What is Community Behavioral Health’s Role in the Opioid Epidemic?
Today in the United States, nearly 2 million people struggle with opioid use or dependence. About 2,500 adolescents will take OxyContin or another prescription pain reliever for the first time. People using prescription drugs will learn that heroin is cheaper and make the switch.
Also today, 46 people will die by prescription opioid overdose.
Addiction to these drugs is a true public health issue that has reached epidemic levels. And this distressing data begs an important question: what can community behavioral health organizations do to address the devastating impact of opioids?
The Office of National Drug Control Policy recommends that providers in specialty behavioral health settings receive training in Medication Assisted Treatment (MAT), or the use of medication combined with counseling and behavioral therapies, to offer a holistic, ‘whole patient’ approach to addiction treatment. In conjunction with psychosocial supports, like support groups and one-on-one therapies, medication proves to be an effective treatment for some individuals with addictions. MAT is one proven treatment strategy to address a person’s overall care for opioid, alcohol and tobacco dependence, using U.S. Food and Drug Administration approved medications.
But not everyone who could benefit from MAT can access it. Of the 2.5 million Americans 12 years and older who used or were dependent on opioids in 2012, fewer than one million received MAT, partly due to the underutilization and limited uptake of MAT. Specialty behavioral health has yet to fully appreciate MAT’s utility, in part because of major barriers such as a staff unfamiliar with and untrained in employing MAT. Proper training would facilitate uptake, which requires significant and challenging practice changes on multiple levels, including health system reform (e.g., inclusion in Medicaid prescription formularies), organizational change (e.g., billing procedures, staffing, inventory storage), clinical advances (e.g., prescriber training) and patient and family education.
Even if organizations fully realize these practice changes, another major challenge exists: our beliefs.
MAT challenges us to explore our beliefs regarding addiction—how it should be treated and what it means be in recovery. Addressing these beliefs, like the belief that MAT is “replacing one drug with another” or that organizations should exclusively use abstinence-only approaches to substance use, can secure buy-in and position specialty behavioral health care with other tools that promote wellness and recovery for individuals with specific addictions.
So, what are we doing about it?
For one, the National Council is launching several projects to provide opportunities for community behavioral health organizations to prepare for MAT adoption. If you don’t know where to start, join the SAMHSA-supported fall webinar series on MAT and opioid addiction to learn more about MAT, FDA-approved pharmacotherapies for opioid dependence, the safety and efficacy of MAT approaches for opioid dependence and the pervasive myths related to MAT approaches to opioid dependence. From there, six organizations will dig deeper into MAT through the Open Society Foundation-funded Medication Assisted Treatment Learning Community, a year-long opportunity that offers expert consultation from the National Council and the American Academy of Addiction Psychiatry to organizations committed to developing their infrastructure to provide medications as an adjunct to behavioral health treatment. You can tap into additional resources from the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS), which provides free one-hour consultations on all things integration, including MAT, and hosts a robust online hub of MAT resources. Finally, look forward to findings from a key report, State Medicaid Interventions for Preventing Prescription Drug Abuse or Overdose from the National Council and the National Association of Medicaid Directors.
Unfortunately, we can not remedy the opioid epidemic overnight. But the stakes are far too high to delay adoption of the full range of tools that can propel individuals into recovery. Community behavioral health organizations and other health care organizations can take the steps today to build the clinical and operational capacity to more effectively address opioid dependence by adopting MAT.
All the research, tools and resources are available to do it.