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Medication-assisted treatment access enhancement initiatives

Health Factors: Alcohol & Drug Use
Decision Makers: State Government Federal Government Healthcare Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Medication-assisted treatment (MAT) for opioid dependence provides medications to individuals diagnosed with opioid use disorder, usually with counseling and behavioral therapies. As of August 2017, the US Food and Drug Administration (FDA) has approved methadone, buprenorphine, and extended release injectable naltrexone for MAT. Methadone is only dispensed through Opioid Treatment Programs (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA); buprenorphine is distributed through OTPs and prescribers who complete required training. Naltrexone can be prescribed by any provider authorized to dispense medications (SAMHSA-MAT). As of 2014, only 28% of patients in treatment services with primary heroin admissions received MAT (SAMHSA-TEDS 2016). Limited insurance coverage and appointment availability and lack of prescribing physicians are often barriers to MAT (Pew-MAT 2016Burns 2016); efforts to enhance access include building availability and capacity to distribute (Jones 2015bCHCF 2016) and expanding Medicaid coverage for MAT (ASAM 2013).

Expected Beneficial Outcomes

Reduced substance abuse
Increased substance use disorder treatment
Reduced overdose deaths

Evidence of Effectiveness

Enhancing access to medication-assisted treatment (MAT) for opioid use disorder is a suggested strategy to increase use of treatment and reduce unmet treatment needs, particularly for individuals with low incomes, individuals in rural areas, and in the criminal justice system as well as to decrease the frequency and amount of opioid misuse and reduce opioid overdose (SAMHSA-MATASAM 2013, AHRQ-MAT, CDAOP Commission 2017).

Medications used in MAT, particularly methadone and buprenorphine, increase treatment retention, reduce opioid abuse and overdose deaths, and reduce related health and social problems such as crime and HIV when used as part of a structured maintenance treatment program with appropriate dosing and clinical oversight (ASAM 2013Campbell-Egli 2009Cochrane-Mattick 2014Cochrane-Mattick 2009Timko 2016, Sordo 2017, Connock 2007). Such medications may also improve treatment retention and birth outcomes for opioid-dependent pregnant women (SAMHSA-MAT, Holbrook 2015). Using extended-release naltrexone, MAT may decrease opioid relapse among opioid-dependent adults in the criminal justice system (Lee 2016). In some cases, counseling and behavioral therapy may increase the effectiveness of MAT (ASAM 2013, Cochrane-Mattick 2009, Timko 2016).

Available evidence suggests that Medicaid coverage for buprenorphine appears to be associated with increases in its use in facilities that offer addiction treatment services (Ducharme 2008). Methadone maintenance use among Medicaid-enrolled adults in opioid addiction therapy is higher in states that allow reimbursement for MAT (Saloner 2016). An assessment of a Baltimore-based effort to fund physicians' MAT training and prescription licensing suggests increasing access to MAT is associated with decreases in opioid overdose deaths (Schwartz 2013). However, additional evidence is needed to determine the effects of initiatives that enhance access to MAT on the use of treatment and health outcomes.

Implementation

United States

In August 2016, federal regulations regarding buprenorphine prescription increased the patient limit per authorized physician from 100 to 275 patients per year (SAMHSA-MAT).

Every state Medicaid program covers buprenorphine, however, coverage details vary considerably (SAMHSA-Medicaid MAT 2014). As of September 2015, 30 states and Washington DC include methadone maintenance therapy on Medicaid preferred drug lists, and naltrexone is covered by Medicaid in every state but Arkansas (MACPAC 2016). As of May 2017, Maryland, Rhode Island, and Vermont implement the Medicaid health home models for opioid dependence treatment, with funding from the Centers for Medicare & Medicaid Services (CMS-Moses 2015, CMS-MHH).

In July 2016, the Agency for Healthcare Research and Quality (AHRQ) issued grants to support efforts to expand access to medication-assisted treatment (MAT) in rural communities in Oklahoma, Pennsylvania, North Carolina, and Pennsylvania; efforts are underway to assess the effects of these initiatives (AHRQ-MAT). Beginning in 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) has committed up to $970 million to support state and local efforts to increase access to MAT through the State Targeted Response to the Opioid Crisis Grants for two years (SAMHSA-Opioid funds).

Vermont’s Hub and Spoke model is an example of community effort to build a workforce and create integrated treatment across settings (APF-VT). 

Wisconsin

The Wisconsin Medicaid program covers medication-assisted treatment using methadone, buprenorphine, and naltrexone as well as related psychotherapy (MACPAC 2016). As of May 2017, there are 19 opioid treatment programs available in the state (OTP directory).

Implementation Resources

Decisions in Recovery - Substance Abuse and Mental Health Services Administration (SAMHSA). Decisions in Recovery: Treatment for opioid use disorder. Accessed on June 1, 2017
Medicaid IAP-MAT tools - Medicaid.gov, Medicaid Innovation Accelerator Program (IAP). SUD tools and resources: Medication-assisted treatment (MAT) clinical pathway and rate design tool. Accessed on September 1, 2017
OTP directory - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid treatment program (OTP) directory. Accessed on May 30, 2017
SAMHSA-MAT regulations - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT): Legislation, regulations, and guidelines. Accessed on May 30, 2017
SAMHSA-OTP guidelines - Substance Abuse and Mental Health Services Administration (SAMHSA). Federal guidelines for opioid treatment programs. HHS Publication No. (SMA) PEP15-FEDGUIDEOTP. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015. Accessed on May 30, 2017

Citations - Description

ASAM 2013 - American Society of Addiction Medicine (ASAM). Advancing access to addiction medications: Implications for opioid addiction treatment. Chevy Chase, MD: 2013. Accessed on May 30, 2017
Burns 2016 - Burns RM, Pacula RL, Bauhoff S, et al. Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013. Substance Abuse. 2016;37(1):63-69. Accessed on May 30, 2017
CHCF 2016 - California Health Care Foundation (CHCF). Recovery within reach: Medication-assisted treatment of opioid addiction comes to primary care. 2016. Accessed on May 30, 2017
Jones 2015b - Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health. 2015;105(8):e55-e63. Accessed on May 30, 2017
Pew-MAT 2016 - The Pew Charitable Trusts (Pew). Medication-assisted treatment (MAT) improves outcomes for patients with opioid use disorder. 2016. Accessed on May 31, 2017
SAMHSA-MAT - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT). Accessed on May 30, 2017
SAMHSA-TEDS 2016 - Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality. Treatment episode data set (TEDS): 2004-2014. National admissions to substance abuse treatment services. BHSIS Series S-84, HHS Publication No. (SMA) 16-4986. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. Accessed on September 1, 2017

Citations - Evidence

AHRQ-MAT - Agency for Healthcare Research and Quality (AHRQ). Increasing access to medication-assisted treatment (MAT) of opioid abuse in rural primary care practices. Accessed on May 30, 2017
ASAM 2013 - American Society of Addiction Medicine (ASAM). Advancing access to addiction medications: Implications for opioid addiction treatment. Chevy Chase, MD: 2013. Accessed on May 30, 2017
Campbell-Egli 2009 - Egli N, Pina M, Christensen P, Aebi M, Killias M. Effects of drug substitution programs on offending among drug-addicts. Campbell Systematic Reviews. 2009;3. Accessed on May 30, 2017
CDAOP Commission 2017 - Commission on Combating Drug Addiction and the Opioid Crisis (CDAOP). Interim report. July 2017. Accessed on September 1, 2017
Cochrane-Mattick 2009 - Mattick RP, Breen C, Kimber J, Davoli, M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews. 2009;(3). Accessed on May 30, 2017
Cochrane-Mattick 2014 - Mattick RP, Breen C, Kimber J, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews. 2014;2(2). Accessed on May 30, 2017
Connock 2007 - Connock M, Juarez-Garcia A, Jowett S, et al. Methadone and buprenorphine for the management of opioid dependence: A systematic review and economic evaluation. Health Technology Assessment. 2007;11(9). Accessed on August 31, 2017
Ducharme 2008 - Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Substance Abuse Treatment, Prevention, and Policy. 2008;3(17):1-10. Accessed on May 30, 2017
Holbrook 2015* - Holbrook AM, Nguyen VH. Medication-assisted treatment for pregnant women: A systematic review of the evidence and implications for social work practice. Journal of the Society for Social Work & Research. 2015;6(1):1-19. Accessed on May 30, 2017
Lee 2016* - Lee JD, Friedmann PD, Kinlock TW, et al. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. New England Journal of Medicine. 2016;374(13):1232-1242. Accessed on August 31, 2017
Saloner 2016* - Saloner B, Stoller KB, Barry CL. Medicaid coverage for methadone maintenance and use of opioid agonist therapy in specialty addiction treatment. Psychiatric Services. 2016;67(6):676-679. Accessed on May 30, 2017
SAMHSA-MAT - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT). Accessed on May 30, 2017
Schwartz 2013* - Schwartz J, Davaran A. Enforcement following 0.08% BAC law change: Sex-specific consequences of changing arrest practices? Addictive Behaviors. 2013;38(10):2506-2512. Accessed on June 19, 2017
Sordo 2017* - Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550. Accessed on August 31, 2017
Timko 2016* - Timko C, Schultz NR, Cucciare MA, Vittorio L, Garrison-Diehn C. Retention in medication-assisted treatment for opiate dependence: A systematic review. Journal of Addictive Diseases. 2016;35(1):22-35. Accessed on May 30, 2017

Citations - Implementation

AHRQ-MAT - Agency for Healthcare Research and Quality (AHRQ). Increasing access to medication-assisted treatment (MAT) of opioid abuse in rural primary care practices. Accessed on May 30, 2017
APF-VT - Addiction Policy Forum (APF). Vermont hub-and-spoke model for treating addiction. 2017. Accessed on September 1, 2017
CMS-MHH - Centers for Medicare & Medicaid Services (CMS). Medicaid health homes (MHH): SPA overview. Centers for Medicare & Medicaid Services (CMS), Health Home Information Resource Center. May 2017. Accessed on September 1, 2017
CMS-Moses 2015 - Moses K, Klebonis J. Designing Medicaid health homes for individuals with opioid dependency: Considerations for states. Centers for Medicare & Medicaid Services (CMS), Health Home Information Resource Center. 2015. Accessed on September 1, 2017
MACPAC 2016 - The Medicaid and CHIP Payment and Access Commission (MACPAC). State policies for behavioral health services covered under the state plan. 2016. Accessed on May 30, 2017
OTP directory - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid treatment program (OTP) directory. Accessed on May 30, 2017
SAMHSA-MAT - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT). Accessed on May 30, 2017
SAMHSA-Medicaid MAT 2014 - Substance Abuse and Mental Health Services Administration (SAMHSA). Medicaid coverage and financing of medications to treat alcohol and opioid use disorders. HHS Publication No. SMA-14-4854. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. Accessed on May 30, 2017
SAMHSA-Opioid funds - Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA to award nearly $1 billion in new grants to address the nation's opioid crisis. December 2016. Accessed on September 1, 2017

Page Last Updated

May 30, 2017

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