Research finds challenges in access to treatment for opioid use disorder

 
(Wikimedia Commons)
By

January 8, 2020

A federal government database of doctors who provide medication-assisted treatment for opioid use disorder is rife with inaccurate information, making it difficult for people seeking help to schedule appointments, shows new research in the Journal of Psychiatric Practice.

Researchers combed the Substance Abuse and Mental Health Services Administration’s database of buprenorphine providers to verify the accuracy of phone numbers and confirm whether the provider was in fact prescribing buprenorphine and accepting new patients. SAMHSA is an agency of the U.S. Department of Health and Human Services.

Buprenorphine, sold under the brand name Subutex, and a component of the drug sold under the brand name Suboxone, is a drug commonly prescribed to treat opioid use disorder.

Researchers called SAMHSA-listed buprenorphine providers in the 10 states with the highest drug overdose death rates according to 2015 Centers for Disease Control and Prevention (CDC) drug overdose death data — West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, Massachusetts, New Mexico, Utah and Tennessee. They then focused on providers listed as practicing within a 25-mile radius of the county with the highest drug-related death rates in 2017, narrowing down the list to 505 providers.

The researchers secured appointments with just 28% — 140 — of providers contacted. In most cases, nobody answered the phone or returned the call, or the phone number listed was incorrect.

Over one quarter — 27.1% — of the numbers listed were incorrect, the researchers report. A similar percentage — 25.9% — of phone numbers corresponded to providers who did not offer buprenorphine.

“Someone who has opioid use disorder, if they try to use the federal database to locate someone to get medication-assisted treatment from, they’re going to find out that the database is full of wrong numbers and practices that aren’t even prescribing buprenorphine,” says author J. Wesley Boyd, an associate professor of psychiatry at Harvard Medical School.

Researchers made two attempts at contact during normal weekday business hours and left voice messages with a callback phone number when given the option. Calls were made over the span of two months. If the researchers made contact with the provider or office staff, they asked whether the provider currently prescribed buprenorphine. If yes, the researchers followed up by asking which insurance they accepted, including Medicaid, whether they were accepting new patients, and when their first available appointment was.

“One of the clinics that I called said to me, ‘Oh, Dr. Wartenberg hasn’t been in this clinic for over 12 years,’” Boyd recalls.

An evidence-based approach

Medication-assisted treatment is an evidence-based treatment for opioid use disorder. It has been shown to reduce the risk of overdose death for people who use opioids. These medications reduce symptoms of craving and withdrawal.

A study of 151,983 adults in England treated for opioid dependence between 2005 and 2009, published in Addiction, found the risk of fatal drug overdose more than doubled for individuals who received only psychotherapy compared with those who received medication-assisted treatment.

An April 2017 systematic review and meta-analysis published in The BMJ found that people receiving medication-assisted treatment were less likely to die of an overdose or other causes than peers with opioid use disorder who did not receive such treatment.

And a March 2015 review of randomized controlled trials in the Harvard Review of Psychiatry compared medication-assisted treatment of opioid use disorder with placebo or no medication and found that medication-assisted treatment “at least doubles rates of opioid-abstinence outcomes.”

Long waits and potential solutions

The researchers of the new paper verified that 310 of the 505 phone listings in their sample — 61.4% — listed correct numbers. Of all the providers who supposedly offered buprenorphine according to the database, only 195, or 38.6% actually did.

The researchers were able to ask 173 of these providers whether they accepted private insurance, and most — 75.7% — did. And more than half of the buprenorphine providers who were asked about whether they accepted Medicaid did — 62.9%.

“To me it was the one pleasant surprise of our findings, namely, that a decent chunk of the practices or individuals that we called did accept Medicaid,” Boyd notes.

But appointments typically required a wait — the average wait was 16.8 days, and the range spanned from 1 to 120 days. “Sixteen days is obviously a dangerous amount of time. Because as far as I’m concerned, every single time you use [opioids], you’re putting your life in jeopardy,” Boyd says.

Boyd notes that an underlying contributor to issues of access to buprenorphine is the relative scarcity of buprenorphine providers due to prescribing restrictions. Under the Drug Addiction Treatment Act of 2000, physicians must complete a training program if they want to prescribe medication-assisted therapy outside of an opioid treatment program.

“In order for people to be able to prescribe buprenorphine, the requirement for them to do additional training is, I think, obsolete and not necessary,” Boyd says. “So one thing is just to eliminate the requirement for specialized training over and above the training that one gets in order to be able to prescribe medications generally.”

Boyd suggests that SAMHSA might shore up the database through mass mailings to listed providers. He acknowledges that people can find medication-assisted treatment other than through the SAMHSA database, but as a provider listed in the database himself, he says he gets calls “infrequently, but regularly” about buprenorphine that likely stem from the listing.

“We were trying to replicate the experience of an opioid user looking for help,” Boyd says. “And this was the best way we thought that we could explore that issue.”

Boyd has conducted similar research on the issue of availability of mental health care. For more on the opioid epidemic, check out our long read.

The image on this page, obtained from Wikimedia Commons, is being used under a Creative Commons license. No changes were made.

 

We welcome feedback. Please contact us here.

Citation: Flavin, Lila; et al. "Availability of Buprenorphine Treatment in the 10 States with the Highest Drug Overdose Death Rates in the United States," Journal of Psychiatric Practice, January 2020. doi: 10.1097/PRA.0000000000000437.