May 7, 2014
More Medication Use Urged to Treat Opioid Addiction,
Prevent Deaths

Washington, D.C.—Public health leaders are calling for expanded use of medications to treat opioid addiction and reduce overdose deaths.

In a recent commentary in the New England Journal of Medicine, leaders of agencies in the U.S. Department of Health and Human Services note that access to the potentially life-saving therapies has been limited because of a number of misconceptions.

The authors—including top administrators at the National Institute on Drug Abuse (NIDA) within the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS)—suggest that that the medications, combined with behavioral therapies, can help drug users recover and stay drug-free. They also urge more data-driven tracking to monitor program progress.

The drug therapies discussed include:
• methadone, usually administered in clinics;
• buprenorphine, which can be given by qualifying doctors; and
• naltrexone, now available in a once-a-month injectable, long-acting form.

“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author and NIDA director Nora D. Volkow, MD. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”

The products have been underused, according to the authors, because of inadequate provider education and misunderstandings about addiction medications by the public, healthcare providers, insurers, and patients. Among those misconceptions, they write, is that medication-assisted therapies may simply replace one addiction for another, although that view is not supported by research.

NIDA now is funding research to improve access to medication-assisted therapies, develop new medications for opioid addiction, and expand access to naloxone by exploring more user-friendly delivery systems, such as nasal sprays, according to the commentary.

The CDC, meanwhile, is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices and better tools for making good prescribing decisions.

“Prescription drug overdoses in the United States are skyrocketing. The good news is we can prevent this problem by stopping the source and treating the troubled,” said co-author and CDC director Tom Frieden, MD, MPH. “It is critical that states use effective prescription drug tracking programs so we can improve prescribing practices and help get those who are abusing drugs into treatment.”

With access to medication-assisted therapies sometimes limited by payment issues, CMS said it was looking at a more comprehensive benefit design as well as greater application of the Mental Health Parity and Addiction Equity Act.

“Appropriate access to medication-assisted therapies under Medicaid is a key piece of the strategy to address the rising rate of death from overdoses of prescription opioids,” said co-author Stephen Cha, MD, MHS, chief medical officer for the Center for Medicaid and Children's Health Insurance Program Services at CMS. “CMS is collaborating closely with partners across the country, inside and outside government, to improve care to address this widespread problem.”

The commentary points out that more than 16,000 people die every year in this country from prescription opioid overdoses, more than heroin and cocaine combined. According to SAMHSA's 2012 National Survey on Drug Use and Health, meanwhile, nearly 2.1 million people in the United States were dependent upon or abusing opioid pain relievers.

U.S. Pharmacist Social Connect