Medication-Assisted Opioid Treatment Severely Underused, Study Finds

Opioid use has grown exponentially over the past several years, and research has found that of the 47,000 drug overdoses in 2014, 60% were caused by opioid and heroin overdose. While there are FDA-approved medications proven to help curb this addiction, not many physicians are taking full advantage of it.

Buprenorphine is a synthetic opioid that is used to block drug cravings and eliminate physical withdrawal symptoms without producing a high. The drug has been effective in helping people stay in recovery from drug use as well as protect them from succumbing to a deadly overdose if the patient relapses. However, fewer than 4% of practicing physicians have the licenses to prescribe buprenorphine and the number of prescriptions a physician can write is restricted. Only 32,000 of the nearly 900,000 physicians in the United States have the ability to write a prescription to only 25 patients in their first year of license and to 100 patients every year after.

While there are several policies in action to help address the hundreds of patients on waiting lists to receive buprenorphine, Colleen LaBelle, BSN, RN-BC, CARN, of the Boston Medical Center employed a Nurse Care Medical Model to several participating centers in Massachusetts as a means of increasing patient access to this medication. The program was featured in Health Affairs.

The program gives nurses more responsibility in terms of working with the patient on their addiction as way to help support the physicians who are not only caring for the patients with an addictive disease, but who are also caring for the hundreds of other patients in their practice. According to Kelly Clark, MD, MBA, president-elect of the American Society of Addiction Medicine, treating patients with an addictive disease can sometimes result in more paperwork and office time than other conditions, and doctors need more support from their staff than is typically affordable in a small primary care practices. [Watch Clark discuss the challenges of accessing opioid addiction treatment, and why addiction should be treated as other chronic conditions are.]

LaBelle’s program requires that nurses and social workers manage the treatment process for patients with addictive disease and control most of the office work for these patients. Nurses test patients for opioid use upon appointment, discuss with them their drug use and health history, and make sure that their insurance is up to date or ensure that it covers buprenorphine as a treatment. Additionally, the nurses explain exactly what the treatment plan entails and work with the social workers to ensure the patient schedules behavioral health or group counseling sessions. The patient must come to monthly office visits over the following years, but the doctor only comes into play to prescribe the medication and approve the treatment plan.

LaBelle expanded her program to a number of community health centers across the state, which increased the number of physicians prescribing buprenorphine from 24 at the Boston Medical Center to 114 throughout the commonwealth. The collaborative model was launched with the help of state funding in 2003.

LaBelle advocated that a delay in treatment has severe consequences for patients with an addictive disease; increasing the number of physicians prescribing buprenorphine can increase patient access and therefore cut down on the number of people waiting for treatment.