Make MAT more accessible to treat addiction
by Randall Dwenger
Mar 10, 2020 | 5915 views | 0 0 comments | 653 653 recommendations | email to a friend | print
Throughout my career in addiction medicine, I have encountered a lot of skeptics when it comes to medication-assisted treatment (MAT). In fact, I was one of them. The thinking was: Are we truly helping people recover from their substance use disorder (SUD) by prescribing them another medication? Aren’t we simply replacing one drug with another?

But I’ve seen firsthand how addiction medications, such as buprenorphine, can save and transform lives. Unfortunately, continued denial that substance use disorder is a disease, continued stigma about MAT and buprenorphine, and the limits placed on those who can prescribe these medications prevent many from receiving lifesaving care.

Buprenorphine is one of our best tools for the treatment of opioid addiction, and one that we now embrace at Mountainside treatment center. In conjunction with Cognitive Behavioral Therapy, other forms of clinical treatment, and self-help support groups, medication-assisted treatment has proven to be effective in combatting the current opioid crisis – and keeping our clients alive.

Throughout most of my 30-plus year career, I have advocated for an abstinence-based model of treatment. But we must realize that every client’s recovery journey varies. According to the Journal of Substance Abuse Treatment, treatment involving buprenorphine can decrease a person’s relapse risk by 50 percent. For many, receiving buprenorphine or other forms of medication-assisted treatment literally is the difference between life and death.

A person undergoing MAT with buprenorphine will not suffer from cravings and uncomfortable side effects after discontinuing their opioid use to the extent that others in withdrawal might. This then enables them to focus on addiction treatment and to learn critical coping skills, such as stress management, goal-setting, and self-care techniques.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has required doctors to apply for a waiver to be able to prescribe buprenorphine to their patients. Currently, only about 7 percent of healthcare providers hold a waiver, which means just a tiny fraction of patients have access to this efficacious addiction medication.

Within the last decade, the federal government has lessened some of the restrictions surrounding buprenorphine waivers. One initiative enables nurse practitioners and physician assistants in addition to doctors to apply for buprenorphine waivers.

Approximately 70 percent of physicians who held a waiver for buprenorphine were limited to treating a mere 30 patients in 2017. What other disease treatment is limited in such a way? Can you imagine a cardiologist being limited to treating 30 patients per year for hypertension? Or endocrinologists only being permitted to prescribe insulin to 30 of their patients?

Currently, there are no buprenorphine providers in 56 percent of counties that see the highest number of opioid overdoses in the nation.

It is well established that clients who stay in treatment longer have better outcomes. Based on our own data, we’ve found that clients enrolled in our MAT program for opioid use disorders have a greater length of stay in residential treatment, with a 96 percent residential treatment completion rate – 16 percent higher than those not enrolled in MAT.

To ensure that MAT can be used to help more people in need, we urge lawmakers to:

• Remove waivers for buprenorphine prescribing to permit more medical professionals to assist patients with SUDs;

• Implement mental health parity laws to reduce financial barriers to MAT; and

• Support and encourage efforts to improve curriculum for addiction education and buprenorphine training in our medical schools and other programs that train new providers.

An estimated 130 people die from opioids every day nationwide. This doesn’t have to be the case. Aside from legislative action, a grassroots movement that embraces people struggling with opioid addiction is needed if we are to solve the issue at hand.

By pledging to destigmatize MAT and addiction as a whole, community members can be instrumental in helping their neighbors get the treatment they need and deserve. Let’s work together to prevent unnecessary loss of life and ensure that no more families are torn apart by this disease.

Dr. Randall Dwenger is chief medical officer at Mountainside, an addiction treatment facility in Connecticut.
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