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Aaron Williams

Director of Training and Technical Assistance for Substance Abuse, SAMHSA-HRSA Center for Integrated Health Solutions

Are You Ready for Medication Assisted Treatment?

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In the midst of an opioid epidemic, communities across the country face increased demands for substance use services.

The CDC reports that:

  • Young adult’s heroin use more than doubled in the past decade.
  • More than 90% of people who use heroin also use atleast one other drug.
  • 45% of people who use heroin are also addicted to prescription opioid painkillers.
  • Prescription opioid drug overdoses increased threefold in three years.

To combat this crisis, federal and state governments increasingly fund addiction services and medication assisted treatment (MAT). Medications such as buprenorphine and methadone consistently prove effective in opioid treatment. In recent years, extended-release naltrexone has also been approved for the treatment of opioid dependence and shown good evidence of effectiveness.  The use of naloxone to reduce opioid related overdose deaths has also become an increasingly important component of local efforts to combat the effects of opioid overdoses, and increasing access to these and other medications and services is critical to stemming the tide of this current epidemic. Additionally, agencies such as the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism are funding research to develop other medications to address alcohol and stimulant abuse.

With all of these changes, a fundamental question arises: Is the behavioral health workforce actually ready to provide services in an environment in which medication use is going to become a significant component of addiction treatment? And if not, what needs to be done? An unprepared workforce can hinder access to services and leave people with limited information on medication benefits as part of comprehensive treatment.

A number of studies in recent years found prescribers’ and counselors’ attitudes were significant barriers to MAT use. In 2012, the SAMHSA-HRSA Center for Integrated Heath Solutions conducted a pilot project to help community safety-net providers expand MAT related services and identified a number of workforce-related barriers to adoption, including:

  • Scarcity of medical providers trained to administer MAT services.
  • Negative workforce attitudes and misunderstandings about the nature and use of medications.
  • Lack of support staff for providers currently administering MAT services.
  • Lack of reimbursable credentials for addiction treatment providers.

Negative attitudes toward MAT are a commonly cited barrier to its use. It is also an extremely troublesome barrier. As new payers continue to enter the marketplace looking to reduce cost and increase quality of care, they will increasingly look for treatment approaches, like MAT, that have solid evidence of improving quality of care and cutting cost. Also, as enforcement of the Mental Health and Substance Abuse Parity Act continues across the country, it will become increasing difficult for arbitrary medication restrictions to continue.

So what should we do about all of this?

Assess Workforce Needs

As you continue working to increase the availability of MAT services, a critical examination of your current workforce must be completed. Questions to be addressed could include:

  • Are there enough trained physicians and nurses to work with treatment programs on MAT? If not, what is your plan for ensuring physicians are trained?
  • What is your state’s level of acceptance of “medical models” of addiction by treatment programs and clinicians?
  • How do specialty addictions treatment clinicians view medication use to help people in treatment?
  • How will you work with your staff and board who need help understanding medications’ role in treatment?
  • Are clinicians in specialty treatment settings eligible for Medicaid reimbursement? If not, how can you help prepare clinicians for reimbursement for clinical services necessary as an adjunct to medications during treatment?

Asking these and other questions will help you get a jumpstart on providing the resources your workforce may need to move forward with MAT.

Develop Incentive Programs

The Department of Health and Human Services and other policymaking entities are already looking into a number of options to increase prescriber availability for MAT, such as allowing nurse practioners to prescribe buprenorphine and getting rid of or increasing the 100 patient limits for current buprenorphine prescribers. In addition to these measures, the development of comprehensive incentive programs for prescribers could help. Existing loan and tuition reimbursement programs could be amended to enable the MAT provision in various settings as a component of participation.

Increase Training on the Biology of Addictions

A lack of understanding of biology of addiction often drives negative clinician attitudes about MAT; schools and trainings across health sectors need to provide more information. Organizations such as NIDA and SAMHSA should continue to lead efforts to ensure addiction-related training materials have scientifically accurate information and information on MAT’s role in treatment.

Intensify Advocacy

Organizations such as NAADAC and International Certification & Reciprocity Consortium must continue to work on behalf of the addiction workforce. These and other organizations help make sure that addictions professionals have the information needed to succeed. Joining forces, or partnering to speak with a unified voice about expanding MAT use would be a significant step forward.

Making these changes and prioritizing the addiction treatment workforce’s needs would go a long way toward improving MAT accessibility.

What do you think will better prepare the behavioral health workforce to provide MAT?