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Access to medication-assisted treatment for opioid use disorder

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 use disorder provides medications along with counseling and behavioral therapies to individuals diagnosed with opioid addiction and dependence. As of May 2017, the US Food and Drug Administration (FDA) has approved methadone, buprenorphine, and 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 prescriptions from physicians who complete required training. Naltrexone can be prescribed by any health care provider authorized to dispense medications (SAMHSA-MAT). Limited insurance coverage and appointment availability, and lack of prescribing primary care physicians are often barriers to MAT; provider and service shortages are most severe in rural and underserved communities (Pew-MAT 2016, Burns 2016). Efforts to increase access to MAT include building local availability and capacity (Jones 2015b, CHCF 2016) and expanding state Medicaid coverage (ASAM 2013).

Expected Beneficial Outcomes

Reduced substance abuse
Increased substance use disorder treatment

Evidence of Effectiveness

Increasing access to medication-assisted treatment (MAT) for opioid use disorder is a suggested strategy to decrease the frequency and amount of opioid use, reduce the risk of opioid overdose, and increase use of treatment, particularly for individuals with low incomes and in rural areas (SAMHSA-MAT, AHRQ-MAT, ASAM 2013). Available evidence suggests methadone maintenance use among Medicaid-enrolled adults in opioid addiction therapy is 30 percentage points higher in states that allow reimbursement than states that do not (Saloner 2016). Medicaid coverage for buprenorphine also appears to be associated with increases in its use in facilities that offer addiction treatment services (Ducharme 2008). However, additional evidence is needed to determine the effects of increased coverage and other efforts to increase access to MAT.

Medications used in MAT, particularly methadone and buprenorphine, have been shown to increase treatment retention and reduce opioid abuse and related health and social problems such as crime and HIV when used with counseling and behavioral therapy and used in appropriate doses (ASAM 2013, Campbell-Egli 2009, Cochrane-Mattick 2014, Cochrane-Mattick 2009, Timko 2016). Such medications may also improve treatment retention and birth outcomes for opioid-dependent pregnant women (SAMHSA-MAT, Holbrook 2015).

Implementation

United States

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).

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

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).

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
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

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
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
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
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
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
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

Page Last Updated

May 30, 2017

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