Most residential treatment facilities do not provide patients with medications considered to be the 'gold standard' for treating opioid addiction, according to a new study.
The analysis, published Friday in JAMA Network Open, found approximately 60% of the more than 2,860 residential facilities examined did not offer any medications approved by the U.S. Food and Drug Administration for treating opioid use disorder in 2017.
The study examined federal survey data that included more than 232,000 admissions to residential treatment centers in 2017 and found opioid use disorder treatment medications were used for only 15% of patients at those facilities.
"The majority are not offering medication to treat opioid use disorder, and when you look at whose being prescribed it is grossly underutilized," said study lead author Andrew Huhn, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.
Approximately 17% of patients admitted to residential facilities located in states that expanded Medicaid received medications compared to just 2% of patients in facilities located in non-expansion states.
The disparity in access to opioid use disorder medications between Medicaid expansion and non-expansion states highlights the importance the program plays in addressing the impact of the opioid crisis, according to Dr. Yngvild Olsen, vice president of the board of directors for the Americans Society of Addiction Medicine.
Olsen expressed concern over the potential impact of guidance released last month by the CMS that would allow states to apply for Section 1115 waivers to participate in the agency's Healthy Adult Opportunity initiative. Under the demonstration, states would expand Medicaid coverage to adults if they agreed to a per capita limit on funding for the program.
Olsen worries that limitations to Medicaid funding will reduce access to treatment and result in more overdose deaths.
A January report from the Centers for Disease Control and Prevention found more than 68,000 people died in 2018 from drug overdose despite a 4% decline in mortality compared to 2017.
Opioids, which include prescription painkillers, heroin and fentanyl, remain the leading cause for overdose death. Those drugs resulted in a combined mortality rate of 18.4 deaths for every 100,000 people in 2018.
The study's findings have huge implications for explaining why the use of medications for addiction treatment has remained low despite the impact of the opioid crisis.
The use of medications such as buprenorphine and methadone along with psychosocial counseling is considered by medical professionals to be the 'gold standard' of addiction treatment.
A study published Wednesday in JAMA Network Open found that between 2015 and 2017, treatment for opioid use disorder with buprenorphine and methadone was associated with a 76% reduction in overdose after three months and a 58% reduction in overdose after 12 months. By contrast, abstinence-based therapies such as detoxification, intensive behavioral health, and naltrexone treatment were not associated with a reduction in overdoses.
Yet that study also found that those medications were vastly underused, with only 12.5% receiving MAT.
The low use of medication within residential facilities highlights an ongoing philosophical debate within the addiction treatment community over the use of medications.
Huhn said stigma could prevent policymakers and some treatment providers from addressing addiction as a chronic brain disease rather than a personal failing.
"A lot of the infrastructure for addiction medicine was built apart from mainstream medicine," Huhn said. "A lot of it still revolves around 12-step philosophy, which is not at odds with using medication for opioid use disorder, but I think it gets misinterpreted."
Both Huhn and Olsen suggested increasing MAT use could be done by eliminating federal regulations that require buprenorphine to be distributed by an opioid treatment program, or by doing away with prior authorization requirements for the drug by health insurers.
Huhn and Olsen also agreed increasing licensure and accreditation requirements for addiction treatment facilities could be a useful way of promoting greater use of MAT. Huhn's study found treatment facilities that were licensed by a hospital or state authority or being accredited by a health organization were more likely to offer medications as part of their opioid use disorder treatment.
"That certainly is one effective way that states and other policymakers can help move this area forward in terms of adoption of evidence-based care," Olsen said.