On November 1, the White House released the long-awaited final report on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The report contains some good news for opioid treatment programs (OTPs)–if the recommendations can be turned into reality.
The 138-page report includes strong support for medication-assisted treatment (MAT), including the use of methadone, buprenorphine, and naltrexone, the three medications approved by the Food and Drug Administration (FDA) for treating opioid use disorders (OUDs).
Here are some key points.
Treating the whole person: The report urges that effective treatment must meet “the needs of the whole person to be successful,” and goes on to recommend a model that OTPs fit perfectly. Citing research by the National Institute on Drug Abuse (NIDA), the report urges that treatment models should “incorporate behavioral, psychosocial, and pharmacological elements,” and be “tailored to the individual client.” The services should include 1) a complete evaluation for OUDs as well as other substance use disorders (SUDs), and psychiatric and medical disorders; 2) access to MAT; and 3) simultaneous access to psychosocial treatment.
Importance of MAT: Medication-assisted treatment for OUDs “is associated with decreases in opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission, while improving social functioning and retention in treatment.”
Insurance and reimbursement: Less than half of privately funded SUD treatment programs offer MAT, and only a third of patients with OUDs at these programs receive MAT, the report says.
Medicare: There are complex barriers for Medicare patients seeking MAT, the report notes. Methadone is covered under Medicare’s Part D program when prescribed for pain, but not when part of an OUD program. “Some MAT reimbursements are part of a bundled payment for inpatient care, but it has come to the attention of the Commission that bundled payments can be a barrier to providers offering an array of services and medications.”
Corrections: There is very limited use of MAT in prisons and jails, and when it does exist, it is usually limited to maintenance for pregnant women, and detoxification for everyone else. In one study, most jail personnel did not support methadone treatment, and some custodial staff have negative attitudes about addiction and about inmates with addiction, in particular, heroin addiction. There is a general assumption that people who overdose get what they deserve. The report noted that progress has been made, but that there is a long way to go.
Linkage to treatment after overdose: Patients hospitalized with an OUD should receive methadone induction in the hospital, followed by “direct linkage to an opioid treatment program,” the report states. Post-overdose engagement in treatment with buprenorphine or methadone can also be facilitated by hospitals. Buprenorphine, recovery coaches, and an opioid urgent care facility adjacent to a hospital are also recommended by the report.
The report does not come with any funding, and many of the recommendations are not feasible without added money. President Trump left this consideration up to Congress, but is not asking for any specific increases. Still, it is an important document; one that stakeholders should refer to, going forward.
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