Dr Kelly Clark Discusses Challenges of Accessing Opioid Addiction Treatment

With only 3 medications FDA-approved to treat opioid addiction, patient access to these treatment options can be difficult, and each medication presents its own challenges, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine.

Transcript (slightly modified)

There are only 3 FDA-approved medications to treat opioid addiction. What are the challenges of patient access to these treatments?

Each of the 3 medications that are FDA-approved to treat opioid addiction comes with their own challenges for patients.

The first is methadone. Methadone has been around for over 50 years, and we have very strong evidence for its efficacy and its cost effectiveness. But it can only be accessed legally to treat addiction through a licensed methadone clinic. There’s a lot of challenge for people particularly who live in rural areas, which are being very hard hit by this current wave of epidemic. And for them to be able to access, every day, a clinic in order to take their methadone, every single day—that’s an access problem.

The extended release naltrexone product, that’s a specialty pharma product. And that has its own challenges with few numbers of providers who are able or willing to work with specialty pharma product that needs to be refrigerated and so on. There are also some problems with fail first requirements by some health plans that get in the way there.

And then, finally, buprenorphine, which is the third medication, has been around in this country for over 15 years and also has a very good database for effectiveness and cost effectiveness. And the problems there are around artificial government restraints on the number of patients that a doctor can treat: only 30 in the first year, and 100 thereafter, which is not based on any clinical evidence but just based on non-clinical political evidence. And so that’s a barrier that physicians who specialize in treating addiction, like myself, have a cap on the number of patients we can treat. I’m a psychiatrist; there’s no cap on the number of patients with schizophrenia I can treat and they’re no easier to treat than people with addictive disease.

There are also problems particularly with buprenorphine with our coverage system. So some plans will only cover buprenorphine if the person’s enrolled in formal counseling for 15 minutes every week or every 2 weeks. There are problems accessing counselors in the United States right now for addiction treatment. Some plans require patients show perfect adherence to their treatment regimen; we don’t ask that for any other disease state.

So there are a number of problems in accessing these medications—all 3 of them.