Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System

Madras, Bertha K.; Ahmad, N. Jia; Wen, Jenny; Sharfstein, Joshua

doi:10.31478/202004b

Cited by 150 publications

(125 citation statements)

References 140 publications

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“…Even though participants highlighted the need for SUD treatment centers to offer a range of evidence-based treatments, only 36% of specialty SUD treatment centers in the United States offer any form of MOUD (Abraham et al, 2020). Several factors likely affect the limited offering of MOUD, including stigma and availability of trained staff (Madras et al, 2020). In the United States, buprenorphine treatment providers must have an “X waiver” from the Drug Enforcement Agency, but 35% of U.S. counties lack a single clinician with such a waiver (Ghertner, 2019).…”

Section: Discussionmentioning

confidence: 99%

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

2020

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Treatment preferences of people with opioid use disorder (OUD) have been underexplored, especially among those with a history of utilizing medications for opioid use disorder (MOUD). Therefore, we sought to understand preferred characteristics of substance use disorder treatment centers among people recovering from OUD with a history of MOUD utilization. We recruited 30 individuals from eight states through snowball sampling initiated at three syringe exchange programs. Telephone interviews were audio-recorded and transcribed in 2018–2019. Inductive thematic analysis in Dedoose software occurred iteratively with recruitment. The following were “ideal” treatment center themes: a menu of treatment options, including MOUD and nonspiritual peer support groups; an integrated system with multiple care levels (e.g., outpatient, residential); a harm reduction approach, including for goal setting and success measures; adjunctive support services (e.g., housing); and employees with recovery experience and professional education. Many preferences directly related to core principles of person-centered care and harm reduction.

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Section: Discussionmentioning

confidence: 99%

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

2020

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“…Previous studies have identi ed numerous barriers to prescribing MOUD in o ce-based settings. The majority of such studies have focused on oral buprenorphine, nding salient barriers to include a lack of training for physicians in MOUD and addiction treatment, concerns about diversion, insurance barriers, and discomfort in treating patients with comorbid psychiatric conditions (15,(24)(25)(26)(27)(28). Fewer studies have examined extended-release naltrexone; current research suggests that insurance-related factors, the requirement that patients are completely opioid-abstinent for 7 to 10 days prior to initiation, inadequate sta ng, and limited education for prescribing physicians are key barriers to prescribing extendedrelease naltrexone (10,(29)(30)(31)(32).…”

Section: Access To Treatment For Opioid Use Disordermentioning

confidence: 99%

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder 

Haffajee

Andraka‐Christou

Attermann

et al. 2020

Preprint

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Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD. Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

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“…Both buprenorphine and methadone are forms of MAT that have been documented to be safe for use during pregnancy and reduce the risk of obstetric complications (Jones et al, 2008;Substance Abuse & Mental Health Service Administration, 2016). Like all substance use recovery programs, OUD treatment services for pregnant or postpartum women must also consider their unique barriers to treatment, including cost, transportation, limited work leave, childcare, and stigma (Madras et al, 2020). Lack of treatment for OUD before and during pregnancy places the mother at risk for overdose and the infant at risk for neonatal abstinence syndrome (NAS).…”

Section: Opioid Use Disorder Treatment During Pregnancymentioning

confidence: 99%

The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid

Reising

Horne

Bennett

2020

Public Health Nursing

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Objective: This paper will discuss the process of mapping opioid use disorder (OUD) treatment resources for pregnant women and discuss the intersection between treatment resources and rates of neonatal abstinence syndrome (NAS). Design: A resource manual was developed through a systematic process with stakeholders across Illinois. Resources were mapped by county and overlaid with county rates of NAS, using hospital discharge data. Results: Across Illinois, 89 treatment resources were identified for pregnant women insured by Medicaid. Resources were concentrated in 36% of Illinois' counties. Counties with limited treatment resources generally had high rates of NAS. Sixty-six percent of NAS cases among rural Illinois residents had no OUD treatment resources in their county. Rural counties had less access to medication-assisted treatment (MAT), the standard of care for treatment of OUD, compared with other counties across the state. Conclusions: Efforts to increase OUD treatment options for pregnant women insured by Medicaid should concentrate on geographic areas with limited access and high need. K E Y W O R D S access to health care, community assessment, medication-assisted treatment, neonatal abstinence syndrome, opioid use disorder, pregnancy, substance use disorder How to cite this article: Reising VA, Horne A, Bennett AC. The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid.

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Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System

Cited by 150 publications

References 140 publications

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder

The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid

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Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System

Cited by 150 publications

References 140 publications

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

Designing an “Ideal” Substance Use Disorder Treatment Center: Perspectives of People Who Have Utilized Medications for Opioid Use Disorder

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder&nbsp;

The interaction of neonatal abstinence syndrome and opioid use disorder treatment availability for women insured by medicaid

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A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder