Report: Better outcomes for opioid addiction lie in greater access to medication

The Legal Action Center has released a strongly worded report advocating wider use of medication-assisted treatment to combat opioid addiction, reserving its harshest criticism for insurers and criminal justice officials for creating obstacles to effective care.

The national law and policy organization states that while medication-assisted treatment has demonstrated effectiveness in both detoxification and ongoing treatment, it remains, “tragically, and senselessly, underutilized,” largely because of unfounded biases. Among the recommendations in its report, the Legal Action Center says that privately and publicly insured patients should have access to all three federally approved medications to treat opioid addiction (methadone, buprenorphine and injectable naltrexone), and that opioid treatment programs (OTPs) should make use of all three treatments as well (many traditionally offer methadone treatment only).

“Not all patients respond to medicines in the same way; as with other chronic diseases, patients should have the right to any FDA-approved alternatives,” states the report, titled Confronting an Epidemic: The Case for Eliminating Barriers to Medication-Assisted Treatment of Heroin and Opioid Addiction. “Insurance formulary tiers need to be updated so all approved addiction medications are covered.”

The report cites numerous published data points that bolster the argument for more widespread use of medication treatments. For example, it states that individuals whose treatment included medications were 75% less likely to experience an addiction-related death. Also, research on methadone maintenance has reported that every dollar spent on methadone treatment generates $38 in benefits, in areas ranging from increased employment opportunity to decreased justice system costs.

Numerous barriers

The report strongly criticizes the public and private insurance systems for failing to ensure unfettered access to these medication treatments for opioid addiction. Only 28 states currently cover in their Medicaid systems all three medications for opioid dependence, the Legal Action Center states.

In private insurance, “many policies impose onerous prior authorization requirements, place arbitrary limits on medication dosage and length of treatment, or require people to 'fail first' at other treatments for one or even all medications,” states the report.

But these insurance obstacles even pale in comparison to the barriers found in the justice system, according to the report. Individuals who are participating in medication-assisted treatment outside of custody are often forced to stop receiving the medication upon entering jail or prison. The report states, “Many courts, probation and parole agencies routinely prohibit individuals under their supervision from receiving [medication-assisted treatment]. Even when prescribed by a physician, those receiving medication-assisted treatment are sometimes sanctioned with jail time and disqualified from alternative sentencing programs.”

The report's release comes at a time when two U.S. senators have reintroduced legislation that would invest in comprehensive treatment initiatives, including those incorporating medication treatments, in communities and the justice system. Sens. Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.) are the main sponsors of the Comprehensive Addiction and Recovery Act (S. 524).

Recommendations

Besides the recommendation on insurance access to medications, the Legal Action Center report offers these recommendations:

• Enforce existing insurance protections for consumers. The report points out that the federal government has yet to issue final guidance on how the federal parity law specifically applies to medication-assisted treatment.

• Support education and outreach for healthcare and justice professionals. The Legal Action Center believes that no judge or other justice official should be allowed to deny an individual medication-assisted treatment that a physician has recommended for that person.

• Treat justice-involved individuals. Medication-assisted treatment should be fully integrated into jails and prisons, with post-release medication options available as well.

• Promote treatment over incarceration, through initiatives such as the proposed federal legislation.