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The Trump administration is prioritizing access to medication-assisted treatment (MAT) as the path forward on tackling the deadly opioid crisis.
Just one-third of treatment programs currently offer the service, an “unacceptable” status quo that needs to be increased to solve the epidemic, new Health and Human Services Secretary Alex Azar told governors Feb. 24. The medications such as buprenorphine are the current evidence-based standard for treating opioid addiction.
“For many people struggling with addiction, failing to offer MAT is like trying to treat an infection without antibiotics,” he said at the National Governors Association Winter Meeting.
State leaders, who have asked the federal government for more funding help in stopping the crisis in its tracks, stressed that more needs to be done, and it will take all stakeholders from pharmacists to law enforcement to come together to find solutions.
That’s especially true in light of a fast-increasing overdose death toll linked to fentanyl, they said. The opioid epidemic claimed more than 42,000 lives in 2016, according to the Centers for Disease Control and Prevention. The pressure comes as Congress is planning hearings the week of Feb. 26 on the opioid abuse crisis.
“We are not being serious enough about solving this problem,” Kentucky Gov. Matt Bevin (R) said.
Bevin said the opioid addiction crisis underscores the importance of Section 1115 Medicaid demonstration projects. The Centers for Medicare & Medicaid Services made it easier last year for state Medicaid programs to cover a larger scope of residential substance abuse treatment under the waivers. And congressional advisers with the Medicaid and CHIP Payment and Access Commission have cautiously supported the move, which exempts states from a long-standing provision limiting federal reimbursement for most inpatient behavioral care in facilities with more than 16 beds. The Trump administration has approved the change in eight states, with many more looking to expand care, according to MACPAC.
“These are the kinds of things that can be removed,” Bevin said.
Across the board, governors pointed to the impact the epidemic is having on their states and their efforts on both abuse prevention and strengthening recovery and treatment. Still, it’s not enough, many said.
“Opioids are becoming our largest problem,” Montana Governor Steve Bullock (D) said.
Maryland saw more deaths from opioid overdoses than guns and traffic accidents and a 70-percent increase in fentanyl overdoses, despite an infusion of a half-billion dollars from the statehouse, Republican Governor Larry Hogan said.
The White House in its fiscal 2019 budget proposal pressed for Medicaid programs to be required to cover medication-assisted treatment for the first time.
Medicaid beneficiaries have been especially hard-hit by the nation’s opioid epidemic and are at higher risk for dependency and overdose, according to the congressional advisory group MACPAC.
The HHS support for MAT in both Azar’s remarks to governors and the budget proposal shows this will be a “top, top priority” going forward, Matt Salo, head of the National Association of Medicaid Directors, told Bloomberg Law. That could indicate change is on the way, but Salo cautioned the move will require a “manageable, sustainable, thoughtful, evidence-based” approach to avoid accidentally building out a cottage industry with the wrong priorities and loose controls.
“We have to figure out going from where we are to how do you build the capacity for it, and how do you afford the capacity for it?” Salo said.
Azar told governors Feb. 24 that a study in Massachusetts found opioid overdose survivors receiving the medication-assisted treatment, as part of a broader therapy plan, had a decreased risk of future deadly overdose by more than half. “That is a remarkable number of lives saved—and speaks to the number of lives we could be saving by expanding access to treatments that work,” he said.
The HHS secretary said the Food and Drug Administration will “soon” release two draft guidance documents focused on MAT, including one for drugmakers looking to new formulations of buprenorphine that might work better among some addicts, such as those in rural areas. The other will focus on “more flexible and creative designs” of studies on medication-assisted treatment that look to examples of success other than complete sobriety (like emergency department visits and overdoses).
Governors said the federal government could “leverage” state efforts and take them further, such as by putting dollars into studying MAT so “people can start to figure out the best approaches for helping people,” Massachusetts Gov. Charlie Baker (R) said.
The states are already working to decrease the stigma to encourage treatment and the use of recovery coaches, who are former opioid addicts themselves, to serve as counselors and role models straight out of medical care.
The National Governors Association launched a separate initiative in February in 12 states to fight the opioid abuse epidemic. The initiative includes efforts to tackle the epidemic’s risk of infectious disease through community prevention and public health surveillance, as well as efforts to boost health care and outcomes for opioid-addicted mothers and babies.
“This is not an issue that’s going to go away in 2019, 2020, or 2021,” Baker said. “We’re going to have to stay on this.”
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