Social & Legal Perspectives on Underuse of Medication-Assisted Treatment for Opioid Dependence

Medication-assisted treatment (MAT) in combination with counseling is considered the most effective treatment for opioid dependence by the World Health Organization, U.S. Department of Health and Human Services, and American Society of Addiction Medicine. Two MAT medications, buprenorphine and methadone, are considered essential medicines by the World Health Organization. Despite MAT’s effectiveness, it is severely underused in U.S. treatment settings, including physicians’ offices, hospitals, the Veterans Administration, residential treatment centers, prisons, and drug courts. The dissertation examines social and legal reasons for under-use of MAT in the U.S., including dominance of abstinence-only treatment methods, separation of addiction treatment from mainstream medical treatment, insurance barriers, statutory and regulatory barriers, under-education of physicians in addiction medicine, under-education of mental health counselors in MAT, lack of physician involvement in the criminal justice system, and public understanding of addiction as a spiritual disease rather than a brain disease. The dissertation concludes with suggestions for expanding access to MAT, including government funding incentives and integration of MAT into existing addiction treatment centers and educational programs

America Needs the TREAT Act: Expanding Access to Effective Medication for Treating Addiction

The article focuses on the underuse of buprenorphine because it is the most widely used medication for treating opioid dependence that is cost-effective in the United States. It discusses restrictions placed on prescribers under the Drug Addiction Treatment Act (DATA) of 2000 and the need to reintroduce the Recovery Enhancement for Addiction Treatment Act

Social & Legal Perspectives on Underuse of Medication-Assisted Treatment for Opioid Dependence

Medication-assisted treatment (MAT) in combination with counseling is considered the most effective treatment for opioid dependence by the World Health Organization, U.S. Department of Health and Human Services, and American Society of Addiction Medicine. Two MAT medications, buprenorphine and methadone, are considered essential medicines by the World Health Organization. Despite MAT’s effectiveness, it is severely underused in U.S. treatment settings, including physicians’ offices, hospitals, the Veterans Administration, residential treatment centers, prisons, and drug courts. The dissertation examines social and legal reasons for under-use of MAT in the U.S., including dominance of abstinence-only treatment methods, separation of addiction treatment from mainstream medical treatment, insurance barriers, statutory and regulatory barriers, under-education of physicians in addiction medicine, under-education of mental health counselors in MAT, lack of physician involvement in the criminal justice system, and public understanding of addiction as a spiritual disease rather than a brain disease. The dissertation concludes with suggestions for expanding access to MAT, including government funding incentives and integration of MAT into existing addiction treatment centers and educational programs

Psychiatric Co-Morbidities in Pregnant Women with Opioid Use Disorders: Prevalence, Impact, and Implications for Treatment

Purpose of Review This review seeks to investigate three questions: What is the prevalence of comorbid psychiatric diagnoses among pregnant women with opioid use disorder (OUD)? How do comorbid psychiatric illnesses impact pregnant women with OUD? And how do comorbid psychiatric illnesses affect the ability of pregnant women with OUD to adhere to and complete OUD treatment? Recent Findings Based on this literature review, 25–33% of pregnant women with OUD have a psychiatric comorbidity, with depression and anxiety being especially common. However, of the 17 studies reviewed only 5 have prevalence rates of dual diagnosis in pregnant women with OUD as their primary outcome measures, their N’s were typically small, methods for determining psychiatric diagnosis were variable, and many of the studies were undertaken with women presenting for treatment which carries with its implicit selection bias. Of the women enrolled in treatment programs for SUD, those with psychiatric comorbidity were more likely to have impaired psychological and family/social functioning than those without psychiatric comorbidity. Greater severity of comorbid psychiatric illness appears to predict poorer adherence to treatment, but more research is needed to clarify this relationship with the psychiatric illness is less severe. Summary While cooccurrence of psychiatric disorders in pregnant women with opioid use disorder appears to be common, large population-based studies with validated diagnostic tools and longitudinal assessments are needed to obtain definitive rates and characteristics of cooccurring illnesses. Integrated prenatal, addiction, and psychiatric treatment in a setting that provides social support to pregnant patients with OUD is most effective in maintaining women in treatment. More research is still needed to identify optimal treatment settings, therapy modalities, and medication management for dually diagnosed pregnant women with OUD

Balancing patient-centered and safe pain care for non-surgical inpatients: clinical and managerial perspectives

Background: Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patient-centered, meaning that it is respectful of patients’ values, preferences, and experiences. However, little is known about delivering care in cases where these goals may not align. For example, hospitals and clinicians are facing the daunting challenge of balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines and complexity of this patient population. Methods: To gather clinical and managerial perspectives on the importance, feasibility, and strategies used to balance patient-centered care (PCC) and safe pain care for nonsurgical inpatients, we conducted in-depth, semi-structured interviews with hospitalists (n=10), registered nurses (n=10), and health care managers (n=10) from one healthcare system in the Midwestern United States. We systematically examined transcribed interviews and identified major themes using a thematic analysis approach. Results: Participants acknowledged the importance of balancing PCC and safe pain care. They envisioned this balance as a continuum, with certain patients for whom it is easier (e.g., opioid-naïve patient with a fracture), versus more difficult (e.g., patient with opioid use disorder). Participants also reported several strategies they use to balance PCC and safe pain care, including offering alternatives to opioids, setting realistic pain goals and expectations, and using a team approach. Conclusions: Clinicians and health care managers use various strategies to balance PCC and safe pain care for nonsurgical patients. Future studies should examine the effectiveness of these strategies on patient outcomes

Clinical perspectives on hospitals’ role in the opioid epidemic

Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic

An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits

America Needs the TREAT Act: Expanding Access to Effective Medication for Treating Addiction

The article focuses on the underuse of buprenorphine because it is the most widely used medication for treating opioid dependence that is cost-effective in the United States. It discusses restrictions placed on prescribers under the Drug Addiction Treatment Act (DATA) of 2000 and the need to reintroduce the Recovery Enhancement for Addiction Treatment Act