Addressing Substance Use Disorders and Improving Access to Treatment

American music legend Prince’s death, which was a result of a prescription opioid overdose, has increased focus on a national public health crisis: substance use disorders.

Drug overdose rates hit record levels in 2014. To put into perspective, on April 21, the day Prince died of an overdose of prescription pain relievers, 52 other people also died of the same cause. The overall increase in record levels is driven by opioids, such as heroin and prescription pain relievers, which are involved in more than 28,000 overdose deaths. This number, while large, does not reflect the full impact of the opioid epidemic, which has left countless individuals, their families, and communities struggling with the health, quality of life, and cost implications of this disease. There is an urgent need to expand access to treatment for substance use disorders.

The Pew Charitable Trusts has proposed several ideas to address substance use disorders by focusing on developing and supporting policies such as the proposed rule to increase the patient limit for qualifying physicians to treat opioid use disorders under Section 303(g)(2) of the Controlled Substances Act. By implementing these policies, the Pew Charitable Trusts hopes:

• to reduce the inappropriate use of prescription drugs while ensuring that patients have access to effective pain management
• to expand access to effective treatment for substance use disorders including through increased use of medication-assisted treatment (MAT)

The Need to Expand MAT

Studies have revealed that the current access to MAT is woefully inadequate. For instance, only 2% of licensed US physicians are approved to prescribe buprenorphine (a medication used to relieve withdrawal symptoms and cravings for opioids). Also, since these physicians practice mostly in urban areas, it leaves more than 30 million people in rural areas with no access to substance abuse treatment. In addition, federal regulations prohibit physician assistants and nurse practitioners from treating any patients with the drug.

The need to expand medication-assisted treatment is imperative. The president’s fiscal year 2017 budget proposal calls for $1.1 billion to support prevention and treatment of substance use disorders. While the proposal is surely welcome, legislative authorities need to also expand prescribing rights to nurse practitioners and physician assistants.

Eliminating the Stigma

Prince’s death underscores the reality that substance use disorders can affect anyone. More importantly, it suggests that treatment for these devastating illnesses is often not readily available to those who need it.

“Substance use disorders are complex brain diseases that must be treated like any other chronic condition; unfortunately, many people still view them as moral failings,” said Cynthia Reilly, director of the Prescription Drug Abuse Project at The Pew Charitable Trusts. “As a result, individuals struggling with dependence on opioids, alcohol, or other addictive substances may be unwilling or unable to ask for help. Even those who speak up often encounter barriers to effective treatment.”

Eliminating the stigma around substance use disorders and expanding access to treatment requires a change in the national conversation.

“With 19,000 people dying each year from prescription opioid overdoses, it’s time that we acknowledge substance use disorders as treatable diseases and work to ensure that people in need have access to effective drug therapies, no matter where they live,” Reilly said.