Pharmacist guide to medication-assisted treatment of substance abuse

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CDC has categorized the current opioid prescription drug overdose problem in the United States as an “epidemic.” The most recent available statistics from CDC show a threefold increase in the total number of overdose deaths from prescription opioid pain relievers. These deaths claimed more than 16,000 lives in 2013. The most recent statistics from 2013 also show that an estimated 1.8 million American have an opioid use disorder related to prescription pain relievers. 


However, the U.S. Department of Health & Human Services (HHS) claims that fewer than 1 million people are receiving treatment, in comparison to the 2.5 million people who currently need it. 


In response to the need for greater prevention of opioid overdose and opioid use disorder, HHS Secretary Sylvia M. Burwell announced earlier this fall the agency’s plan to make medication-assisted treatment (MAT) more widely available.


Know the facts about medication-assisted treatment


MAT is growing in acceptance as concern over opioid abuse continues to spread and treatment providers see the benefit of medications being integrated into addiction treatment protocols. 


In a nutshell, MAT combines the use of medication with counseling and behavioral therapies to treat substance abuse disorders, primarily for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The Substance Abuse and Mental Health Services Administration (SAMHSA) calls it a more comprehensive, individually tailored program of medication and behavioral therapy. 


Research also supports the effectiveness of MAT when medications are administered correctly and when treatment includes necessary supportive services, such as counseling. According to SAMHSA, MAT has proved to be clinically effective and has been able to significantly reduce the need for inpatient detoxification services for patients. The goal of MAT is full recovery. 


Under federal law, patients diagnosed with opioid use disorder who are being treated in an opioid treatment program (OTP) must receive medical attention and various counseling services in addition to prescribed medication. OTPs are SAMHSA certified and located in every state except North Dakota and Wyoming (see http://dpt2.samhsa.gov/treatment/directory.aspx for SAMHSA’s OTP Directory). FDA-approved medications used in MAT for opioid treatment are normally dispensed through a SAMHSA-certified OTP.


According to SAMHSA, methadone, buprenorphine, and naltrexone are all used to treat opioid dependence and addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semisynthetic opioids like oxycodone and hydrocodone. These medication treatments can be used for months or several years, according to SAMHSA. 


A recent treatment improvement protocol guide from SAMHSA said that “With the approval of buprenorphine for physician’s office–based opioid treatment, MAT availability is expected to increase.”


HHS said it would expand access to MAT even more by revising the current regulations related to prescribing buprenorphine to treat opioid dependence. Under current regulations for MAT, physicians can only prescribe buprenorphine to a limited number of patients, but HHS wants to revise this regulation to “provide a balance between expanding the supply of this important treatment, encouraging use of evidence-based MAT, and minimizing the risk of drug diversion.” 


Expanding naloxone access


HHS also announced plans to increase access to naloxone—a drug that reverses an opioid overdose—in rural communities. The agency will award grants to rural communities in 13 states who will then be able to purchase naloxone, train health care providers and local emergency responders in the use of naloxone, and facilitate the referral of people with opioid use disorder to substance abuse centers. 


Resources for pharmacists


Pharmacists can learn more about the different medication used in MAT by visiting SAMHSA’s website. Additional information about prescription drug abuse prevention can be found on the National Council on Patient Information and Education’s (NCPIE) website.


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