If it weren’t for proprietary financing interests, there would be little growth in opioid treatment programs (OTPs), according to Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). The reason for this is partly funding, but there are still barriers based on stigma.
Despite those barriers, for-profit providers can adapt more quickly to market demands and have better access to capital than not-for-profit providers, said John Peloquin, PhD, vice president of CRC Health Group. CRC itself is for-profit. “But I don’t think this should be seen as a for-profit versus not-for-profit issue,” Dr. Peloquin told AT Forum. “There is a clear opioid epidemic going on across the United States.”
Dr. Peloquin also doesn’t like to refer to the epidemic as a “heroin” epidemic, because prescription opioids are definitely part of the problem.
However, the epidemic has not made it easier to site a facility, said Dr. Peloquin, who oversaw CRC expansion in several cities in 2014. Nevertheless, the opioid epidemic is “so severe in some counties that facilities offering medicated treatment are being viewed more as a solution to a local need rather than an unnecessary stigmatized service.”
Neighborhood challenges to expansion are “driven either by the stigma of medication- assisted treatment [MAT] or lack of acceptance that the location we are targeting is appropriate,” he said. “There remain countless patient success stories every day in each community we serve. More community-based education on the efficacy of MAT will help bring providers and communities closer together, and that will help promote the efficacy of the MAT modality.”
Meanwhile, some state regulations actually impede expansion in many cases. For example, in Mississippi, no OTP has opened since the first one, in Jackson, in 2005. “The state seems to be stuck in its regulatory policy and will not create any amendment which would encourage a second or third OTP in the state,” said Mr. Parrino. “Alabama is not opening new OTPs either, and Maine OTPs are just hanging on for dear life.” In Maine, the governor and many legislators are opposed to long-term maintenance, capping it at two years if paid by Medicaid. In other states, like Tennessee and West Virginia, Medicaid can’t be used at all for OTPs.
Editor’s Note: Acadia and CRC announced last fall that Acadia would acquire CRC.
