Addiction Policy Forum Blog

9 min read

The truth about MAT? Patients know the virtue

By Mark Gold, MD on October 3, 2019

47,600 people died from drug overdoses involving opioids in 2017. Between 2012 and 2018, the number of fentanyl-induced fatal overdoses rose dramatically, accounting for a majority of overdose deaths. While preliminary data from the Centers for Disease Control shows a marginal decline in fatal overdoses in 2018, from 70,237 to 68,557, it also reveals that fentanyl is still the primary cause of fatal overdoses.1 Naloxone is a non-opioid wonder drug that can reverse an opioid overdose. It is short-acting, and by temporarily reversing the effects of opioids, it gives a person with an opioid use disorder (OUD) a second chance—an opportunity to receive treatment. As a result of campaigns by, among others, the Surgeon General2 and the CDC to improve naloxone access, retail pharmacies increased naloxone dispensing from 2012 to 2018. Despite the increase in dispensation by pharmacies, only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions in 2018.3 In the old days, I remember patients saying that they felt stigmatized at the pharmacy when they heard, "Mr. Jones, your Elavil is ready." Stigma kept many depressed patients from filling prescriptions. But in this case, is the challenge both stigma and the lack of pharmacist or health care provider education?4 It is tough to pinpoint a cause explaining this data. 

The CDC and Surgeon General encourage us to improve naloxone access at the local level, including through prescribing and pharmacy dispensing. Widespread distribution of naloxone is an essential component of the public health response to the opioid overdose epidemic. Unfortunately, the lowest rates of naloxone dispensing are in the areas with the highest opioid overdose rates. We are in the third phase of the opioid epidemic, with pain clinics’ overprescribing practices overtaken first by heroin and, more recently, by fentanyl. Individuals who overdose often overdose again, and many patients treated in addiction programs or health providers' offices through MAT often relapse.

For the treatment community, adverse outcomes and continued overdose deaths are, naturally, extremely upsetting. OUD treatment program employees frequently complain of burnout. High turnover in many programs is a major problem. Some are frustrated by recidivism rates, others because some patients are not offered MAT. Some patients cease their MAT course, and others drop out of treatment altogether. Yet experts have consistently agreed that while MAT, due to a lack of options, has not helped us combat cocaine or methamphetamine use disorders, it can be enormously helpful in managing OUD. A recent review, written by James Bell and John Strang, looks at the overall evidence on MAT and compares the relative benefits of different medications, helping to shed light on this critical public health issue. It is important to keep in mind, however, how contentiously and frequently some of our evidence is debated. We lack, for example, prospective, long-term, oncology-like, 5-year studies on the subject. MAT is debated—and so are standards measuring patient "outcomes." For a physician with an OUD, the relevant outcome standards may include a return to practice, 5-year sobriety, urine testing, and fitness for duty. In other cases, outcome standards may include coming to a treatment program, or following an MAT course, or simply not overdosing or dying. 

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3 min read

My Journey to Recovery: How an Employer Changed My Life

By Jay Ruais on August 14, 2019

On Tuesday, March 9, 2010, I awoke with a feeling that had become as expected as having the sunrise and set. I had a splitting headache and a nervous pit in my stomach as I dared to begin piecing together the night before.

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3 min read

Now is the Time to Support Parents Seeking Treatment for Substance Use Disorders

By The Urban Institute on July 30, 2019

Last year, a national survey by The Associated Press-NORC Center for Public Affairs Research reported that two-thirds of respondents thought their communities were not doing enough to make treatment programs accessible and affordable to those who need them.

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4 min read

The Impact of Racism and Mindfulness on Health

By Mark Gold, MD on June 20, 2019

A recent study brings forward some important insight into how racial discrimination affects behavioral health outcomes among young Black Americans. Read further to find out more about the negative impact of discrimination and how mindfulness may prove to be an effective strategy in mitigating associated health risks.

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1 min read

Ask a Counselor: What is an Intensive Outpatient Program (IOP)?

By Addiction Resource Center on May 29, 2019

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3 min read

The Paradox of Diverted Buprenorphine

By Mark Gold, MD on April 19, 2019

Buprenorphine, a μ-opioid (pronounced mu-opioid) receptor partial agonist, is a highly effective, evidence-based medication for treating opioid use disorders (OUD). In order to prescribe buprenorphine, qualifying practitioners must obtain a waiver from the Drug Enforcement Agency (DEA), which places strict limits on the number of patients they may treat annually. Previous legislation and regulation meant buprenorphine treatment existed nearly entirely outside the traditional healthcare system. Despite legislation that increases the number of patients a doctor can prescribe to, and allowing individual medical providers to become certified, there is still hesitation among many providers over becoming certified to prescribe the medication, many waivered physicians do not have many patients on buprenorphine - some waivered physicians have none at all.

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