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ADVOCACY NEWS


State Policy Trends Affecting Treatment of Addiction Involving Opioid Use

January 9, 2018

By: Brad Bachman, Manager, State Advocacy & Government Relations

 

The opioid epidemic continued throughout the United States in 2017. State legislatures have remained engaged on this issue, with every state enacting some type of measure supporting prevention, treatment, or recovery in the past two years.[i] Successful policies ASAM and its state chapters supported last year include Tennessee requiring managed care organizations to report annually on mental health and addiction benefits claims, as well as Minnesota removing the “buy and bill” requirement so providers can bill practitioner-administered medications for substance use disorder treatment, like naltrexone, as a pharmacy benefit.

 

While legislators are genuine and compassionate in their urgency to respond to the epidemic, certain proposed policies are not supported by the science and evidence of addiction medicine. For example, some legislation could harm patients by inadvertently limiting access to evidence-based treatments. Over the past year, addiction recovery advocates and stakeholders have responded to policies across multiple states that could have this effect. Below are examples of policies that could negatively impact opioid addiction treatment and recovery:

 

  • Attempting to expand access to medications that treat addiction involving opioid use, but emphasizing antagonist modalities and mandating a treatment goal of opioid abstinence. Emphasizing one type of medication could contribute to stigma and misunderstanding of other types of medications used in the treatment of addiction involving opioid use. In addition, legislating treatment goals is inappropriate as these decisions should be between treatment providers and their patients. Instead, treatment legislation should require providers to provide directly or through referral all Food and Drug Administration (FDA)-approved medications for opioid use disorder, consistent with federal requirements under Section 303 of the Comprehensive Addiction and Recovery Act.

 

  • Imposing licensure requirements and/or fees for office-based opioid treatment (OBOT) to ensure the quality of treatment with buprenorphine and reduce its diversion to illicit use. Proposed requirements have included: every OBOT-waivered clinician to be credentialed with Medicaid; all patients participate in behavioral counseling; and high licensure fees. Finding physicians who are willing to provide services to this population can be challenging enough without additional licensing requirements, care restrictions, and imposition of large fees. Moreover, inability to access treatment is a predictor for diversion, so these requirements can be counterproductive and increase diversion.[ii]

 

  • Attempting to reduce injection drug use by limiting the prescribing of buprenorphine without naloxone (i.e., buprenorphine monoproduct) to specific populations, such as patients pregnant or nursing, patients transitioning from methadone to buprenorphine, or patients exhibiting adverse reactions to naloxone. However, these restrictions should reflect recent advancements in addiction medicine and should not apply to new FDA-approved formulations of buprenorphine monoproduct, such as injectables and implantables that are administered or implanted by health care providers.

 

As addiction recovery advocates and stakeholders continue to fight for solutions to our nation’s opioid epidemic, educating lawmakers and regulators on unintended consequences is critical. By working together, legislation addressing the opioid epidemic will have the true intent that most elected officials hope to achieve: preventing opioid misuse and addiction and increasing access to evidence-based treatments for people with the disease of addiction.

 


 [i] http://www.ncsl.org/bookstore/state-legislatures-magazine/federalism-hot-legislative-issues-2018.aspx

[ii] Lofwall, Michelle R., & Havens, Jennifer R. (2012). Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine. Drug Alcohol Depend. 2012 Dec 1; 126(3): 379–383.