As the opioid crisis continues, frontline caregivers need the most appropriate tools to combat the opioid crisis, including medication-assisted treatment (MAT).
But do they have access to them? And are there enough of these frontline caregivers with the tools they need to help people suffering from an opioid addiction?
Access is a challenge
Medication-assisted treatment, or MAT, involves the use of certain medications, along with counseling and other behavioral therapies. Buprenorphine is one of the three FDA-approved medications used in MAT, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Currently, access to this kind of treatment is a challenge for patients across the country, says Mohammad Zare, MD, associate professor and vice chair of community services in the Department of Family and Community Medicine at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and the chief of staff of Ambulatory Care Services in the Harris Health System.
In Houston, the methadone clinics can’t handle the volume of patients affected with an opioid use disorder.
Improving access to treatment and recovery services and promoting the use of overdose-reversing drugs are two of the U.S. Department of Health and Human Services’ five top priorities in responding to the ongoing opioid crisis, but clinicians can’t just prescribe buprenorphine when they want to; physicians must obtain a special waiver certifying that they’ve completed relevant training.
The federal Drug Addiction Treatment Act of 2000 (DATA 2000) requires that healthcare practitioners apply for a waiver in order to prescribe or dispense buprenorphine as a treatment for an opioid use disorder. First, physicians convey their intent to apply for a waiver to the SAMHSA Center for Substance Abuse Treatment (CSAT). Currently, physician applicants must provide proof they’ve completed an eight-hour training course, plus their DEA number and their state medical license number, to be eligible to apply for a first-time waiver.
Zare is the co-site principle investigator of a site in Houston that’s part of the national Primary care Opioid Disorders (PROUD) study, a clinical trial designed to examine which strategies can increase buprenorphine prescription rates in primary care settings.
Zare’s team is testing out a collaborative care approach called the Massachusetts Model. They’re comparing one clinic with a clinical nurse manager to support three waiver-trained primary care providers against a control clinic without that additional support. They hope to find out if that support can expand the number of patients they’re able to see and treat in a primary-care setting.
The goal is to find an approach that reaches more people who need MAT so they can experience long-term success. “They become more functional. They go back to work against. They start having a job and going back to their families,” says Zare.
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