Adoption of Medications in Substance Abuse Treatment: Priorities and Strategies of Single State Authorities

Abstract

Research has confirmed the effectiveness of medications, when used in conjunction with ongoing counseling, to treat substance abuse disorders. This article describes a national, mixed-methods research project designed to investigate single state authorities' (SSAs) perceptions of adoption of evidence-based practices in substance abuse treatment. Results are focused specifically on medication-assisted treatment, one of five evidence-based practices defined by the National Quality Forum. Medication-assisted treatment (MAT) is an important and effective part of comprehensive care options available to clients who are chronically ill with alcohol and other drug disorders. Despite mounting clinical evidence and increased availability, overall rates of implementation and sustained adoption of medications to treat addiction remain limited. The results illustrate that the SSA representatives who fund public treatment programs believe MAT is a priority and worthy of system-wide implementation. Current strategies utilized by SSAs to support the adoption of MAT are detailed, as are barriers to adoption and implementation.

Improving Treatment for Opioid Dependence: A Perspective From the Ohio Valley Node of the NIDA Clinical Trials Network

“…Lack of buy-in from clinic staff and leadership is frequently reported as a significant barrier to medication adoption. 14,19–20 An abstinence-based recovery approach to addiction treatment was a major barrier at Maryhaven that was, ultimately, addressed by an incremental process of adoption that resulted in a medication assisted recovery philosophy. However, philosophical barriers to medication use were not a barrier at Midtown may be due to Midtown being part of a larger medical system where medications are used on a routine basis to treat psychiatric and medical conditions.…”

“…5,17 For some treatment programs and clinicians, the barrier may be the philosophical belief that medications should not be used to treat addictions despite the overwhelming evidence of efficacy and effectiveness. 20 …”

Barriers to Use of Pharmacotherapy for Addiction Disorders and How to Overcome Them

“…Barriers include the requirement to attend an 8-hour training session in order to prescribe office-based treatment for opioid dependence with buprenorphine, third party payer reimbursement obstacles, lack of parity in insurance coverage, complex rules regarding Medicaid coverage of pharmacotherapy, and limits and restrictions on treatment coverage (including pharmacy benefits) [32, 36, 38•, 39]. For instance, insurance plans may exclude medications for alcohol or opioid dependence from their formularies or require prior authorization.…”

“…Opioid substitution treatment programs that provided suboptimal dose levels, did not include patient participation in decision-making about medication dose, were punitive in response to illicit drug use, and did not follow practice guidelines had poorer treatment retention and outcomes [42, 47]. Treatment philosophy also affects the way in which treatment is offered (e.g., separate clinics) and can lead to stigmatization, poor access, and poor coordination of care [34, 36, 42, 48–52]. Offering pharmacotherapy in separate treatment settings may also result in fewer physician role models across medical specialties with expertise in addiction medicine [38•].…”

The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources

“…Multiple stakeholders, including the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and SAMHSA, have worked to disseminate evidence-based practices (EBPs) through websites, publications, and conferences (Martino et al, 2010;The Addiction Technology Transfer Center Network Technology Transfer Workgroup, 2011;Warren and Hewitt, 2010). State SUD authorities (SSAs; also known as singlestate agencies) have been involved to varying degrees in promoting EBPs (Rieckmann et al, 2009(Rieckmann et al, , 2010, together with pharmaceutical companies holding active patents on these medications. Prior cross-sectional research has shown that pharmaceutical detailing is positively associated with the odds that SUD programs offer medications .…”