When I read last Sunday’s edition of The Philadelphia Inquirer, I was surprised that perceptions of addiction treatment hadn’t progressed further. The article, People Taking Medication To Treat Opioid Addiction Face Stigma That They’re Not ‘Fully Recovered’, was focused on the perception that recovery excludes the use of medications. They quoted a consumer who had been in recovery for over a year, but was still being referred to as “Methadone Mary” in her 12-step meeting. And, a clinical professional reflecting on his “patients who believe they aren’t ‘clean’ because they’re on MAT (medication-assisted treatment).” One solution offered in the article was creating specific 12-step programs for people who are in MAT programs.
The science is pretty clear – medication-assisted therapy is more effective than alternative approaches not using medications. Medication-assisted treatment has been shown to be more effective at keeping consumers in treatment and reducing their use of opioids (see Methadone Maintenance Therapy Versus No Opioid Replacement Therapy For Opioid Dependence and Injectable, Sustained-Release Naltrexone for the Treatment of Opioid Dependence: A Randomized, Placebo-Controlled Trial); reducing fatal heroin overdoses (see Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009); and reducing heavy drinking among consumers with alcohol dependence (see Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence). But like much of the health care field, science doesn’t always drive practice. Culture and tradition play big roles in slowing the adoption of new treatment techniques and technologies.
So where are we in our adoption of MAT-based programs? While the number of units paid by Medicaid for MAT increased by 183% between 2011 and 2017 (see Medicaid Payments For Opioid MAT Drugs Nearly Tripled Over Past Six Years), research also shows that only 60% of individuals with an opioid dependence are able to access MAT (see If MAT For Addictions Is So Good, Why Aren’t More Consumers Using It?). Eight percent of licensed substance abuse facilities provide methadone or buprenorphine, accounting for 24% of all patients receiving addiction treatment (see Medication-Assisted Treatment For Opioid Addiction).
The tide is certainly changing on the reimbursement side of the equation. Health plans are actively seeking addiction treatment programs that incorporate MAT into their approach (see The Addiction Treatment Landscape: The California Transformation, The Shift From Residential: The Changing Addiction Treatment Landscape, and Changing The ‘How’ & The ‘Where’ In Addiction Treatment).
The Department of Health and Human Services’ will take a new approach to MAT by increasing the share of programs that offer MAT and expanding the types of MAT it will approve (see Feds To Focus On Increasing Share Of Medication Assisted Opioid Addiction Treatment). And, the Food and Drug Administration (FDA) is focused on moving the needle on MAT as well. In November of 2017, a statement from FDA Commissioner Scott Gottlieb, M.D. echoed this focus (see Statement From FDA Commissioner Scott Gottlieb, M.D., On The Approval Of A New Formulation Of Buprenorphine And FDA’s Efforts To Promote More Widespread Innovation And Access To Opioid Addiction Treatments). He noted:
To support more widespread adoption of MAT, the FDA will continue to take steps to address the unfortunate stigma that’s sometimes associated with use of these products. It’s part of our public health mandate to promote appropriate use of therapies. Misunderstanding around the profile of these products ‒ even among many in the medical and addiction fields ‒ enables stigma to attach to their use.
Any time that the health and human service field lags behind science, there are opportunities for innovative provider organizations. My recent discussions with managers of health plans is that community-based addiction treatment programs using MAT are in short supply — and particularly programs that serve populations with specific needs. But while the payers and health plans are in line, the on-the-ground reality is that professionals working with consumer with addiction will need to address the stigma issue related to medications. For more on our coverage of stigma, check out Have We Moved Beyond Stigma In Marketing? and Starting A New, Post-Parity Conversation About Stigma. And for more on our coverage of MAT, check out these resources from the OPEN MINDS Industry Library:
- Naloxone – A New MAT Weapon
- The State ‘Crazy Quilt’ Of Opioid Treatment Policy
- How Far Does $3.3 Billion Go?
- Buprenorphine & Methadone – Do We Actually Need To Increase Treatment Capacity?
- Changing The ‘How’ & The ‘Where’ In Addiction Treatment
- The Framework For A Marketing Strategy For Addiction Treatment Programs
- Untangling The Access Issues For Addiction Treatment
- The Politics Of Addiction
- Residential Addiction Treatment-The Opportunity In Changing Medicaid Policy
- Keeping Up With The Changing Medicaid Addiction Treatment Landscape
For more, join me on October 24 at The 2018 OPEN MINDS Technology & Informatics Institute for my plenary address, “Meeting The Innovation Challenge In Health & Human Services: Building A Nimble Management Team To Respond To Opportunities In A Value-Based Market.”