Michael Boyle, Associate Researcher
Center for Health Enhancement Systems Studies
Despite their proven effectiveness, medications for substance use disorders are still not widely prescribed. Results of the National Treatment Center Study conducted in 2009–2010 revealed that 62% of publicly-funded providers did not offer a single medication for the treatment of a SUD. I don’t think much has changed since the study was published. I’d like to offer a few factors for treatment organizations to weigh when considering whether or not to offer medications for substance use illnesses (a term that I prefer, as opposed to substance use “disorders.”)
The National Quality Forum (NQF) is a public-private partnership that develops consensus measures for a variety of health conditions. In 2007, the NQF released 11 standards for treating substance use illnesses. Four of the standards highlight the importance of using medications as a component of treatment for detoxification, opiates, alcohol, and nicotine. The standards are titled “voluntary,” but the aim is to encourage payers to establish contracts and provide reimbursements only to organizations that implement them.
Treatment organizations can meet the NQF standards for medication-assisted recovery (with the exception of using medications for detoxification) by referring to providers who can prescribe. For organizations that lack resources to employ medical staff who can prescribe medications, developing a relationship with a local Federally Qualified Health Center may be a viable option, particularly in states that are expanding Medicaid coverage. Another benefit of linking with an FQHC is that people in treatment for a substance use illness can also receive primary care.
And failure to offer FDA-approved medications for a substance use illness may result in lawsuits for malpractice.
That’s one idea that came up a recent TweetChat (#attcbridge) on the Fall 2013 issue of The Bridge, an electronic journal published by the ATTC. This issue of The Bridge focused on the consumer’s and family role in expanding medication-assisted treatment (MAT). I joined my fellow contributing editors and others to share our thoughts on this topic, in 140 characters or less on the TweetChat.
(You can follow the TweetChat conversation on the ATTC Network homepage.)
Tweeting about the legal implications of not offering approved medications for substance use disorders brought up parallels to primary care. A doctor who diagnoses hypertension but doesn’t tell the patient about effective medications—or offer a prescription—is asking for legal trouble if the patient later suffers a stroke. The medical record leaves a trail that will most likely result in a lawsuit.
There’s also a business case for offering medication-assisted recovery, using Suboxone in particular. For years, even patients with limited financial resources have been seeking medication at private-pay methadone clinics. These same patients would be willing to pay for medication and the related physician and counseling visits that help them repair relationships, obtain employment and housing, and basically get their lives back. Family members are often willing to help pay for effective treatment for their loved ones. And patients also see a cost benefit, as the medication and related treatment costs are less expensive than opiates.
These are just a few factors that I urge organizations and clinicians to consider when making decisions about using the medications now available to help their patients manage a substance abuse illness.
Share your thoughts with Mike in comments section that follows!
Michael Boyle is an Associate Researcher at the Center for Health Enhancement Systems Studies at the University of Wisconsin–Madison and provides consulting services. He was formerly President and CEO of Fayette Companies, a behavioral health organization located in Peoria, Illinois, and is the Director of the Behavioral Health Recovery Management project. Boyle recently served on a National Quality Forum committee charged with defining an episode of continuing care for a substance abuse treatment encounter. He has authored several articles and book chapters. His current activities include integrating mental health, addiction and primary care services, implementing evidence-based clinical practices within recovery oriented systems of care, and exploring the development and use of electronic technologies to support behavioral health treatment and recovery.