In a state that has adopted numerous strategies to combat opiate addiction and a crisis in overdose deaths, a research project that will begin next year will test whether incentives at the payer level can step up use of medication-assisted treatment.
Even with nearly 50 treatment programs and more than 430 physicians in Ohio able to use the medication buprenorphine for their patients, numerous pockets of the state suffer from a shortage of available medication treatment. The process improvement center NIATx has received a five-year grant from the National Institute on Drug Abuse (NIDA) to test strategies to improve adoption rates for the Suboxone formulation of buprenorphine in Ohio.
NIATx deputy director Todd Molfenter says the project will work primarily through addiction treatment centers, some of which will partner with primary care physicians based in the community. In eight of 16 county board jurisdictions that will be part of the project, participants will implement NIATx process improvement strategies for improving access to and retention in medication-assisted treatment. In the other eight jurisdictions, participants will add to the NIATx model the use of several additional incentivizing strategies.
“The question we’ll be seeking to answer is, ‘Are there system levers to enhance use of buprenorphine?’” Molfenter says. “Can you increase reimbursement? Can you decrease regulatory barriers?”
Sanford Starr, director of research at the Ohio Department of Alcohol and Drug Addiction Services (ODADAS), says the prevalence of opiate addiction vis-à-vis other substance use problems in Ohio has clearly intensified over the past decade. Overdose deaths have reached such crisis proportions in areas of the state (particularly in the southern region) that they have contributed to a “sea change” in addiction treatment provider attitudes about the importance of medication-assisted treatment as part of the overall approach, Starr says.
Overdose deaths surpassed motor vehicle accidents as the state’s leading cause of accidental death by 2007. Many of the deaths have resulted from non-medical use of prescription opioids, but recently many individuals have turned to heroin as state enforcement efforts in the prescription drug arena have cracked down on “pill mills” and other sources of medication misuse.
State officials from numerous departments have been involved in efforts to mitigate the opiate addiction problem in Ohio. Efforts out of ODADAS include the establishment of two dozen opiate task forces focusing on treatment, prevention and law enforcement; the launching of a “Don’t Get Me Started” public education campaign; and the enrollment of more than 4,000 individuals in a program that provides treatment and employment training for opiate addicts.
The NIATx project also will involve physician training efforts in the participating counties. Molfenter adds, “We are not working directly with the pharmaceutical company. We’re looking at system changes that should assist medication treatment in general.”