In October 2017, President Donald Trump declared opioid addiction a health emergency, calling it the worst drug crisis in U.S. history. Drug overdoses killed more than 72,000 Americans in 2017, and over 49,000 deaths were attributed to opioids.
Michigan remains stubbornly at the heart of the crisis. Moving beyond it – and saving lives – is going to require new and dynamic approaches to battle addiction, and embracing proven new solutions that help individuals beat it. Michigan’s physicians are on the frontlines of the fight, they’ve championed critical reforms, and they’ve implemented them. To really make a difference in this fight, MSMS continues to work on the state and national levels – with providers and with policymakers – to empower physicians with better access to proven medication-assisted therapies (MATs).
Medication-assisted treatment is an evidence-based treatment for opioid addiction that involves the use of any of a few specific medicines that stop the physical symptoms of withdrawal and controls cravings for opioids. The medicine allows the patient to do the hard work of recovery, including 12-step meetings, individual therapy, and group therapy.
“The goal of these psychosocial interventions is to teach the individual to live life on life’s terms without using mind-altering substances,” said Sandy Dettmann, MD, DABAM, FASAM, the Founder and Addiction Medicine Specialist at The Dettmann Center P.C. “As the patient gains coping skills and rebuilds his or her life, the dose of medication can be tapered. MAT should always be combined with solid psychosocial interventions.”
According to research published by Pew Trusts, MAT reduces illicit drug use, disease rates, overdoses and crime. Patients who use medications to treat opioid abuse are less likely to use illegal opioids, and walk longer on the road to recovery.
Additional research published in the Journal of Substance Abuse Treatment indicates the use of MATs saves money. Their work says MATs reduce general health care expenditures, lower the frequency of their use, decrease inpatient hospital admissions, and lower outpatient emergency department visits.
“Unfortunately, access to MAT is a struggle, given the limited number or clinicians who practice addiction medicine,” said Edward A. Jouney, DO, the Associate Medical Director for University of Michigan Addiction Treatment Services. “There are too few clinicians certified to prescribe buprenorphine, and this limits access to care. Methadone is an excellent treatment with nearly a 50 year track record. However, many counties in Michigan and even some states do not have methadone maintenance clinics. Naltrexone can be prescribed by any licensed prescriber, but the number of clinicians familiar with the fundamentals of addiction treatment are scarce.”
The statistics are startling. 90 percent of patients who need addiction treatment services don’t have access to treatment, and patients need full access to treatment, with as few barriers related to coverage, formularies, and administrative burdens as possible.
Better embracing the promise of MAT requires a multipronged approach – reform at the payer level to tear down barriers for patients to take advantage of effective treatments, and a more robust embrace by health care providers across Michigan.
Legally prescribing buprenorphine products requires a DATA 2000 waiver, issued by the DEA. Courses are offered at the MSMS Foundation’s scientific meeting but also by both the American Society of Addiction Medicine and by the Michigan Opioid Collaborative (MOC), and physicians have a variety of ways to complete their training, including live sessions, web-based training, or a combination of the two.[KM1]
Doctor Dettman suggests physicians get trained, and in the meantime, know which other physicians can help. “All prescribers should have a list of addiction medicine specialists to whom they can easily refer patients when the need arises.”
Members are encouraged to contact the Michigan State Medical Society to help identify training opportunities, and reliable clinics and addiction medicine specialists in their area.
Together, we’re saving lives.