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01.06.2017 | Substance Use and Related Disorders (F Levin and E Dakwar, Section Editors)

Update on Barriers to Pharmacotherapy for Opioid Use Disorders

verfasst von: Anjalee Sharma, Sharon M. Kelly, Shannon Gwin Mitchell, Jan Gryczynski, Kevin E. O’Grady, Robert P. Schwartz

Erschienen in: Current Psychiatry Reports | Ausgabe 6/2017

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Abstract

Purpose of Review

The recent heroin and prescription opioid misuse epidemic has led to a sharp increase in the number of opioid overdose deaths in the USA. Notwithstanding the availability of three FDA-approved medications (methadone, buprenorphine, and naltrexone) to treat opioid use disorder, these medications are underutilized. This paper provides an update from the recent peer-reviewed literature on barriers to the use of these medications.

Findings

These barriers are interrelated and can be categorized as financial, regulatory, geographic, attitudinal, and logistic. While financial barriers are common to all three medications, other barriers are medication-specific.

Summary

The adverse impact of the current opioid epidemic on public health can be reduced by increasing access to effective pharmacotherapy for opioid use disorder.

Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–6. doi:10.1001/jamapsychiatry.2014.366.CrossRefPubMed

Maxwell J. The pain reliever and heroin epidemic in the united states: shifting winds in the perfect storm. J Addict Dis. 2015;34:127–40.CrossRef

Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82. doi:10.15585/mmwr.mm6450a3.CrossRefPubMed

Zibbell JE, Hart-Malloy R, Barry J, Fan L, Flanigan C. Risk factors for HCV infection among young adults in rural New York who inject prescription opioid analgesics. Am J Public Health. 2014;104(11):2226–32.CrossRefPubMedPubMedCentral

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington: Author; 2013.CrossRef

Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;3:CD002209. doi:10.1002/14651858.CD002209.pub2.

SAMHSA. Buprenorphine waiver management. Retrieved from: http://www.samhsa.gov/medication-assisted-treatment. Accessed 1 Oct 2016.

Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207. doi:10.1002/14651858.CD002207.pub4.

Auriacombe M, Fatseas M, Dubernet J, Daulouede JP, Tignol J. French field experience with buprenorphine. Am J Addict. 2004;13(Suppl 1):S17–28. doi:10.1080/10550490490440780.CrossRefPubMed

10.

Caplehorn JR, Dalton MS, Haldar F, Petrenas AM, Nisbet JG. Methadone maintenance and addicts’ risk of fatal heroin overdose. Subst Use Misuse. 1996;31(2):177–96. doi:10.3109/10826089609045806.CrossRefPubMed

11.

Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction. 2011;106(1):32–51. doi:10.1111/j.1360-0443.2010.03140.x.CrossRefPubMed

12.

Gibson A, Degenhardt L, Mattick RP, Ali R, White J, O'Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008;103(3):462–8. doi:10.1111/j.1360-0443.2007.02090.x.CrossRefPubMed

13.

Langendam MW, van Brussel GH, Coutinho RA, van Ameijden EJ. The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health. 2001;91(5):774–80.CrossRefPubMedPubMedCentral

14.

Schwartz RP, Gryczynski J, O'Grady KE, Sharfstein JM, Warren G, Olsen Y, et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995–2009. Am J Public Health. 2013;103(5):917–22. doi:10.2105/AJPH.2012.301049.CrossRefPubMedPubMedCentral

15.

Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet. 2011;377(9776):1506–13. doi:10.1016/S0140-6736(11)60358-9.CrossRefPubMed

16.

Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson Jr RA, et al. Extended-release naltrexone to prevent opioid relapse in criminal justice offenders. N Engl J Med. 2016;374(13):1232–42. doi:10.1056/NEJMoa1505409.CrossRefPubMed

17.

Department of Health and Human Services (DHHS). Opioid abuse in the U.S. and HHS actions to address opioid-drug related overdoses and deaths, March 26, 2015. Retrieved from: https://aspe.hhs.gov/sites/default/files/pdf/107965/ib_Opioidinitiative.pdf. Accessed 3 Oct 2016.

18.

•• Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):e55–63. doi:10.2105/AJPH.2015.302664. This paper noted that most of the nation’s OTPs are at or exceed 80% of their capacity and if all of the physicians waivered to prescribe buprenorphine treatment were at full capacity, there would still remain a gap of nearly 1 million adults in need of treatment for opioid use disorder CrossRefPubMedPubMedCentral

19.

SAMHSA. National Survey of Substance Abuse Treatment Services: 2013. Data on substance abuse treatment facilities. HHS Publication No. SMA 14–4890. Rockville, MD. Substance Abuse and Mental Health Services Administration; 2014.

20.

Sigmon SC, CM A, Hruska B, Ochalek T, Rose G, Badger GJ, et al. Bridging waitlist delays with interim buprenorphine treatment: initial feasibility. Addict Behav. 2015;51:136–42. doi:10.1016/j.addbeh.2015.07.030.CrossRefPubMedPubMedCentral

21.

SAMHSA. Opioid treatment program survey: data on substance abuse treatment facilities with OTPs, 2011. BHSIS Series S-65, HHS Publication No. (SMA) 14–4807. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.

22.

Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Subst Abuse Treat Prev Policy. 2008;3:17. doi:10.1186/1747-597X-3-17.CrossRefPubMedPubMedCentral

23.

Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, et al. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy. 2015;10:13. doi:10.1186/s13011-015-0009-2.CrossRefPubMedPubMedCentral

24.

Aletraris L, Bond Edmond M, Roman PM. Adoption of injectable naltrexone in U.S. substance use disorder treatment programs. J Stud Alcohol Drugs. 2015;76(1):143–51.CrossRefPubMedPubMedCentral

25.

Levit KR, Stranges E, Coffey RM, Kassed C, Mark TL, Buck JA, et al. Current and future funding sources for specialty mental health and substance abuse treatment providers. Psychiatr Serv. 2013;64(6):512–9. doi:10.1176/appi.ps.201200298.CrossRefPubMed

26.

Mark TL, Levit KR, Vandivort-Warren R, Buck JA, Coffey RM. Changes in US spending on mental health and substance abuse treatment, 1986–2005, and implications for policy. Health Aff (Millwood). 2011;30(2):284–92. doi:10.1377/hlthaff.2010.0765.CrossRef

27.

•• Burns RM, Pacula RL, Bauhoff S, Gordon AJ, Hendrikson H, Leslie DL, et al. Policies related to opioid agonist therapy for opioid use disorders: the evolution of state policies from 2004 to 2013. Subst Abus. 2016;37(1):63–9. doi:10.1080/08897077.2015.1080208. This survey of state officials found that, in 2013, the Medicaid Program in five states did not pay for buprenorphine treatment and did not pay for methadone treatment in eight states CrossRefPubMed

28.

Cowell A, McCarty D, Cowell A. Impact of federal substance abuse block grants on state substance abuse spending: literature and data review. J Ment Health Policy Econ. 2003;6(4):173–9.PubMed

29.

Woodward A. The CBHSQ Report: the substance abuse prevention and treatment block grant is still important even with the expansion of Medicaid. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2015.

30.

•• Saloner B, Stoller KB, Barry CL. Medicaid coverage for methadone maintenance and use of opioid agonist therapy in specialty addiction treatment. Psychiatr Serv. 2016;67(6):676–9. doi:10.1176/appi.ps.201500228. Using national archival data, this report found that Medicaid and block grant coverage for methadone treatment play an important role in providing access to such treatment for low-income individuals CrossRefPubMed

31.

• Hutchinson E, Catlin M, Andrilla CH, Baldwin LM, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12(2):128–33. doi:10.1370/afm.1595. Hutchinson 2014: This study of rural family practitioners found that lack of access to counseling (beyond that provided by the physician), in a state whose Medicaid Program requires such counseling, was a barrier to physician prescribing buprenorphine CrossRefPubMedPubMedCentral

32.

Fiellin DA, Barry DT, Sullivan LE, Cutter CJ, Moore BA, O'Connor PG, et al. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med. 2013;126(1):74 e11–7. doi:10.1016/j.amjmed.2012.07.005.CrossRef

33.

Ling W, Hillhouse M, Ang A, Jenkins J, Fahey J. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013;108(10):1788–98. doi:10.1111/add.12266.CrossRefPubMed

34.

Weiss RD, Potter JS, Fiellin DA, Byrne M, Connery HS, Dickinson W, et al. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011;68(12):1238–46. doi:10.1001/archgenpsychiatry.2011.121.CrossRefPubMedPubMedCentral

35.

• Alanis-Hirsch K, Croff R, Ford 2nd JH, Johnson K, Chalk M, Schmidt L, et al. Extended-release naltrexone: a qualitative analysis of barriers to routine use. J Subst Abus Treat. 2016;62:68–73. doi:10.1016/j.jsat.2015.10.003. This paper found that negative attitudes toward buprenorphine treatment among substance abuse treatment staff were barriers to providing such treatment and that logistical barriers impede the use of extended-release naltrexone CrossRef

36.

Federal Register. Medication assisted treatment for opioid use disorders. a rule by the Health and Human Services Department on 07/08/2016. Retrieved from: https://www.federalregister.gov/documents/2016/07/08/2016-16120/medication-assisted-treatment-for-opioid-use-disorders. Accessed on 10/3/2016.

37.

Legal Action Center. Know your rights: rights for individuals on medication-assisted treatment. HHS Publication No. (SMA) 09–4449. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 2009.

38.

Schwartz RP, Highfield DA, Jaffe JH, Brady JV, Butler CB, Rouse CO, et al. A randomized controlled trial of interim methadone maintenance. Arch Gen Psychiatry. 2006;63(1):102–9. doi:10.1001/archpsyc.63.1.102.CrossRefPubMed

39.

Yancovitz SR, Des Jarlais DC, Peyser NP, Drew E, Friedmann P, Trigg HL, et al. A randomized trial of an interim methadone maintenance clinic. Am J Public Health. 1991;81(9):1185–91.CrossRefPubMedPubMedCentral

40.

Greenfield L, Brady JV, Besteman KJ, De Smet A. Patient retention in mobile and fixed-site methadone maintenance treatment. Drug Alcohol Depend. 1996;42(2):125–31.CrossRefPubMed

41.

Knudsen HK. The supply of physicians waivered to prescribe buprenorphine for opioid use disorders in the United States: a state-level analysis. J Stud Alcohol Drugs. 2015;76(4):644–54.CrossRefPubMedPubMedCentral

42.

Rosenblatt RA, Andrilla CH, Catlin M, Larson EH. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015;13(1):23–6. doi:10.1370/afm.1735.CrossRefPubMedPubMedCentral

43.

•• Stein BD, Gordon AJ, Dick AW, Burns RM, Pacula RL, Farmer CM, et al. Supply of buprenorphine waivered physicians: the influence of state policies. J Subst Abus Treat. 2015;48(1):104–11. doi:10.1016/j.jsat.2014.07.010. Using SAMHSA and census data, these authors found an uneven distribution of waivered physicians with counties located in states that provided Medicaid or other state funding for buprenorphine having the highest rates of waivered doctors CrossRef

44.

McCarty D, Rieckmann T, Green C, Gallon S, Knudsen J. Training rural practitioners to use buprenorphine; using the change book to facilitate technology transfer. J Subst Abus Treat. 2004;26(3):203–8. doi:10.1016/S0740-5472(03)00247-2.CrossRef

45.

Walley AY, Alperen JK, Cheng DM, Botticelli M, Castro-Donlan C, Samet JH, et al. Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008;23(9):1393–8. doi:10.1007/s11606-008-0686-x.CrossRefPubMedPubMedCentral

46.

DeFlavio JR, Rolin SA, Nordstrom BR, Kazal Jr LA. Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural Remote Health. 2015;15:3019.PubMed

47.

Friedmann PD, Hoskinson R, Gordon M, Schwartz R, Kinlock T, Knight K, et al. Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions. Subst Abus. 2012;33(1):9–18. doi:10.1080/08897077.2011.611460.CrossRefPubMedPubMedCentral

48.

Hunt DE, Lipton DS, Goldsmith DS, Strug DL, Spunt B. “It takes your heart”: the image of methadone maintenance in the addict world and its effect on recruitment into treatment. Int J Addict. 1985;20(11–12):1751–71.CrossRefPubMed

49.

Mitchell SG, Willet J, Monico LB, James A, Rudes DS, Viglioni J, et al. Community correctional agents’ views of medication-assisted treatment: examining their influence on treatment referrals and community supervision practices. Subst Abus. 2016;37(1):127–33. doi:10.1080/08897077.2015.1129389.CrossRefPubMedPubMedCentral

50.

Schwartz RP, Kelly SM, O'Grady KE, Mitchell SG, Peterson JA, Reisinger HS, et al. Attitudes toward buprenorphine and methadone among opioid-dependent individuals. Am J Addict. 2008;17(5):396–401. doi:10.1080/10550490802268835.CrossRefPubMedPubMedCentral

51.

Stancliff S, Myers JE, Steiner S, Drucker E. Beliefs about methadone in an inner-city methadone clinic. J Urban Health. 2002;79(4):571–8.CrossRefPubMedPubMedCentral

52.

Wallack SS, Thomas CP, Martin TC, Chilingerian J, Reif S. Substance abuse treatment organizations as mediators of social policy: slowing the adoption of a congressionally approved medication. J Behav Health Serv Res. 2010;37(1):64–78. doi:10.1007/s11414-008-9132-4.CrossRefPubMed

53.

White W, Coon B. Methadone and the anti-medication bias in addiction treatment. Counselor. 2003;4(5):58–63.

54.

Boutwell AE, Nijhawan A, Zaller N, Rich JD. Arrested on heroin: a national opportunity. J Opioid Manag. 2007;3(6):328–32.PubMed

55.

Rich JD, McKenzie M, Larney S, Wong JB, Tran L, Clarke J, et al. Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial. Lancet. 2015;386(9991):350–9. doi:10.1016/S0140-6736(14)62338-2.CrossRefPubMedPubMedCentral

56.

Fu JJ, Zaller ND, Yokell MA, Bazazi AR, Rich JD. Forced withdrawal from methadone maintenance therapy in criminal justice settings: a critical treatment barrier in the United States. J Subst Abus Treat. 2013;44(5):502–5. doi:10.1016/j.jsat.2012.10.005.CrossRef

57.

Mitchell SG, Kelly SM, Brown BS, Reisinger HS, Peterson JA, Ruhf A, et al. Incarceration and opioid withdrawal: the experiences of methadone patients and out-of-treatment heroin users. J Psychoactive Drugs. 2009;41(2):145–52. doi:10.1080/02791072.2009.10399907.CrossRefPubMedPubMedCentral

58.

National Association of Drug Court Professionals. History of drug courts. Retrieved from: http://www.nadcp.org/learn/what-are-drug-courts/drug-court-history. Accessed 17 Oct 2016.

59.

•• Matusow H, Dickman SL, Rich JD, Fong C, Dumont DM, Hardin C, et al. Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes. J Subst Abus Treat. 2013;44(5):473–80. doi:10.1016/j.jsat.2012.10.004. Through a survey of drug court personnel, these authors found that half of drug courts do not make opioid agonist treatments available and only 40% of courts permit patients who were already on such treatment to continue to receive it CrossRef

60.

Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D. Drug abuse treatment success among needle exchange participants. Public Health Rep. 1998;113(Suppl 1):129–39.PubMedPubMedCentral

61.

Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. J Subst Abus Treat. 2000;19(3):247–52.CrossRef

62.

Strathdee SA, Ricketts EP, Huettner S, Cornelius L, Bishai D, Havens JR, et al. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: results from a community-based behavioral intervention trial. Drug Alcohol Depend. 2006;83(3):225–32. doi:10.1016/j.drugalcdep.2005.11.015.CrossRefPubMed

63.

Fox AD, Chamberlain A, Sohler NL, Frost T, Cunningham CO. Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants. J Subst Abus Treat. 2015;48(1):112–6. doi:10.1016/j.jsat.2014.07.015.CrossRef

64.

Mannelli P, Wu LT, Peindl KS, Swartz MS, Woody GE. Extended release naltrexone injection is performed in the majority of opioid dependent patients receiving outpatient induction: a very low dose naltrexone and buprenorphine open label trial. Drug Alcohol Depend. 2014;138:83–8.CrossRefPubMedPubMedCentral

65.

Sullivan M, Bisaga A, Pavlicova M, Choi CJ, Mishlen K, Carpenter KM et al. Long-acting injectable naltrexone induction: a randomized trial of outpatient opioid detoxification with naltrexone versus buprenorphine. Am J Psychiatr. 2017 10, doi: 10.1176/appi.ajp.2016.16050548.

66.

Friedmann PD, Lemon SC, Stein MD, D'Aunno TA. Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations. Health Serv Res. 2003;38(3):887–903.CrossRefPubMedPubMedCentral

67.

Noysk B, Anglin M, Brissette S, Kerr T, Marsch D, Schackman B, et al. A call for evidence-based medical treatment of opioid dependence in the United States and Canada. Health Aff. 2013;32:1462–9.CrossRef

68.

SAMHSA. Federal guidelines for opioid treatment programs. HHS Publication No. (SMA) PEP15-FEDGUIDEOTP. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.

69.

American Academy of Addiction Psychiatry. Providers’ clinical support system for opioid therapies. Retrieved from: http://pcssmat.org/ Accessed 17 Oct 2016.

70.

Hall G, Neighbors CJ, Iheoma J, Dauber S, Adams M, Culleton R, et al. Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals. J Subst Abus Treat. 2014;46(4):511–5. doi:10.1016/j.jsat.2013.11.002.CrossRef

71.

Musto D. The American disease: origins of narcotics control. Third ed. Oxford: Oxford University Press; 1999.

Titel: Update on Barriers to Pharmacotherapy for Opioid Use Disorders
verfasst von: Anjalee Sharma
Sharon M. Kelly
Shannon Gwin Mitchell
Jan Gryczynski
Kevin E. O’Grady
Robert P. Schwartz
Publikationsdatum: 01.06.2017
Verlag: Springer US
Erschienen in: Current Psychiatry Reports / Ausgabe 6/2017
Print ISSN: 1523-3812
Elektronische ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-017-0783-9

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