More resources needed for medication-assisted treatment

It would be a sensible move for healthcare executives to include medication-assisted treatment (MAT) high on the list of clinical tools used to treat opioid addiction, according to experts.

G. Caleb Alexander, MD, MS, of the Johns Hopkins Bloomberg School of Public Health, and colleagues, recently conducted a study published in Addiction, that demonstrates the need for greater resources devoted to MAT.

Daubresse

“MAT is when patients being treated for opioid addiction are given medications containing low-doses of opioids to reduce withdrawal symptoms and cravings,” says study co-author Matthew Daubresse, a doctoral student in the Department of Epidemiology at the Bloomberg School. “These medications are given in addition to counseling and behavioral therapy.”

More than two in five people receiving buprenorphine, a drug commonly used to treat opioid addiction, are also given prescriptions for other opioid painkillers-and two-thirds are prescribed opioids after their treatment is complete. Methadone has been the most common drug to treat opioid use disorders, but over the past 15 years, buprenorphine, a shorter-acting opioid similar to methadone, has been increasingly used instead.

For this study, the researchers looked at prescriptions for buprenorphine and Suboxone, a combination of buprenorphine and naloxone, an anti-overdose medication. Unlike methadone, buprenorphine can be prescribed for opioid use disorders in primary care, so it is an important treatment option for clinicians and patients to have, according to Daubresse.

The researchers examined pharmacy claims for more than 38,000 new buprenorphine users who filled prescriptions between 2006 and 2013 in 11 states. They looked at non-buprenorphine opioid prescriptions before, during, and after each patient’s first course of buprenorphine treatment, which typically lasted between one to six months. Even though there are no universally agreed-upon guidelines regarding the optimal length of treatment, most people discontinued buprenorphine within three months.

This is the first report to examine non-buprenorphine opioid utilization among buprenorphine patients using large all-payer claims data from multiple states. The study also shows how rates of opioid use change based on the length of buprenorphine treatment. 

The study found that 43% of patients who received buprenorphine filled an opioid prescription during treatment and 67% filled an opioid during the 12 months following buprenorphine treatment. The authors noted some of the patients that were being examined could have received buprenorphine for chronic pain rather than MAT. Most patients continued to receive similar amounts of opioids before and after buprenorphine treatment.

Because the study data lacked information on patients’ use of illegal opioids such as heroin, the results likely underestimate the proportion of patients using opioids during and after buprenorphine treatment.

“Some buprenorphine-containing drugs block the effects of other opioids, so concomitant use of these drugs may be ineffective,” says Daubresse. “Although concomitant use of buprenorphine and other opioids may be clinically appropriate for some patients, in many cases this may represent a lack of care coordination which impacts the quality and safety of care.”

Many managed care organizations do cover MAT for substance abuse disorders because studies have shown that buprenorphine is comparable to methadone in reducing illicit opioid use, according to Daubresse. “MAT is an evidence-based treatment for opioid use disorders, but individuals with opioid use disorders have a lifelong vulnerability to opioids, just as those with alcohol or other substance use disorders are vulnerable lifelong to those products.”

Daubresse advises making ongoing professional education and support available to physicians providing MAT.

“Ensuring providers have access to tools designed to prevent unnecessary opioid prescribing, such as Prescription Drug Monitoring Programs, is important, especially when patients are under the care of multiple providers,” he says. “We should continue trying to find new ways to keep patients engaged in stable ongoing MAT.”