Almost twice as many opioid abusers as treatment slots

An estimated 2.3 million people abused opioids or were opioid-dependent in 2012, but there were only 1.4 million spots available to them in opioid-agonist based medication-assisted treatment (MAT) programs, according to a study published in the American Journal of Public Health. According to HHS, the rate at which opioid abuse or dependence exceeded treatment capacity has increased over the years, from 634.1 per 100,000 in 2003 to 891.8 per 100,000 in 2012. Access to methadone or buprenorphine-based MAT programs, the most effective form of treatment for opioid use disorders, is necessary to combat the growing epidemic.

Opioid abuse

Prescription opioids resulted in more than 16,000 deaths in 2013; in that same year, 432,000 seniors “misused” prescription pain relievers, including opioids, which include drugs like oxycodone, hydrocodone, and codeine (see Do Part D plans disfavor abuse-deterrent opioids?, Health Law Daily, June 10, 2015). HHS has made combating opioid abuse and death a priority (see HHS hoping to reduce opioid addiction with new initiative, Health Law Daily, March 26, 2015). In a March 26, 2015 issue brief, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) discussed steps to attain its goal of expanded the use of MAT to reduce opioid use disorders and overdose. MAT involves the use of buprenorphine, methadone, or extended-release injectable naltrexone, combined with counseling and behavioral therapies, to treat opioid use and other substance use disorders. The issue brief described plans for investment in MAT services, in part through a Substance Abuse and Mental Health Services Administration (SAMSHA) demonstration grant program. It also discussed the FDA’s use of expedited review programs to review applications for the development of medications for the treatment of opioid use disorders.

ACA

The issue brief also addressed plans for the National Institute on Drug Abuse (NIDA) to conduct research into the Patient Protection and Affordable Care Act’s (ACA’s) (P.L. 111-148) effects on MAT implementation. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), which became law as part of the Emergency Economic Stabilization Act of 2008 (P.L. 110-343), extended mental health parity to apply to substance use disorders. The ACA extended the provisions of the MHPAEA to the individual health insurance market, qualified health plans (QHPs) established by the ACA, and Medicaid non-managed care benchmark and benchmark-equivalent plans (see Mental health coverage: is parity the point?, Health Law Daily, April 6, 2015). In addition, the ACA may have an impact on access to MAT programs due Medicaid expansion and increased insurance coverage through the health insurance Marketplace.

Need for treatment

“Opioid drug abuse is a devastating epidemic facing our nation,” said Richard Frank, ASPE. MAT is considered an effective way to stem such abuse. Frank continued, “Connecting people in need to the right treatment is critical to saving lives and addressing the opioid epidemic.”