Medication-assisted treatment critical to fight addiction

Medication-assisted treatment critical to fight addiction

With the clock ticking on the appropriations process and elections around the corner, congressional action on opioids should remain a front-burner issue. President Obama himself proclaimed during National Prescription Opioid and Heroin Epidemic Awareness Week that we need to keep the pressure on.

The Comprehensive Addiction and Recovery Act (CARA), passed by Congress and signed by the president in July, authorized $181 million in additional funding for programs related to prevention and treatment, including medication-assisted treatment. This was a good start, but Congress should and must act through the appropriations process, including state block grants, to ensure the programs authorized in the bill have the resources necessary to be fully be implemented.  

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However, the fight around funding should be put in context — taxpayer-funded grants are a temporary bridge over a fundamental barrier to addiction recovery: the lack of meaningful access to recovery medication.

Only 20 percent of people with addiction receive any kind of treatment, and unfortunately, the vast majority of them are only receiving behavioral counseling. Behavioral counseling alone is not substantiated as the most effective treatment. Behavioral counseling in concert with recovery medication, often referred to as medication-assisted treatment, is the most effective, yet underused, evidence-based recovery treatment. 

The science is clear: A study published in The New England Journal of Medicine found that buprenorphine reduced the craving to use an opioid by roughly 50 percent and increased the odds of not taking an opioid by about 3.5 times. The World Health Organization, UNAIDS, the United Nations Office on Drug Policy and the National Institute on Drug Abuse (NIDA) all agree that people dependent on heroin and other opioids should have access to medication assisted treatment. 

So why is medication-assisted treatment so underutilized? One reason is that public and private insurance restrict access. The National Institute for Drug Abuse and the American Society of Addiction Medicine released a report in 2013 that revealed restrictions such as prior authorization, counseling requirements, quantity limits, step therapy requirements, duration limitations and network requirements. We would never give a person with Type 1 diabetes testing strips with no insulin, yet that is exactly what is done when we pay for behavioral counseling while restricting recovery medications for opioid addiction. 

State and federal government leaders need to look hard at how government insurance covers opioid recovery treatment, to make sure it is based on the evidence and the guidelines for medication assisted treatment.

Our organization, Advocates for Opioid Recovery, commissioned an IMS Health Institute report that was released that shows how medication-assisted treatment is funded by state. The variance was so astronomical, the only summary conclusion is that coverage is inconsistent and suboptimal in many parts of the country. 

For example, the share of recovery prescriptions paid for by state Medicaid programs ranged from 68 percent in Vermont to 4 percent in Mississippi. In nine states, at least 40 percent of buprenorphine prescriptions were paid for by Medicaid, yet in 12 states, the share of Medicaid payment was less than 10 percent. Four state Medicaid programs — Mississippi, Utah, Florida and Alabama — make up less than 5 percent of the payments in their states. 

There’s no question: Serious barriers are blocking access to recovery medication in the states. Public funding for grant programs should be tied to a thorough review of Medicaid and state employee health coverage for medication-assisted treatment. There are clearly barriers in the fine print of the coverage that block Medicaid beneficiaries from getting access to this medication and are likely in violations of the mental health parity law. 

The bottom line is that with the influx of federal dollars to fight this disease, let’s make sure the money we are already spending through government-sponsored health insurance supports evidence-based, medication-assisted addiction recovery. 

Gingrich served for nearly 20 years in the House of Representatives and as Speaker from 1995 to 1999. Kennedy is the founder of the Kennedy Forum and served in the House of Representatives from 1995 to 2011. Jones is a CNN commentator and president of Dream Corps and #cut50. The authors are paid advisers of Advocates for Opioid Recovery, at www.opioidrecovery.org