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Expanded Use of Opioid Addiction Treatment Needed: Government Health Officials

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Health care providers must expand their use of medications to treat opioid addiction, in order to reduce overdose deaths, according to government health officials. Misperceptions have resulted in limited access to the medications, they argue in The New England Journal of Medicine.

“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author Nora D. Volkow, MD, Director of the National Institute on Drug Abuse (NIDA). “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies (MAT) are markedly underutilized.”

Methadone is usually administered in clinics; buprenorphine can be administered by qualifying doctors; and naltrexone is available in a once-a-month injectable, long-acting form, MedicalXpress reports.

According to Dr. Volkow and her colleagues, the public, insurers, patients and health care providers have misperceptions about these medications. Some people mistakenly believe these medication-assisted therapies simply replace one addiction for another, they wrote.

Many treatment facility managers and staff favor an abstinence model of treatment, the officials note. Or they may prescribe inadequate doses of MAT. “Systematic prescription of inadequate doses further reinforces the lack of faith in MATs, since the resulting return to opioid use perpetuates a belief in their ineffectiveness,” they wrote.

Insurance rules also place barriers to effective MAT treatment, they said. “These barriers include utilization-management techniques such as limits on dosages prescribed, annual or lifetime medication limits, initial authorization and reauthorization requirements, minimal counseling coverage, and ‘fail first’ criteria requiring that other therapies be attempted first.”

The Affordable Care Act can increase MAT use by expanding the number of high-risk people who receive treatment through either public or private insurance, the government officials noted.

6 Responses to this article

  1. Tracy / May 19, 2014 at 7:44 pm

    This drug epidemic needs to be addressed starting with the easy access to prescription drugs
    to kids and adults which is a gateway to more drug addiction. Kids can buy all sorts of prescription drugs on the streets. Also there needs to be better treatment options for people not capable of helping themselves and insurance companies need to provide coverage for treatment more than a week it takes longer to quit smoking than that.

  2. Avatar of Thomas
    Thomas / May 2, 2014 at 6:48 am

    Yes it is time to begin making policy decisions based on neuroscience and not based on outdated prejudiced political science beliefs. Lift the 100 patient limit and get insurance companies to recognize buprenorphine as a maintainance therapy and stop forcing tapers on successful patients.

  3. Jean / April 30, 2014 at 9:56 am

    I sure hope this philosophy turns into a mountainous trend! Those of us in the addiction field have known this for years now. It is time addiction – especially opiod addiction – was treated like what it is – a brain disease that needs medical treatment just like other mental health issues!

  4. Avatar of kbruaw@cnsp.com
    kbruaw@cnsp.com / April 29, 2014 at 5:25 pm

    Thank you for this article! I am the director of Inside Out a peer run center in Espanola, New Mexico. Our town has the grim statistic of the highest rate of heroin overdoses per capita nationally. We struggle with huge waiting lists for people who are seeking admission to the program to obtain Subutex. Our doctors are overwhelmed with the task as they are only allowed to serve 100 clients. Perhaps the federal rules need to be changed so that people who seek medically assisted treatment can access it. For an addict, waiting months for treatment may represent arrest, serious health risks, or a death sentence. I would also suggest incentives for the fine medical professionals who agree to train and license to dispense this treatment.
    Kathy Sutherland-Bruaw, M.A., Executive Director, Inside Out

  5. Eric Wood, MA LCAC CADAC II / April 29, 2014 at 3:39 pm

    It’s time to ease the restrictions on Suboxone doctors. Federal regulations require Suboxone providers to have no more than 100 patients. This limitation not only makes it nearly impossible for patients to find a provider with availability, it also significantly restricts Suboxone providers from maintaining a viable business model.

  6. Skip Sviokla MD ABAM / April 29, 2014 at 12:54 pm

    Thank you, Dr Volkow et al for this much needed commentary.
    Support from such an esteemed source should go a long way toward legitimizing MAT.
    Skip Sviokla MD ABAM
    author “From Harvard to Hell and back”

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