Medication-assisted treatment has been controversial in the United States because opioid recovery drugs like buprenorphine (also known by the brand name Suboxone) and methadone are opioids themselves.
While they do not generate a high at a prescribed dosage, they help satisfy cravings and reduce withdrawal symptoms as patients seek to cut back and quit heroin, fentanyl and other deadly opioids.
The medicines have been shown to reduce the mortality rate among people addicted to opioids by half or more, but some officials and providers worry that the substance-replacement approach encourages ongoing drug use.
The Opioid Crisis
From powerful pharmaceuticals to illegally made synthetics, opioids are fueling a deadly drug crisis in America.
Under the proposal, addiction experts will focus on improving access to the medication in communities with the highest rates of addiction. Health care providers who treat veterans — more than one million of whom have been diagnosed with substance use disorder — will undergo training and start pilot programs to integrate medication into existing care models.
The Indian Health Service, which serves American Indians and Alaska Natives, will train employees to screen women who are pregnant or of childbearing age for opioid use disorders and will expand its prescribing dashboard to include access to buprenorphine. The move is “a technical but powerful nudge to normalize it, to make it part of the fabric of how we treat this condition,” Dr. Lembke said.
SAMHSA will track the number of obstetricians and midwives who are approved to prescribe buprenorphine, hire a dedicated associate administrator for women’s services, and develop national certification standards for peer recovery support specialists. The plan also includes tens of millions of dollars in various grants to organizations, hospitals and rural communities.
Some policy experts worried that, because the report emphasizes education for medical providers and court employees, without long-term financial incentives or consequences for institutions, health systems won’t move fast enough to boost their addiction care capacity.
Dr. Stefan Kertesz, a clinician and addiction researcher at the University of Alabama at Birmingham, and Mr. Kessler suggested, for example, that the Biden administration should have tied hospital credentialing standards or even federal funding to whether the institutions had the capacity to offer immediate addiction treatment to patients seeking care for any condition, whether pregnancy or a respiratory infection.
“If all health care institutions were ready to offer care, then it would be a lot easier to make that care happen” Dr. Kertesz said. Instead, he said, most obstetricians and addiction specialists have never been in the same room, and families enter into “chaotic, dysfunctional bureaucracies” that don’t have a robust, interdisciplinary response plan in place.