Medication-assisted treatment access enhancement initiatives
Medication-assisted treatment (MAT) for opioid dependence provides medications to individuals diagnosed with opioid use disorder, usually with counseling and behavioral therapies. As of August 2017, the U.S. Food and Drug Administration (FDA) has approved methadone, buprenorphine, and extended release injectable naltrexone for MAT. Methadone is only dispensed through Opioid Treatment Programs (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA); buprenorphine is distributed through OTPs and prescribers who complete required training. Naltrexone can be prescribed by any provider authorized to dispense medications1. As of 2014, only 28% of patients in treatment services with primary heroin admissions received MAT2. Limited insurance coverage and appointment availability and lack of prescribing physicians are often barriers to MAT3, 4; efforts to enhance access include building availability and capacity to distribute5, 6 and expanding Medicaid coverage for MAT7.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced substance abuse
Increased substance use disorder treatment
Reduced overdose deaths
What does the research say about effectiveness? This strategy is rated expert opinion.
Enhancing access to medication-assisted treatment (MAT) for opioid use disorder is a suggested strategy to increase use of treatment and reduce unmet treatment needs, particularly for individuals with low incomes, individuals in rural areas, and in the criminal justice system as well as to decrease the frequency and amount of opioid misuse and reduce opioid overdose1, 7, 8, 9.
Medications used in MAT, particularly methadone and buprenorphine, increase treatment retention, reduce opioid abuse and overdose deaths, and reduce related health and social problems such as crime and HIV when used as part of a structured maintenance treatment program with appropriate dosing and clinical oversight7, 10, 11, 12, 13, 14, 15. Such medications may also improve treatment retention and birth outcomes for opioid-dependent pregnant women1, 16. Using extended-release naltrexone, MAT may decrease opioid relapse among opioid-dependent adults in the criminal justice system17. In some cases, counseling and behavioral therapy may increase the effectiveness of MAT7, 12, 13.
Available evidence suggests that Medicaid coverage for buprenorphine appears to be associated with increases in its use in facilities that offer addiction treatment services18. Methadone maintenance use among Medicaid-enrolled adults in opioid addiction therapy is higher in states that allow reimbursement for MAT19. An assessment of a Baltimore-based effort to fund physicians’ MAT training and prescription licensing suggests increasing access to MAT is associated with decreases in opioid overdose deaths20. However, additional evidence is needed to determine the effects of initiatives that enhance access to MAT on the use of treatment and health outcomes.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
In August 2016, federal regulations regarding buprenorphine prescription increased the patient limit per authorized physician from 100 to 275 patients per year1.
Every state Medicaid program covers buprenorphine, however, coverage details vary considerably21. As of September 2015, 30 states and Washington, D.C. include methadone maintenance therapy on Medicaid preferred drug lists, and naltrexone is covered by Medicaid in every state but Arkansas22. As of May 2017, Maryland, Rhode Island, and Vermont implement the Medicaid health home models for opioid dependence treatment, with funding from the Centers for Medicare & Medicaid Services23, 24.
In July 2016, the Agency for Healthcare Research and Quality (AHRQ) issued grants to support efforts to expand access to medication-assisted treatment (MAT) in rural communities in Oklahoma, Pennsylvania, North Carolina, and Pennsylvania; efforts are underway to assess the effects of these initiatives8. Beginning in 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) has committed up to $970 million to support state and local efforts to increase access to MAT through the State Targeted Response to the Opioid Crisis Grants for two years25.
Vermont’s Hub and Spoke model is an example of community effort to build a workforce and create integrated treatment across settings26.
Implementation Resources
OTP directory - Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid treatment program (OTP) directory.
SAMHSA-MAT regulations - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT): Legislation, regulations, and guidelines.
SAMHSA-OTP guidelines - Substance Abuse and Mental Health Services Administration (SAMHSA). Federal guidelines for opioid treatment programs. HHS Publication No. (SMA) PEP15-FEDGUIDEOTP. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.
Decisions in Recovery - Substance Abuse and Mental Health Services Administration (SAMHSA). Decisions in Recovery: Treatment for opioid use disorder.
Medicaid IAP-MAT tools - Medicaid.gov, Medicaid Innovation Accelerator Program (IAP). SUD tools and resources: Medication-assisted treatment (MAT) clinical pathway and rate design tool.
Addictions-Heroin - Addictions.com. Heroin addiction.
Footnotes
* Journal subscription may be required for access.
1 SAMHSA-MAT - Substance Abuse and Mental Health Services Administration (SAMHSA). Medication-assisted treatment (MAT).
2 SAMHSA-TEDS 2016 - Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality. Treatment episode data set (TEDS): 2004-2014. National admissions to substance abuse treatment services. BHSIS Series S-84, HHS Publication No. (SMA) 16-4986. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.
3 Pew-MAT 2016 - The Pew Charitable Trusts (Pew). Medication-assisted treatment (MAT) improves outcomes for patients with opioid use disorder. 2016.
4 Burns 2016 - Burns RM, Pacula RL, Bauhoff S, et al. Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013. Substance Abuse. 2016;37(1):63-69.
5 Jones 2015b - Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. American Journal of Public Health. 2015;105(8):e55-e63.
6 CHCF 2016 - California Health Care Foundation (CHCF). Recovery within reach: Medication-assisted treatment of opioid addiction comes to primary care. 2016.
7 ASAM 2013 - American Society of Addiction Medicine (ASAM). Advancing access to addiction medications: Implications for opioid addiction treatment. Chevy Chase, MD: 2013.
8 AHRQ-MAT - Agency for Healthcare Research and Quality (AHRQ). Increasing access to medication-assisted treatment (MAT) of opioid abuse in rural primary care practices.
9 CDAOP Commission 2017 - Commission on Combating Drug Addiction and the Opioid Crisis (CDAOP). Final report. November 2017.
10 Campbell-Egli 2009 - Egli N, Pina M, Christensen P, Aebi M, Killias M. Effects of drug substitution programs on offending among drug-addicts. Campbell Systematic Reviews. 2009;3.
11 Cochrane-Mattick 2014 - Mattick RP, Breen C, Kimber J, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews. 2014;2(2).
12 Cochrane-Mattick 2009 - Mattick RP, Breen C, Kimber J, Davoli, M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews. 2009;(3).
13 Timko 2016 - Timko C, Schultz NR, Cucciare MA, Vittorio L, Garrison-Diehn C. Retention in medication-assisted treatment for opiate dependence: A systematic review. Journal of Addictive Diseases. 2016;35(1):22-35.
14 Sordo 2017 - Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.
15 Connock 2007 - Connock M, Juarez-Garcia A, Jowett S, et al. Methadone and buprenorphine for the management of opioid dependence: A systematic review and economic evaluation. Health Technology Assessment. 2007;11(9).
16 Holbrook 2015 - Holbrook AM, Nguyen VH. Medication-assisted treatment for pregnant women: A systematic review of the evidence and implications for social work practice. Journal of the Society for Social Work & Research. 2015;6(1):1-19.
17 Lee 2016 - Lee JD, Friedmann PD, Kinlock TW, et al. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. New England Journal of Medicine. 2016;374(13):1232-1242.
18 Ducharme 2008 - Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Substance Abuse Treatment, Prevention, and Policy. 2008;3(17):1-10.
19 Saloner 2016 - Saloner B, Stoller KB, Barry CL. Medicaid coverage for methadone maintenance and use of opioid agonist therapy in specialty addiction treatment. Psychiatric Services. 2016;67(6):676-679.
20 Schwartz 2013 - Schwartz J, Davaran A. Enforcement following 0.08% BAC law change: Sex-specific consequences of changing arrest practices? Addictive Behaviors. 2013;38(10):2506-2512.
21 SAMHSA-Medicaid MAT 2014 - Substance Abuse and Mental Health Services Administration (SAMHSA). Medicaid coverage and financing of medications to treat alcohol and opioid use disorders. HHS Publication No. SMA-14-4854. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
22 MACPAC 2016 - The Medicaid and CHIP Payment and Access Commission (MACPAC). State policies for behavioral health services covered under the state plan. 2016.
23 CMS-Moses 2015 - Moses K, Klebonis J. Designing Medicaid health homes for individuals with opioid dependency: Considerations for states. Centers for Medicare & Medicaid Services (CMS), Health Home Information Resource Center. 2015.
24 CMS-MHH - Centers for Medicare & Medicaid Services (CMS). Medicaid health homes (MHH): SPA overview. Centers for Medicare & Medicaid Services (CMS), Health Home Information Resource Center. April 2020.
25 SAMHSA-Opioid funds - Substance Abuse and Mental Health Services Administration (SAMHSA). HHS, SAMHSA to maintain funding formula for $1B opioid grant program. October 2017.
26 APF-VT - Addiction Policy Forum (APF). Vermont hub-and-spoke model for treating addiction. 2017.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/medication-assisted-treatment-access-enhancement-initiatives
To see all strategies:
countyhealthrankings.org/whatworks