Excerpt from yesterday's Opioid Commission interim report.
Immediately establish and fund a federal incentive to enhance access to Medication
-
Assisted Treatment (MAT). Require that all modes of MAT are offered at every licensed
MAT facility and that those decisions are based on what is best for the patient. Partner
with the
National Institutes of Health (NIH)
and the industry to facilitate testing and
development of new MAT treatments.
MAT
has proven to reduce overdose deaths, retain persons in treatment, decreas
e use of
heroin, reduce relapse
and
prevent spread of
infectious disease. Expansion of MAT
availability for qualified individuals and for short
-
or long
-
term treatment is an essential
DRAFT
5
component of treatment services. Yet approximately 10 percent of conventional drug
treatment facilities in the United States provide MAT
for opioid use disorder.
Individuals seeking SUD treatment, and even those currently enrolled in a treatment
system, often find barriers to using MAT as a component of their treatment. Particularly for
populations with opioid use disorders (OUDs) involved in the criminal justice system, there
is often inadequate access to FDA
-
approved medications that are proven to improve
outcomes as part of a full continuum of care. Multiple studies have sh
own that individuals
receiving MAT during and after incarceration have lower mortality risk, remain in treatment
longer, have fewer positive drug screens
,
and have lower rates of recidivism than other
individuals with OUDs that do not receive MAT.
The DOJ, in consultation with HHS and
ONDCP, should be directed to increase the use of MAT for OUDs in these correctional
settings.
In addition,
the Centers for Medicare & Medicaid Services (CMS)
should require all
federally-qualified health centers (FQHCs) to man
date that their staff physicians, physician
assistants, and nurse practitioners possess waivers to prescribe buprenorphine.
There are several barriers to the use of MAT, including a prevalent belief that use of MAT
does not constitute true recovery or so
briety. The Federal Government, as a major
purchaser of health care services, has a tremendous opportunity to increase the availability
of MAT for individuals with OUDs. For example, across the Veterans Administration (VA)
and
Indian Health Services, there
is a lack of providers able
to prescribe/administer MAT.
For Medicare patients, the Part B physician benefit does not cover methadone treatment
and the Part D pharmaceutical benefit does not cover it either, as it is administered by a
medical professional. CMS should send a letter to state health officials requesting that state
Medicaid programs cover all FDA
-
approved MAT drugs for OUD.
Additionally, all FDA
-
approved MAT should be offered by authorized providers, not just one
or two of these approved options. These decisions of which (if any) MAT to be used must
be based upon what is best for the patient, not what is best for the provider. This can be
mandated by the Executive Branch.
Finally, we urge you to instruct the
NIH to begin to immediately work with the
pharmaceutical industry in two areas; the development of additional MAT options and the
development of new,
non-opioid pain relievers based on research to clarify the biology of
pain.
The nation needs more options to treat those already addicted and can help to
prevent addiction in the first place by avoiding the prescription of opioids. The NIH is best
positioned, in our opinion, to lead this effort with industry partners.