Strategies to Address the Heroin/Prescription Opioid Epidemic
Traditional treatment for opioid addiction has a high failure rate unless the patient is receiving medication assisted treatment. Once buprenorphine, methadone, or naltrexone injections are added to the treatment, the treatment success rate goes up significantly. When a person relapses and re-enters treatment, success rates are even better the second time around.
- Medication assisted treatment must be more readily available.
- More opioid treatment programs must be created
- More physicians must be certified
Strategies to Engage Wider Participation from the Physician Community in the Provision of Treatment for Addiction
- Create a regional addiction medicine training initiative
- Implement an enhanced payment system. Insurance companies are providing quality incentives for diabetes and hypertension. For patients on buprenorphine products, New York should create an incentive payment system such as a monthly management fee in addition to a visit fee, or a supplemental payment tied to quality. This would reduce the number of physicians who do not take insurance, increase the number of physicians who are willing to prescribe, and improve access and overall quality
- Provide resources to medical societies like NYSAM to provide mentoring and assistance to doctors who are starting to prescribe buprenorphine
- Create a better payment model for physician’s offices that give Vivitrol injections. The current ten dollar injection fee does not cover all the work the office has to do
- Engage major healthcare systems in a statewide effort to recruit and train physicians to offer medication assisted treatment in their practices and to publicize the availability of addiction medicine
How to Address Insurance Protocols that Create Barriers to Treatment
- No prior approval for addiction medicines
- Use approved criteria to determine level of care
Challenges Posed by Poor Pain Management Practices and How to Address Those Challenges
- All primary care residents should be required to be trained in the use of buprenorphine
- All pain clinics should be able to prescribe buprenorphine on site or have a place to refer patients with pain and addiction.
Protocols for Connecting People to Treatment after a NARCAN Intervention
Unfortunately, patients receiving Narcan and are taken to emergency departments, observed for a short, and sent home without making contact with an addiction treatment resource. Ideally patients should receive counseling and medication as needed.