Maintenance Therapy as Harm Reduction: Reducing Overdose Deaths with Opioid Agonist Treatment

The death rate from prescription opioid overdose has quadrupled in the last decade and has reached epidemic proportions; expanding access to addiction treatment services is imperative. In this perspective piece, Nora Volkow, MD, the Director of the National Institute on Drug Abuse (NIDA), and colleagues from the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services outline some of the efforts made by multiple agencies to reduce harmful opioid use and safeguard legitimate and appropriate access to opioid agonist treatment (OAT).

• There are a number of barriers contributing to the underutilization of and poor access to OAT:
  • A lack of trained providers as well as misunderstandings about addiction pharmacotherapy, including the notion that OAT simply replaces one addiction with another, abstinence-based treatment models, and systematic under-dosing of OAT.
  • Policy barriers, including dosage limits, annual or lifetime medication limits, prior authorization and reauthorization requirements, minimal coverage of counseling, “fail first” criteria, and lack of coverage of certain OAT by commercial insurance plans.
• Department of Health and Human Services agencies are working collaboratively to reduce these barriers by improving utilization of and expanding access to OAT along with other efforts to reduce opioid overdoses.

Comments:

Implementation of the Affordable Care Act along with the Mental Health Parity and Addiction Equity Act will increase access to addiction treatment services for many Americans. One aspect of reducing opioid overdose deaths is to improve utilization of and access to OAT, which is recognized as a priority area by many federal agencies. However, to be successful, these efforts require buy-in from the medical community as a whole.

Jeanette M. Tetrault, MD

Reference:

Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies—tackling the opioid overdose epidemic. N Engl J Med. 2014;370(22):2063–2066.