WASHINGTON– Doctors need a variety of options to treat opioid addiction and more training on safe opioid prescribing, according to experts called to testify before the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations.
One of the primary options – medication-assisted treatment (MAT) utilizing buprenorphine – was criticized by Subcommittee Chairman Tim Murphy (R-Pa.).
Rep. Tim Murphy (R-Penn.)
Increased availability of MAT is among the recommendations made in late March by the Health & Human Services department.
“We are not going to end this opioid epidemic by increasing the use of opioids,” Rep. Murphy said at the April 23 hearing. “We need an exit strategy that enables Americans to become opioid free altogether. We can do better than addiction maintenance.”
Physicians testifying to the subcommittee unanimously suggested that MAT needs to be a vital part of the treatment toolbox, noting that for some patients, it is an essential component of recovery.
Witnesses called for recognition that opioid addiction is a long-term issue; patients can need life-long treatment to help prevent relapse.
“Opiate dependence is not like the common cold. It does not go away” Dr. Robert DuPont, president of the Institute for Behavior and Health, testified. “It is a lifetime problem. A person who has opiate dependence is going to deal with that problem one way or another for his or her lifetime. People are not fixed in treatment.”
Treatment options, including MAT, almost always are short term, and that needs to change, Dr. DuPont said, adding that it is critically important to get health insurers to recognize longer-term treatment.
Dr. Anna Lembke of the departments of psychiatry and behavioral science at Stanford (Calif.) University, testified regarding the difficulty in getting Medicaid and private insurers to cover addiction treatment.
“When you try to get coverage for addiction treatment, they give you the huge runaround,” she said, noting that ironically, that it’s fairly easy to prescribe opioids and have those covered by most insurers.
“What that means is that if you want to get addiction treatment for patients who are struggling with the disease addiction, you can’t insurance to pay for it, which means that patients don’t access the treatment,” Dr. Lembke said, adding that it leaves patients to find and pay for treatments themselves.
While many insurers cover MAT, their utilization management techniques can make it challenging to get and keep patients in the programs, she said. “Once you start someone on buprenorphine, you don’t want to just suddenly not have it available to them, but that happens frequently because all of a sudden you have been denied coverage.”
Witnesses also called for better guidance on prescribing opioids. Dr. Patrice A. Harris, secretary of the American Medical Association board of trustees, highlighted some of her organizations efforts to improve education and awareness of the dangers of overprescribing opioid pain medications for physicians as well as patients. She noted, and other panelists agreed, that addiction needs to be looked at and treated as any other chronic condition. That shift in perspective could help alleviate the stigma attached to seeking treatment.
Dr. Lembke called for changes to Medicare to lead private insurance to better incentivize the proper use of addiction treatment, including both medication and non–medication based treatments, including setting quality measures to ensure proper use of opioids, removing any connection in customer satisfaction surveys to whether or not they receive prescription opioids, and to incentivize greater use of prescription drug monitoring programs.
She also called for changes in federal regulations to make it easier for doctors to communicate with one another on such issues as addiction and what medications they might be on to help better coordinate treatment and to prevent patients from getting opioid prescriptions from one doctor while getting treatment from another.