to receive coverage for drugs that treat opioid addiction.
And yet there is ample evidence and extensive research establishing MAT as the standard of care in treating addiction. According to the National Institute on Drug Abuse and a sampling of scientific literature, MAT for opioid addiction is associated with decreases in the number of overdoses from heroin abuse, increases retention of patients in treatment, and decreases drug use.
Furthermore, eliminating gaps in coverage of this treatment could provide cost savings. Opioid-related hospitalizations rose 72 percent between 2002 and 2012, and the costs associated with this increase had a significant impact on the U.S. health care system. Total inpatient charges for opioid-related hospitalizations reached $15 billion in 2012---nearly quadruple the total inpatient charges related to opioids in 2002.
Medication-assisted treatment is a key part of the Obama administration’s strategy to address the nation’s opioid epidemic. In August, U.S. Department of Health and Human Services announced $53 million in funding to 44 States, four American Indian tribes, and the District of Columbia to improve access to treatment for opioid use disorders, reduce opioid-related deaths, and strengthen drug abuse prevention efforts. The funding supports six programs, including a program that will provide up to $11 million to 11 states to expand access to MAT services for individuals with opioid use disorder---an important new funding stream for states adopting MAT.
Understanding the numerous barriers to substance abuse treatment is the first step toward reversing the trend of rising opioid deaths in the U.S. Healthcare reform has created an opportunity to address these barriers and the overall shortfalls in the addiction treatment system. The public sector has taken this opportunity to expand access to medication-assisted-treatment for substance use disorders, and it will only be a matter of time before the private sector moves in this direction.
Nicole Witowski is an associate analyst at DRG and a behavioral health expert. Follow her on Twitter at @NicoleWitDRG.