By David Heitz
Although it has been scientifically proven that medication-assisted therapies can greatly improve a person with opioid addiction’s chances of recovery,1 a study of more than 100,000 commercially insured patients showed less than half were being prescribed the medications.2
And the future looks even more bleak for those who don’t have commercial insurance and rely on Medicaid and Medicare instead.
The study of the patients with private insurance was conducted by Indivior, a maker of medications used to treat opioid addiction. Researchers analyzed claims from the Truven Health MarketScan Commercial Database between 2008 and 2014, with a mean follow-up duration of 708 days.
“As one of the largest studies of its kind, researchers found that post-diagnosis, nearly one-third (31.6 percent) of patients were receiving no opioid dependence treatment,” Indivior reported in a news release. “Further, less than half (48.2 percent) of patients were prescribed medication-assisted therapy, with buprenorphine/naloxone being the most commonly prescribed (34.4 percent of the overall opioid use disorder patients).
The majority of patients who did receive treatment did so in an outpatient setting.
So why are these medications, which get people back to work and help them mend shattered relationships, not being prescribed to those who need them?
Still Plenty of Capacity for Physicians to Prescribe
A recent study published in JAMA revealed that physician capacity to prescribe medication-assisted therapy isn’t really the problem.
Still, some lawmakers hope that by changing laws related to how clinicians prescribe these treatments, those who need them will gain greater access.
The Indivior study looked at more than 3,200 buprenorphine prescribers totaling more than 245,000 patients receiving a new prescription of buprenorphine from 2010 to 2013.
“The authors found that monthly patient censuses for buprenorphine-prescribing physicians were substantially below patient limits; more than 20 percent treated three or fewer patients, and fewer than 10 percent treated more than 75 patients,” according to a JAMA news release.3
Worse, the news release adds, “The median treatment duration (53 days) was lower than expected given clinical recommendations of maintenance treatment for up to 12 months.”
Only addiction specialists and physicians who complete an eight-hour course and get U.S. Drug Enforcement Administration approval can prescribe buprenorphine. Clinicians are limited to serving up to 100 patients per year.
Policymakers have argued the limits need to be increased so the millions of people in America with opioid use disorder can get the help they need.
Yet this study suggests that may not be the problem.
“Novice prescribers cite insufficient access to more experienced prescribers and insufficient access to substance abuse counseling for patients as barriers to treating more patients. Such barriers might be addressed by web-based or tele-counseling for patients and by programs providing mentoring and telephone consultation from more experienced prescribers.”
Is Science Being Ignored in Halls of Government?
There could be even more problems looming for people needing medication-assisted treatment for opioid use disorder. In a startling remark that goes against the very advice of our nation’s addiction experts, SAMSHA, Health and Human Services Secretary Tom Price declared “If we’re just substituting one opioid for another, we’re not moving the dial much.”
According to Mother Jones, “Asked about drug treatment options, Price touted faith-based programs while showing less support for medication-assisted programs in which addicts are weaned off heroin with other opioids like Suboxone or methadone.”4
In March, President Trump announced with great fanfare the creation of a national opioid commission by executive order. Former New Jersey Gov. Chris Christie, who promised to tackle the burgeoning problem in his state and delivered during his final year in office, heads the commission.
“By the end of 2016, the state had expanded access to naloxone – an opioid antidote that reverses potentially fatal overdoses within minutes – and created a program that uses electronic data to track how often doctors and pharmacists doll out prescription drugs,” PBS News Hour reported.5
“Christie’s administration also devoted more resources to the state’s drug courts, which allows defendants who face drug charges to choose between treatment or jail time.”
It remains to be seen whether the commission simply will come up with idealistic solutions or help expand access to treatment grounded in science.
1 Fudala, P. et al. (2003). Office-Based Treatment of Opiate Addiction with a Sublingual-Tablet formulation of Buprenorphine and Naloxone. New England Journal of Medicine. 349; 949-958. Retrieved June 3, 2017
2 PR Newswire. (2016, April 15). Indivior Presents Late-Breaking, Real-World Data Revealing Less than Half of Patients with Opioid Use Disorder Receive Medication-Assisted Treatment. Retrieved June 3, 2017, from http://www.prnewswire.com/news-releases/indivior-presents-late-breaking-real-world-data-revealing-less-than-half-of-patients-with-opioid-use-disorder-receive-medication-assisted-treatment-300252253.html
3 Stein, B. et al (2016, Sept. 20). Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment. JAMA. Retrieved June 3, 2017, from http://jamanetwork.com/journals/jama/fullarticle/2553439
4 Lurie, J. (2017, May 10). Mother Jones. Trump’s Health Secretary Says Addiction Meds Are ‘Substituting One Opioid for Another.’ Retrieved June 3, 2017, from http://www.motherjones.com/politics/2017/05/tom-price-opioid-addiction-treament
5 Santhanam, L. Here’s what Trump’s new executive order means for opioid addiction. PBS NewsHour. Retrieved June 3, 2017, from http://www.pbs.org/newshour/rundown/heres-trumps-new-executive-order-means-opioid-addiction/