BPTI News: Fighting the Opioid Crisis
There is good news from the front of the fight against the opioid epidemic. Several news services reported the Department of Health and Human Services (DHHS) would be giving $1billion in federal grants to states to fight opioid addiction (Azar, 2018). These grants go to all states to fund addiction treatment, prevention, and recovery services. There are also grants from the Centers for Disease Control and Prevention to improve data gathering and prevention. Special funding goes to health centers in rural areas to help them provide addiction treatment.
Two important changes stand out in that funding. Medication-assisted treatment (MAT) which has been in short supply for the treatment of opioid addiction, will be expanded through the funding of the use of telemedicine to provide MAT. MAT is any treatment for opioid addiction that includes a medication (e.g., methadone, buprenorphine, levo-alpha acetyl methadol [LAAM], naltrexone, suboxone) approved by the U.S. Food and Drug Administration (FDA) for opioid addiction detoxification or maintenance treatment.
Prescribing drugs that are used in MAT requires certification and training of physicians who are willing to prescribe. A recent article in the Journal of Substance Abuse Treatment polled 558 physicians across the U.S. (with and without a waiver to allow them to prescribe buprenorphine) to find what barriers there were to participating in MAT. Huhn & Dunn (2017) reported that, of the physicians surveyed, the main reasons that they failed to increase prescribing were: lack of belief in agonist (e.g., buprenorphine) treatment, lack of time to treat more patients, and belief that reimbursement rates would be insufficient. Thirty nine percent of the physicians polled also reported that one thing that would encourage them to prescribe would be to have access to an experienced provider.
The DHHS grant will allow those physicians who do NOT have buprenorphine certification to use telemedicine to link their patients up with certified providers who can prescribe buprenorphine. This may help overcome the barriers to treating those most at risk of being seriously affected by the opioid epidemic.
An August 24, 2018 opinion column in the NY Times (Editorial Board, 2018, August 24) compares states in which opiate use is decreasing to states in which it is not decreasing. States like Hawaii, Massachusetts, North Dakota, Oklahoma, Rhode Island, Utah, Vermont and Wyoming have implemented practices which have resulted in decreased opiate overdose deaths. These states, according to the Centers for Disease Control, have implemented increased access to MAT and to the anti-overdose medication Naloxone. The Times notes that part of the success can be attributed to efforts to increase the number of insured individuals. Massachusetts and Vermont have expanded Medicaid under the Affordable Care Act, and have helped people sign up for private insurance. The percentage of uninsured individuals is lower in Vermont and Massachusetts than the average in the country as a whole. Part of the reason that opiate overdose deaths are not decreasing in states like Maine and Florida is that the uninsured rates are high, and the legislatures have refused to expand Medicaid.
Resources
Azar, Alex (2018, September 19). USA Today Retrieved from https://www.usatoday.com/story/opinion/2018/09/19/donald-trump-opioid-crisis-epidemic-addiction-nalaxone-heroine-column/1347574002/
Editorial Board. (2018, Aug 24). New York Times. On the opioid epidemic. Retrieved from https://www.nytimes.com/2018/08/24/opinion/opioid-epidemic-states.html
Huhn, A. & Dunn, K. (2017). Journal of Substance Abuse Treatment 78, 1–7.