In March 2019, the National Academies of Sciences, Engineering and Medicine released a report titled “Medications for Opioid Use Disorder Saves Lives”. It can be read for free online here or purchased as an eBook from The National Academies Press.
The 156-page report arrives at these seven conclusions (sourced directly from the report linked above):
- Opioid use disorder is a treatable chronic brain disease.
- U.S. Food and Drug Administration–approved medications to treat opioid use disorder are effective and save lives.
- Long-term retention on medication for opioid use disorder is associated with improved outcomes.
- Lack of availability or utilization of behavioral interventions is not a sufficient justification to withhold medications to treat opioid use disorder.
- Most people who could benefit from medication-based treatment for opioid use disorder do not receive it, and access is inequitable across subgroups of the population.
- Medication-based treatment is effective across all treatment settings studied to date. Withholding or failing to have available all U.S. Food and Drug Administration–approved classes of medication for the treatment of opioid use disorder in any care or criminal justice setting is denying appropriate medical treatment.
- Confronting the major barriers to the use of medications to treat opioid use disorder is critical to addressing the opioid crisis.
If you’re reading this, you most likely have experience in the provision of OUD treatment services and were nodding your head in agreement at each one of the conclusions as you read it.
Evidently, Mark Parrino, President of AATOD, agrees…to a point. In his May 2019 analysis of the report he says that the report is both “thoughtful and comprehensive” and suggests “the report has great value and should be widely read“.
However, he also expresses disapproval of the term “Medication-Based Treatment”, as it pertains to opioid use disorder, and disagrees with some of the report’s recommendations for which he says are “divorced from the evidence stated in the report and there are contradictions in different sections of the recommendations“.
Over 15 years ago, the Substance Abuse and Mental Health Services Administration (SAMHSA) coined the term “Medication Assisted Treatment” (MAT) indicating that clinical support services should be used in conjunction with the medication.
While the report projects an understanding that opioid use disorder is a complex disease and not simply a neurological disorder, Mr. Parrino notes that “Like most complex illnesses, it has a number of behavioral components.” and asserts that “this represents a contradiction in the approach of medication being the treatment“.
As for the report’s recommendations, he specifically disagrees with this assertion in the report’s assertion in its seventh conclusion that a major barrier to treatment is “Current regulations around methadone and buprenorphine, such as waiver policies, patient limits, restrictions on settings, and other policies that are not supported by evidence or employed for other medical disorders.“
Mr. Parrino suggests “The true limitation to access to the availability of OTPs are based on zoning board restrictions, legislative interventions, moratoriums on opening new OTPs and the lack of third-party reimbursement.“
Agree or disagree with its recommendations, one thing this study’s conclusions do is prove that these are not just beliefs of people involved with opioid use disorder treatment…they are facts.