Fighting Opioid Addiction with Medication, Not Abstinence

In what appears to be part of an important change in thinking about how best to treat opioid addiction, the federal government recently took a new tack, shifting from a stance of abstinence toward embracing more medication-assisted treatments (MAT) like methadone and Suboxone (buprenorphine and naloxone). MAT refers to the practice of using a combination of medication and behavioral therapy/counseling to treat drug addiction.

Specifically, $12 million was given to the Substance Abuse and Mental Health Services Administration (SAMHSA) to distribute to U.S. states demonstrating the greatest increases in people seeking help for opioid addiction. SAMHSA then awarded roughly $1 million to each of 11 states to serve 24 communities; the agency spent the final $1 million on technical assistance for the grantees. “These grants are an excellent idea and come at an important time when we’re facing a growing scourge of opioid addiction,” says Robert Lubran, director of SAMHSA’s division of pharmacologic therapies. “This money will help the nation’s most high-risk communities provide medication-assisted treatment.”

“MAT is Underutilized for Opioid Addiction”

The change in funding comes on the heels of the Centers for Disease Control’s classifying of heroin and prescription opioid addiction as an epidemic and studies showing that many treatment centers are overwhelmed, while access to the opioid-addiction medications methadone and buprenorphine is inadequate. “We have enough data to show there’s a great underutilization of medication-assisted treatment for opioid addiction,” says Lubran. “These grants will help states increase awareness to treatment centers about [these drugs’] efficacy. It will also help states train healthcare providers in how to prescribe and monitor medications” to treat addiction to prescription painkillers like hydrocodone and oxycodone as well as heroin.

While states that received money have broad discretion about how to use it, using funds to pay for prescriptions for methadone, buprenorphine, naltrexone and the overdose-reversal drug naloxone is a last resort, according to Lubran. “Ideally, prescriptions would be paid for through insurance or Medicaid,” he says. “But when that’s not possible, this money can help.”

259 Million Pain Pill Prescriptions

Communities hardest hit by the heroin epidemic will need all the help they can get to reverse the trend. In 2012, healthcare providers wrote nearly 259 million prescriptions for painkillers — enough for every adult in the U.S. to have the pills, according to the CDC. And heroin, which is cheaper and more dangerous than prescribed pain pills, is flowing into the country easily, Lubran says. “Overprescribing [of narcotic painkillers] and readily available heroin have created this perfect storm that’s led to a major health crisis,” he notes. “And some communities simply don’t have the facilities or enough trained doctors to handle how many people need treatment.”

The new grants championing MAT attracted applications from nearly two dozen states. Those that didn’t receive the grant will have to wait until next year to apply again. SAMHSA has asked for an additional $13 million in the 2016 budget, which it hopes to use for additional grants that would enable a nationwide effort to expand the number of doctors capable of prescribing opioid medication.

The current grants are just one indication that the government is moving away from advocating that people find a way to give up use opioids (abstinence) and moving toward medication-assisted treatment. SAMHSA’s sister organization, the Health Resources and Services Administration (HRSA) announced in July that it plans to award $100 million to expand the use of MAT to 310 existing substance abuse treatment centers. The grant requires centers to increase the number of doctors capable of prescribing opioid medication and to invest in education for healthcare providers about medication that can be used to fight addiction. Applications are due by September 28, 2015. “This is a pretty major investment that goes directly to treatment centers,” says Lubran. “This will touch a lot of lives since HRSA serves nearly 22 million people in health centers.”

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