- The Washington Times - Thursday, October 27, 2016

Access to medications that help opioid addicts kick the habit isn’t keeping pace with the raging prescription painkiller and heroin epidemic that’s battering every corner of the U.S., government investigators said Thursday.

Many of the 1,400 opioid treatment programs that administer drugs like methadone to help patients stave off withdrawal and cravings are clustered in urban areas, forcing addicts in rural areas to travel hours for their dosage, according to the Government Accountability Office.

Even when they’re accessible, programs tend to operate at 80 percent capacity or more, and some new patients end up on a wait list.

About 2.3 million were abusing opioids or dependent on them in 2012, yet only 1.4 million people could access medication-assisted treatment, investigators said.

The rate of overdose deaths from prescription drugs and heroin has hit record levels since then, killing nearly 30,000 in 2014, and more people are dying from the epidemic than from automobile accidents in some places. Pop-music legend Prince died of an opioid fentanyl overdose in the spring, raising the visibility of the issue.

Congress passed a comprehensive bill to tackle the epidemic, though all sides say more could be done to address the problem.

The prevalence of doctors who can prescribe buprenorphine, a key opioid-treatment drug, varies widely from place to place, and lifting the cap on how many patients each of these doctors can serve from 30 to 100 in 2006 hasn’t been enough, the GAO found.

Prescribing buprenorphine for opioid addiction was a relatively new practice when Congress established the program in 2000, so lawmakers wanted to tread carefully by capping the number of patients a qualified doctor could treat, while empowering the Health and Human Services Department to lift the cap in the future.

Hoping to ease the backup, the Obama administration took regulatory steps to raise the limit to 275 patients.

Still, other factors are limiting the deployment of medication-assisted treatment, or MAT, to those swallowed up by the opioid epidemic.

Some treatment centers are stigmatized for accepting drug addicts, while some drug courts and sentencing officials are denying access to the treatment for a variety of reasons.

“These included a lack of understanding about the nature of addiction and MAT, such as the belief that MAT is substituting one addiction for another,” the GAO found. “In addition, some judges may view opioid addiction as a social problem that is best addressed through abstinence.”

Cost is also a problem. A month’s supply of daily-dose buprenorphine comes in at $200 and $450, so patients without insurance face “prohibitive” out-of-pocket costs.

Some health providers are also reluctant to use injectable naltrexone for opioid treatment on the uninsured, because it costs from $750 to $1,200 a month.

GAO said more patients could access coverage for drug treatment under Obamacare’s expansion of Medicaid, though officials in two states that expanded the insurance program for the poor still have concerns about access.

“Specifically,” the GAO said, “officials in these states reported difficulties providing Medicaid enrollees with access to certain MAT medications due to lack of physicians willing to prescribe these drugs for Medicaid enrollees.”

Michael P. Botticelli, director of the Office of National Drug Control Policy, said the report offered an “excellent summary” of the efficacy of medication-assistant treatment and the obstacles that some patients face.

He said his office is taking a number of steps to tear those barriers down, from encouraging health providers and the criminal justice system to embrace medications as part of their opioid treatment to convincing recovery support groups to accept persons who rely on medication-assisted treatment.

His office told states to leverage certain block grants to help pay for the cost of treatment, and it is making sure Medicare and programs for federal employees and veterans cover it, too.


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