Leaders of four agencies within the U.S. Department of Health and Human Services (HHS) recently decided that the nation's longstanding opioid addiction crisis requires a concerted response on which all four should align. Outlined in an April 23 commentary published in the New England Journal of Medicine, the strategy clearly places great responsibility on the medical community to seek earlier identification of problem use and to champion medication-assisted treatments where clinically indicated.
“We want to embed providing screening, early intervention and treatment,” Jack Stein, PhD, director of the National Institute on Drug Abuse's (NIDA's) Office of Science Policy and Communications, said in an interview with Addiction Professional. “This is not the sole responsibility of the specialty [addiction] treatment sector. But there will always be a need for the specialty sector.”
As evidence of the focus on primary care, Stein was speaking this week from the site of a Massachusetts training session for chief medical residents interested in working with patients with addictions.
Leaders of NIDA, the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare & Medicaid Services (CMS) co-authored the commentary, titled “Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic.” Stein points out the significance of a unified stance among the federal agencies overseeing research, public health initiatives, treatment service delivery and public reimbursement.
While emphasizing the importance of using medication treatments in conjunction with behavioral therapies, the commentary clearly expresses the need for expanded use of medications both for overdose prevention and addiction treatment. It cites numerous explanations for slow adoption of medication-assisted therapies, from inadequate provider education to what it terms the unsupportable notion that medications such as methadone and buprenorphine merely substitute one addiction for another.
“We already have a number of medications to treat opioid addiction. If the issue is a lack of training, or a lack of appreciation for the medications' use, we can take actions and then see shifts in that,” says Stein.
One medication that has taken the spotlight in recent months is naloxone, because of its great potential and now widespread use in overdose prevention. Stein expressed enthusiasm about ongoing developments with new delivery systems for naloxone, such as the recently introduced auto-injector and possible nasal spray formulations.
He says he hopes new medications for opioid addiction treatment may emerge, though he adds that these are “not right around the corner.” Historically, challenges have existed over “having pharmaceutical companies feel as if it was worthwhile to devote huge amounts of money to this market,” Stein says.
CMS's involvement in speaking out on this issue acknowledges the critical importance of the reimbursement component. According to a news release, the agency is working to enhance medication access under Medicaid through a more comprehensive benefit design, as well as a more robust application of parity mandates.