The Next Step States Need to Take to Combat the Opioid Crisis
Making medication-assisted treatment for opioid use disorder more readily available is a cost-effective, life-saving strategy. Some states are showing the way.
Despite billions of federal dollars flowing into states to help fight the opioid epidemic -- which was responsible for nearly 48,000 deaths in the United States in 2017, or approximately 130 each day -- this public health crisis continues to grow. The number of overdose deaths has risen precipitously over the past 20 years, and policymakers and officials at the state and local levels have struggled to make meaningful progress in reducing this trend.
But the ongoing tragedy of opioid-related deaths is not the full story. Today, more than two million Americans suffer from opioid use disorder (OUD), a chronic, debilitating brain condition caused by recurrent use of opioids for which too few have access to effective treatment. Only one in nine people with a substance use disorder receives any kind of care, including medication-assisted treatment (MAT), the most effective therapy for OUD. MAT combines Food and Drug Administration-approved drugs with behavioral therapies such as counseling and has been proven to help individuals adhere to treatment longer, reduce illicit drug use and infectious-disease transmission, and decrease overdose deaths.
But the drugs that help alleviate symptoms associated with OUD are not readily available across the country, which makes managing the problem especially difficult. Today, only 23 percent of publicly funded treatment centers report offering MAT drugs, and less than half of privately funded treatment centers report that their health care providers make these drugs available.
In addition, prescribers who want to treat patients with buprenorphine, one of three drugs approved by the FDA to treat OUD, must first undergo hours of training and obtain a waiver from the U.S. Drug Enforcement Administration. In contrast, the agency does not require health care providers to obtain additional training or waivers before prescribing opioids, the medications at the core of this public health crisis. As a result, 44 percent of U.S. counties -- where 20 million Americans live -- had no prescribers authorized to order buprenorphine in 2017.
With state budgets continually stretched by competing demands, policymakers and officials must be judicious in how they allocate funds to combat the opioid crisis. Putting public dollars into expansion of access to MAT as a way to help manage the opioid crisis would be a cost-effective and life-saving strategy.
Several states have taken steps to increase access to MAT and report promising results. Rhode Island, for example, has focused on expanding OUD treatment for people within the corrections system. Today, all of Rhode Island's jails and prisons offer access to the three FDA-approved medications for OUD -- buprenorphine, methadone and naltrexone -- and individuals are referred to continued treatment immediately upon their release, the period when research shows they are most susceptible to relapse and overdose. The state has seen a significant reduction in overdose deaths since it implemented this initiative in 2016.
In Virginia, the Addiction Recovery Treatment Services Program has transformed how the state's Medicaid program approaches OUD treatment. Since 2017, Medicaid recipients in Virginia have had access to the full spectrum of services associated with MAT, which is more readily available in medical office settings. In addition, reimbursement rates for treatment now align with the average rates for private insurance. As a result, more than 3,500 Virginia Medicaid recipients are now receiving OUD treatment, an increase of 51 percent since the program started, and no patient has to travel more than 60 miles to receive treatment.
Vermont has implemented a care delivery model known as "hub and spoke," in which patients can receive treatment for substance use disorder in one of nine hubs -- where intensive therapy options are available -- and in provider spokes, where treatment is often integrated into general medical care in communities across the state. As a result of adopting this model in 2013, Vermont has the highest capacity to treat OUD of any state in the country. In addition, the number of Vermont physicians who have obtained waivers to prescribe buprenorphine has increased 64 percent, with a 50 percent rise in patients served by these doctors.
Finally, in Indiana, Louisiana and Wisconsin -- three states where The Pew Charitable Trusts provided technical assistance to combat the opioid crisis -- state lawmakers have implemented policies designed to expand access to MAT. In Indiana, Gov. Eric Holcomb signed legislation in 2018 that would open nine opioid treatment facilities where patients take medications for OUD under the supervision of medical staff and receive counseling and other care services. Once all the sites are operational, OUD treatment will be no more than an hour's drive for any Indiana resident. In Wisconsin, which was facing a shortage of substance use disorder counselors, then-governor Scott Walker signed legislation in 2018 that modified the state's counselor certification and licensure process to ensure that qualified providers are able to treat patients. And in Louisiana, Gov. John Bel Edwards just signed legislation that will require all licensed residential facilities that treat substance use disorder to offer at least two forms of MAT on-site by 2021.
Federal and state funds have been critical to implementing these evidence-based initiatives. As states continue to grapple with the opioid crisis, public officials and managers would do well to dedicate available resources to expanding access to MAT, the most proven therapy for OUD.