Perspectives: Make Methadone Clinics Available To Help Break Opioid Addiction, Save Lives From Overdose Deaths

Stat: It's Time For Methadone To Be Prescribed As Part Of Primary Care
Opioid use disorder, which claims 115 lives a day by overdose in the United States, is a complex, chronic medical condition, but one that can be successfully treated with proven medications. And yet, one of the oldest and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws. Of the three medications approved by the Food and Drug Administration to treat opioid use disorder, federal law relegates only methadone to be dispensed in separate clinics apart from the general health care system. It’s not unusual for methadone clinics to be in out-of-the-way locations and often inaccessible by public transportation, especially in rural and suburban communities. When individuals trying to break an addiction to opioids can’t get to a methadone clinic on a daily basis, they can’t get treatment. (Jeffrey Samet, Michael Botticelli and Monica Bharel, 7/5)

New England Journal of Medicine: Primary Care And The Opioid-Overdose Crisis — Buprenorphine Myths And Realities
Despite widespread awareness of the opioid-overdose crisis, the epidemic continues to worsen. In 2016, there were 42,249 opioid-overdose deaths in the United States, a 28% increase from the previous year. According to the National Center for Health Statistics, life expectancy in the United States dropped in 2016 for the second consecutive year, partly because of an increase in deaths from unintentional injuries, including overdoses. It was the first 2-year decline since the 1960s. How can we be making so little progress? In part, the overdose crisis is an epidemic of poor access to care. One of the tragic ironies is that with well-established medical treatment, opioid use disorder can have an excellent prognosis. Decades of research have demonstrated the efficacy of medications such as methadone and buprenorphine in improving remission rates and reducing both medical complications and the likelihood of overdose death. Unfortunately, treatment capacity is lacking: nearly 80% of Americans with opioid use disorder don’t receive treatment. (Sarah E. Wakeman, M.D., and Michael L. Barnett, 7/3)

Stat: Why Aren't Doctors Stepping Up To Treat People With Opioid Addictions?
Dear Doctor, Please help me understand why so few of you have chosen to treat people with opioid addictions. I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of care for individuals with opioid addiction (a term that those in the know tell me I should replace with opioid use disorder). That means treatment with methadone, buprenorphine, naltrexone, or combinations of these — medications you could prescribe if you wanted to. (Patrick Skerrett, 7/5)

New England Journal of Medicine: Moving Addiction Care To The Mainstream — Improving The Quality Of Buprenorphine Treatment
More than 40,000 Americans died from opioid overdoses in 2016 — more than the number killed in motor vehicle accidents. The stunning increase in overdose deaths since the 1990s has revealed a pervasive lack of capability to meet the need for treatment in the 2.1 million Americans who have an opioid use disorder. Since less than one fifth of people with opioid use disorder receive addiction treatment, recent national initiatives have understandably focused on increasing access to care, and especially access to medications, for addiction treatment. Even when patients do obtain treatment, however, they often experience care as fragmented and difficult to navigate. These challenges exist worldwide but are particularly acute in the United States, given the magnitude of opioid-related injury and death rates in this country and the historical marginalization and underfunding of addiction care. Payers and health systems can help move treatment to the mainstream, and increase the proportion of patients who recover, by expanding the pool of clinicians who treat opioid use disorder, improving measurement of treatment quality, and linking payment to outcomes. Like HIV/AIDS or diabetes, opioid use disorder is a chronic condition that can be managed using medication as a component of care. (Brendan Saloner, Kenneth B. Stoller, and G. Caleb Alexander, 7/3)

The Hill: Shut The Back Door To America’s Opioid Epidemic
As a former U.S. Senator and attorney general for New Hampshire, I’ve witnessed first-hand the devastating impact of opioid addiction in our communities. At pharmacies, opioid prescriptions are purchased one of two ways, using health insurance or with cash. Several initiatives by Pharmacy Benefit Managers (PBMs), the middlemen who administer pharmacy benefits for health insurance plans, have limited the supply of opioids that can be purchased by using health insurance. These efforts include limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy and limiting the daily dosage of opioids dispensed based on the strength of the opioid. While helpful, these steps are insufficient and leave a back door wide open for opioid abuse and so-called pill mills by providing little or no limits on cash purchases. This is how the back door works. People pay cash for prescriptions because they lack insurance coverage or because they want to circumvent health insurance controls.  Cash prices for prescription drugs are set at artificially high markups, often as much as ten times more than the prices paid for the same drugs by health insurance plans. To gain modest discounts to inflated cash prices, cash purchasers turn to prescription coupons known as “cash discount cards.” Even as PBMs limit access to opioids for patients using insurance, they issue cash discount cards that make opioid purchases easier to buy and more profitable for them. Prescription cash discount cards are heavily promoted in doctors’ waiting rooms, on television and on the Internet. (Kelly Ayotte, 7/3)