Reduce barriers to MAT in the treatment of opioid addiction
Throughout my career in addiction medicine, I have encountered a lot of skeptics when it comes to medication-assisted treatment (MAT). In fact, I was one of them. The thinking was: Are we truly helping people recover from their substance use disorder (SUD) by prescribing them another medication? Aren’t we simply replacing one drug with another? But I’ve seen firsthand how addiction medications, such as buprenorphine, can save and transform lives. Unfortunately, continued denial that substance use disorder is a disease, continued stigma about MAT and buprenorphine, and the limits placed on those who can prescribe these medications prevent many from receiving lifesaving care.
Buprenorphine is one of our best tools for the treatment of opioid addiction, and one that we now embrace at Mountainside treatment center. In conjunction with Cognitive Behavioral Therapy, other forms of clinical treatment, and self-help support groups, medication-assisted treatment has proven to be effective in combatting the current opioid crisis – and keeping our clients alive. Throughout most of my 30+ year career, I have advocated for an abstinence-based model of treatment. But we must realize that every client’s recovery journey varies. According to the Journal of Substance Abuse Treatment, treatment involving buprenorphine can decrease a person’s relapse risk by 50 percent. For many, receiving buprenorphine or other forms of Medication-Assisted Treatment literally is the difference between life and death.
A partial opiate agonist, buprenorphine binds to a person’s opiate receptors, releases the “feel-good” neurotransmitter dopamine, and then blocks the symptoms of opioid withdrawal. Therefore, a person undergoing MAT with buprenorphine will not suffer from cravings and uncomfortable side effects after discontinuing their opioid use to the extent that others in withdrawal might. This then enables them to focus on addiction treatment and to learn critical coping skills, such as stress management, goal-setting, and self-care techniques. Thanks to MAT, more people are able to lead healthy, productive, and fulfilling lives – a welcome outcome in light of the opioid crisis, which continues to devastate the nation.
Buprenorphine is an evidence-based treatment that can be prescribed in a doctor’s office to treat those suffering from opioid use disorder. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has required doctors to apply for a waiver to be able to prescribe buprenorphine to their patients. Currently, only about seven percent of healthcare providers hold a buprenorphine waiver, which means just a tiny fraction of patients have access to this efficacious addiction medication.
Within the last decade, the federal government has lessened some of the restrictions surrounding buprenorphine waivers. One initiative that aims to improve public accessibility to MAT providers is the Comprehensive Addiction Treatment and Recovery Act (CARA) of 2016 – which enables nurse practitioners and physician assistants in addition to doctors to apply for buprenorphine waivers.
A recently published study by the Annals of Internal Medicine found that the number of buprenorphine-waivered prescribers increased 300 percent in the last decade, from 17,000 in 2009 to 68,000 in 2019. For proponents of MAT, this may sound like a cause for celebration. While this is a step in the right direction, certain factors continue to obstruct healthcare providers in maximizing the use of buprenorphine to aid their addicted patients.
For example, approximately 70 percent of physicians who held a waiver for buprenorphine were limited to treating a mere 30 patients in 2017. What other disease treatment is limited in such a way? Can you imagine a cardiologist being limited to treating 30 patients per year for hypertension? Or endocrinologists only being permitted to prescribe insulin to 30 of their patients? In 2017, about 46,000 people died of an opioid overdose. The need for effective treatment is stronger than ever with the rise of even more potent opioids such as fentanyl. Access to ethical and qualified buprenorphine prescribers should be expanded, not limited. Currently, there are no buprenorphine providers in 56 percent of counties that see the highest number of opioid overdoses in the nation.
Further complicating the issue of accessibility to MAT is a lack of knowledge among primary care physicians when it comes to treating those struggling with SUDs. Even some medical professionals who hold a waiver may feel they do not have sufficient addiction training to properly and successfully treat patients with SUDs, according to the International Journal of Drug Policy.
SAMHSA’s Buprenorphine Practitioner Locator also contributes to the problem of accessibility, containing inaccurate records that confound patients’ ability to find buprenorphine prescribers near them. Many who are struggling turn to online resources and may refrain from seeking care altogether if they can’t find an appointment – or correct provider contact information, for that matter.
It is well established that clients who stay in treatment longer have better outcomes. Based on our own data, we’ve found that clients enrolled in our MAT program for opioid use disorders have a greater length of stay in residential treatment, with a 96 percent residential treatment completion rate – 16 percent higher than those not enrolled in MAT. For years, Mountainside has offered a form of sublingual buprenorphine (Suboxone®) as well as the injectable opiate-antagonist naltrexone Vivitrol®, which each help decrease cravings and block opiate receptors for clients with opiate use disorder. In 2018, Mountainside became one of the first treatment centers in Connecticut to champion the use of the long-acting monthly injectable form of buprenorphine, Sublocade™, a partial agonist that blocks opiate receptors, manages cravings, and reduces the risk of diversion and misuse often associated with sublingual buprenorphine.
To ensure that MAT can be used to help more people in need, we urge lawmakers to…
- Remove waivers for buprenorphine prescribing to permit more medical professionals to assist patients with SUDs
- Implement mental health parity laws to reduce financial barriers to MAT
- Support and encourage efforts to improve curriculum for addiction education and buprenorphine training in our medical schools and other programs that train new providers
An estimated 130 people die from opioids every day nationwide. This doesn’t have to be the case. Aside from legislative action, a grassroots movement that embraces people struggling with opioid addiction is needed if we are to solve the issue at hand. By pledging to destigmatize MAT and addiction as a whole, community members can be instrumental in helping their neighbors get the treatment they need and deserve. Let’s work together to prevent unnecessary loss of life and ensure that no more families are torn apart by this disease.
nsure that MAT can be used to help more people in need, we urge lawmakers to…
- Remove waivers for buprenorphine prescribing to permit more medical professionals to assist patients with SUDs
- Implement mental health parity laws to reduce financial barriers to MAT
- Support and encourage efforts to improve curriculum for addiction education and buprenorphine training in our medical schools and other programs that train new providers
An estimated 130 people die from opioids every day nationwide. This doesn’t have to be the case. Aside from legislative action, a grassroots movement that embraces people struggling with opioid addiction is needed if we are to solve the issue at hand. By pledging to destigmatize MAT and addiction as a whole, community members can be instrumental in helping their neighbors get the treatment they need and deserve. Let’s work together to prevent unnecessary loss of life and ensure that no more families are torn apart by this disease.
Dr. Randall Dwenger is the Chief Medical Officer at Mountainside, a rehab facility located at 187 South Canaan Road in Canaan, CT
