We know that medication-assisted treatment (MAT) saves lives. So why is it used by only a fraction of people with opioid use disorder (OUD)?
It’s a question that bedevils experts.
The evidence is clear: outcomes for patients with opioid use disorder (OUD) are vastly improved when they’re on medication-assisted therapy. OUD is a chronic brain disease that changes the structure of the brain. Simply stopping cold turkey is excruciating and mostly unsuccessful.
The three FDA-approved medications normalize brain structure and function, reducing cravings, significantly decreasing risk of relapse, preventing overdoses, and helping to prevent infectious diseases like HIV.
MAT has been effective in every treatment setting where it has been studied. Echoing the position of many other major health bodies, the National Academies of Sciences, Engineering, and Medicine asserts, “To stem the opioid crisis, it is critical for all FDA-approved options to be available for all people with opioid use disorder.”
But as the opioid epidemic rages on, a great majority of people with opioid use disorder (OUD) don’t receive MAT.
Most people receive no treatment of any kind at all.
Related blog: MAT Facts: What Is Medication-Assisted Treatment?
Experts are trying to understand why MAT is rarely used when it has been demonstrated to be so successful.
With support from the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Academies of Sciences, Engineering, and Medicine brought together experts to identify the barriers preventing people from accessing MAT.
With the resulting report, Medications for Opioid Use Disorder Save Lives, the committee came to four conclusions:
- Inadequate training about OUD and the effectiveness of MAT for professionals, who frequently encounter those suffering with OUD, such as clinical professionals, law enforcement, and other criminal justice personnel
- Stigma and misunderstandings about addiction, individuals with OUD, and MAT. For example, some health professionals think that MAT is just another form of substance use, though the evidence demonstrates that MAT results in dramatic decreases in addiction behavior and leads to sustained recovery. There are also clinicians unwilling to prescribe medications due to concerns about misuse and diversion, or illegal channeling of regulated medications to the illicit market. The facts show, however, that the rate of diversion is much less than that for other prescribed controlled substance medications and that the rate of diversion declines as access to MAT to treat OUD increases.
- Fragmented system of care for people with OUD due to financing and payment policies. For years insurance coverage to MAT was very limited, and people had to pay out of pocket to get care. Those with limited income could not afford to get treatment. Coverage for MAT has gotten better, but there is still not enough access to high quality addiction treatment.
- Current regulations around methadone and buprenorphine, such as waiver policies, panel limits, restrictions on settings where medications are available, and other policies that are not supported by evidence or employed for other medical disorders.
Because of these barriers, many sub-groups of the population have less access than others, making MAT unevenly available. These sub-groups include adolescents and young adults, people in rural areas, and racial and ethnic minority groups.
For example, a new study in JAMA Psychiatry found that white populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans. This use disparity coincides with the faster rise of opioid overdose deaths among blacks than whites.
The evidence shows that MAT is effective for treating OUD in all groups of the population, including adolescents, pregnant women, and people with co-morbidities.
SAMHSA asserts that withholding or failing to have available all classes of medications approved by the FDA for opioid addiction in any care or criminal justice setting is denying appropriate medical treatment. There is no justification to withhold MAT to treat opioid addiction.
“The United States is experiencing a public health crisis of almost unprecedented scale — an epidemic of opioid use disorder and related overdose deaths,” said Alan Leshner, chief executive officer emeritus of the American Association for the Advancement of Science, and chair of the committee that conducted the study. “The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment.”
The study recommends additional research on differences in the nature of OUD in subgroups, as well as on the potential need for specific medication-based treatment guidelines for subpopulations.
Research should also be expanded on new and better medications to treat OUD, determining behavioral therapies that can help maximize outcomes, and refining the most appropriate protocols for their effective use.
“Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector,” said Leshner, including “Health care, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.”
CleanSlate treats patients suffering from opioid or alcohol addiction with medications and a continuum of integrated care to support each individual's journey to recovery. If you or someone you love needs help, contact us at 833-505-HOPE, or visit our website at www.cleanslatecenters.com to find the center nearest you.
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