MAT underutilized by hospitals in treating opioid addiction

The findings were published Tuesday in the Annals of Internal Medicine, which looked at the outcomes of more than 17,000 Massachusetts adults who survived an opioid overdose between 2012 and 2014.

The analysis found that 12 months following an overdose, 11% of patients studied received methadone for an average of five months, 17% were given buprenorphine for an average of four months, and 6% were prescribed naltrexone for about one month.

Researchers from Boston Medical Center's Grayken Center for Addiction found that patients who were prescribed the methadone treatment were associated with a 59% decrease in mortality and those who receive buprenorphine saw a 38% lower death rate after one year. The results did not identify a decline in mortality for patients who received naltrexone.

A total of 5% of patients who initially survived an overdose died within one year of the study period.

"We have two treatments in methadone and buprenorphine that are life-saving but we're only getting those medication to about 3 in 10 patients," said study lead author Dr. Marc LaRochelle, a general internist and researcher at the Grayken Center. "We really need to do a better job in getting people access to those meds."

The number of opioid prescriptions sold in the U.S. declined by 11% in 2017 compared with 2016, according to new research released Tuesday by advisory firm Avalere Health.

But the number of deaths from drug overdose has kept steadily rising, reaching more than 64,000 in 2017, according to the Centers for Disease Control and Prevention.

In January, Health Affairs published a blog that included 2016 data from the U.S. Substance Abuse and Mental Health Services Administration that found that among the country's more than 12,000 treatment facilities, 41% reported offering at least one form of MAT while only 3% offered methadone, buprenorphine and naltrexone. As many as eight states did not have a facility that offered all three forms of MAT, according to the analysis.

"Addiction treatment has been outside of the medical model," said Christopher Smithers, president of the Christopher D. Smithers Foundation, which advocates for eliminating stigmas related to substance abuse treatment. "Addiction is not really treated in hospitals and doctors aren't trained much in medical school because it's not something you necessarily have to treat in a medical setting."

Smithers said the majority of addiction treatment has been left to rehabilitation centers, some of which opt to not provide MAT in favor of abstinence-based therapy such as 12-step programs. While most healthcare providers agree that MAT is the most effective way to treat opioid addiction, Smithers said he believes the lack of consensus within the recovery community has hindered efforts to expand access to such therapies.

Smithers called for a more medicalized approach to opioid treatment than what has traditionally been offered at rehab clinics. But expanding access to MAT within the healthcare industry has been challenging since distributing buprenorphine and methadone is highly regulated.

"Our current treatment system is not performing at the level where it needs to," LaRochelle said. The current standard of treatment within a hospital setting oftentimes entails a patient coming to the emergency department after overdose, staying there long enough to detox, and then being discharged with or without a referral to a treatment facility.

LaRochelle said a better approach would be for healthcare providers to begin MAT while a patient is in the hospital. "These are all people who have had an encounter with the healthcare system and we missed that opportunity," he said.