Written By: Michael Weaver, MD, DFASAM
Opioid use disorder (OUD) is a chronic, relapsing disease. However, OUD is treatable and long-term treatment is typically necessary. Treatment options include non-medication abstinence-based therapy, or medication treatment with opioid antagonists (naloxone) or opioid agonists (methadone or buprenorphine). Medication for OUD (MOUD) is very effective at reducing or eliminating illicit opioid use and the consequences that result from addiction. Treatment for OUD often takes place in specialized treatment programs.
Federal legislation in 2016 and 2018 enhanced patient access to buprenorphine and other treatments for OUD. A recent article published in the New England Journal of Medicine by the director of the White House Office of National Drug Control Policy (ONDCP) outlines President Biden’s National Drug Control Strategy, which recommends 6 steps to allow access to MOUD for anyone with OUD by 2025. As a healthcare professional, I agree with the recommendations of the ONDCP regarding use of MOUD. The 6 steps focus on education for healthcare professionals, ways to increase access to MOUD, and reducing stigma.
The focus on education for healthcare professionals is essential. There is a shortage of qualified addiction treatment providers entering the workforce, and many providers are untrained, making them hesitant or fearful about treating addiction. Nearly all clinicians believe patients with substance use disorders are more challenging to care for than the “average” patient, and the “hidden curriculum” in medical training across the education continuum assumes that addiction cannot be adequately treated. An education gap exists between the clinical settings in all medical specialties and the amount of curricular time devoted to training in addiction. This contributes to the treatment gap between the numbers of patients needing addiction treatment and the numbers of physicians with adequate training to identify, treat, and prevent addiction. A variety of resources are available for enhancing education and training at all levels of education. This includes MOUD content in medical schools and continuing education about addiction medicine for healthcare professionals in practice. Enhancing education about addiction for healthcare practitioners with help to close the treatment gap.
Access to MOUD is essential, so I applaud the goal of universal access by 2025. Unfortunately, these medications are not being used in a majority of addiction treatment programs, even though they are evidence-based and standard of care. Physicians and nurse practitioners can take the initiative and prescribe naltrexone or buprenorphine to appropriate patients right away with no need for specialized training. Another of the steps recommended to increase access to MOUD is through low-threshold buprenorphine treatment. Community-based programs that provide low-threshold buprenorphine treatment help meet patients where they are. Another way to reach more people is through telehealth and extending the flexibility of this beyond the COVID-19 pandemic. The federal government has a Treatment Finder website to help patients and physicians connect people with treatment programs. The web address is www.findtreatment.samhsa.gov and it can find treatment programs across the U.S. Offering MOUD during incarceration is another way to reach a challenging patient population and can help reduce reincarceration. The fewer the barriers to access and the more opportunities for access to MOUD, the more patients that can be helped and lives that can be saved.
Stigma towards patients with OUD and other addictions is unfortunately still prevalent among healthcare providers. Efforts to reduce stigma are essential. Most notably, stigma among healthcare professionals can be reduced by providing clinical exposure to patients with substance use disorders, especially those actively in recovery. Education about addiction combined with positive experiences with patients with substance use disorders can help healthcare providers become much more comfortable and competent at treating this patient population.
Regardless of which type, treatment of OUD helps save lives. The time to act is now to take advantage of these medications that can have a profound impact of the lives of people struggling with opioid addiction. If you recognize opioid addiction, you can save lives by referring patients to treatment for their addiction.