Expanded access to addiction treatment drugs and services should be part of national strategy to combat overdoses from opioid pain medications, according to a commentary by leading federal health officials in the New England Journal of Medicine.
The commentary calls on health care providers and insurers to expand patient access to medications to treat opioid addiction.
“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author Nora Volkow, MD, Director of the National Institute on Drug Abuse. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”
The commentary was co-authored Thomas Frieden, MD, Director of the Centers for Disease Control and Prevention; Pamela Hyde, Administrator of the Substance Abuse and Mental Health Services Administration; and Stephen Cha, MD, Chief Medical Officer of the Centers for Medicare and Medicaid Services.
More than 16,000 Americans die every year from prescription opioid overdoses, although many of the deaths also involve alcohol or other drugs.
Of the 2.5 million Americans who abused or were addicted to opioids in 2012, fewer than 1 million received medication assisted therapies, according to health officials.
“A number of barriers contribute to low access to and utilization of MATs (medication assisted therapies), including a paucity of trained prescribers and negative attitudes and misunderstandings about addiction medications held by the public, providers, and patients. For decades, a common concern has been that MATs merely replace one addiction with another,” said Volkow.
Use of the drugs is also limited because many addiction treatment providers favor an abstinence model. Many of the doses that are prescribed are inadequate. The lack of effective treatment leads some patients to return to opioid use, which perpetuates a belief in the ineffectiveness of addiction treatment.
“We have three highly different but effective medications to treat opioid addiction - more than any other drug of abuse except alcoholism. Yet only a small fraction of opioid-addicted patients receive these medications,” said Percy Menzies, president of Assisted Recovery Centers of America.
“There are several reasons the treatment and especially medications are not used extensively. Addictive disorders which include alcoholism have remained outside the realm of medicine and continue to be seen through the prism of criminal justice.”
Menzies said a “team approach” in a clinical setting is the most effective treatment for opioid addicts – and methadone clinics are in a unique position to offer all three medications.
“Patients could be detoxed using methadone or buprenorphine and then switched to naltrexone. But that rarely happens,” Menzies wrote in an email to National Pain Report.
“Most patients addicted to opioids are not aware about treatment options. Similarly, physicians prescribing buprenorphine do not do much more than the monthly renewal of the prescription and a urine screen.”
Menzies says methadone is an effective medication that reduces cravings for heroin and other narcotics, yet it remains controversial and carries an unfounded stigma. Because of its potential for abuse and diversion, methadone can only be given in a clinic setting.
Buprenorphine, which is sold under the brand name Suboxone, is a narcotic that was first approved as a treatment for opioid addiction in the U.S. in 2002. When combined with naloxone, the two drugs can be used to help wean addicts off opioids such as heroin, Vicodin, OxyContin, and hydrocodone.
Over three million Americans with opioid dependence have been treated with buprenorphine. Although praised by addiction experts as a tool to wean addicts off opioids, some are fearful the drug is overprescribed and misused. Buprenorphine is highly prized by drug addicts and has become a street drug. According to one estimate, about half of the buprenorphine obtained through legitimate prescriptions is either being diverted or used illicitly.
Naltrexone is the only non-addicting medication approved by the FDA. It requires patients to be detoxed off all opioids before starting treatment, which Menzies says is “not any easy task.” Low doses of naltrexone are prescribed off-label by some doctors to treat fibromyalgia and other types of chronic pain.