Until we make evidence-based treatments such as buprenorphine and methadone as easy to get as heroin, we will not make headway against the deadly epidemic of opioid-use disorder (OUD).
It starts with abolishing the “prior authorization” requirements for such treatments (“Eager to quit opioids, facing red tape,” Aug. 6). These requirements are an unnecessary barrier that creates opportunities for recurrences, overdoses and death. Other states, such as Massachusetts, have abolished prior authorization for this reason. Minnesota needs to follow suit, not just for public programs like Medical Assistance (Medicaid), but for all insurers.
Massachusetts General Hospital created a bridge clinic to provide low-threshold access to buprenorphine, with drop-in availability seven days a week. As part of that process, it also encouraged all of its emergency physicians to become certified to treat patients with buprenorphine; 90 percent now are. This allowed for patients presenting with OUD or after an overdose to be immediately started on buprenorphine. The results have been that 72.2 percent of patients started on buprenorphine in the emergency room followed up for treatment, compared with only 11.9 percent after detox only. Some 78 percent of patients engaged in ongoing buprenorphine treatment when started in the emergency room, compared with 37 percent who were referred out for treatment.
In 2016, Rhode Island began a program offering all of its inmates with OUD medication for addiction treatment. The result was a post-discharge reduction in mortality of 61 percent.
Other countries have gotten much more innovative with great results.
In 1995, France made it so any doctor could prescribe buprenorphine without any special licensing or training. With the change in policy, the majority of buprenorphine prescribers in France became primary-care doctors, rather than addiction specialists or psychiatrists. Suddenly, about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent.
Starting in 1991, the Swiss government shifted from a “war on drugs” to decriminalizing drug consumption to stop overdose deaths and the spread of HIV/AIDS. It opened up clean, supervised consumption rooms where users could inject themselves with clean needles provided for them.
The government also provided a hotline for heroin users to call and begin immediate methadone treatment. Patients were not required to come every day and were given a three-week supply of methadone to use at home. Those who continued to struggle with heroin use were offered heroin-assisted treatment, for which they receive pharmaceutical-grade heroin at daily clinic visits. New cases of OUD dropped almost to zero. The cost to the Swiss government dropped 90 percent compared with incarceration or no treatment of OUD at all.
Minnesota is way behind the curve in battling the opioid overdose epidemic. It is time to wake up.
Jeffrey B. Sawyer is an addiction psychiatrist in Spring Lake Park.