States, cities, counties and tribal governments nationwide will soon receive a windfall through several major opioid settlements. Drug distributors and manufacturers will relinquish a total of about $32 billion for their role in the overdose crisis.
These funds cannot come quickly enough for the communities poised to receive them.
Opioid overdoses soared 28.5% to a record high of 100,306 in the 12 months ending in April 2021, according to the most recent data available. But only 6.5% of Americans with substance use disorders receive any kind of treatment. And only 30% of those who get help receive medications that are effective at treating opioid use disorders.
In my view, money spent increasing access to methadone and buprenorphine, drugs backed with strong evidence, would significantly narrow this treatment gap.
The settlements could help because they recommend that at least some of those billions fund treatment. State legislatures will ultimately decide where most of this money goes.
Ensuring that the settlement funds support what they’re supposed to pay for is only one hurdle.
A separate challenge is defining what counts as treatment. The field is vast and varied. Treatment can come in a pill or consist of talk therapy. It can require a residential rehab stint or outpatient programs.
And while no approach works for everyone, clear evidence suggests that more people should have access to medications for opioid use disorder. These medications interrupt chaotic drug use and remove the highs and lows of addiction.
More people should have access to medications for opioid use disorder.
The Food and Drug Administration has approved three drugs: methadone, a solution taken by mouth dispensed in specialized clinics; buprenorphine, a tablet or film taken in doctors’ offices; and naltrexone, a pill or injection that physicians may administer.
Buprenorphine and methadone, which reduce opioid cravings and withdrawal symptoms, cost an average $6,250 per year. Naltrexone, which blocks the feelings of euphoria that opioids create, costs about $14,000 annually.
A study found that patients on methadone or buprenorphine were significantly less likely to die by overdose than patients who didn’t take them. Methadone was associated with a 53% reduction in overdose risk, and buprenorphine was associated with a 37% decline.
In contrast, people who took naltrexone were just as likely to overdose as those taking no medication.
Research suggests that residential programs, which can cost as much as $60,000 for 90 days of inpatient rehab, and other nonmedical approaches are less effective at treating opioid use disorder than drugs.
Sadly, some people enrolled in inpatient, abstinence-based programs may even experience harm because someone with an opioid use disorder is vulnerable to relapse right after treatment ends.
If the medication works well for treating opioid use disorders, why is it so hard for people who need help to get these drugs?
First, federal laws tightly restrict distribution. Methadone can be provided only in federally certified opioid treatment programs, and physicians who prescribe it must register annually with the Drug Enforcement Administration. Patients getting methadone must attend counseling and visit a clinic daily to receive a single dose.
A second barrier is that physicians are reluctant to prescribe buprenorphine, which the FDA approved to treat opioid use disorders in 2002. Physicians can prescribe buprenorphine from their offices as long as they get a Drug Enforcement Administration waiver.
Pharmacists could also take on this task. Pilot studies have shown that they can effectively treat patients with buprenorphine through collaboration with physicians. If scaled up, pharmacy-based programs could significantly expand access.
The third barrier is that although patients run a high risk of dying after surviving an overdose, most emergency departments send them away without helping them find long-term treatment.
Emergency medicine physicians I have interviewed tell me they don’t have ways to make these referrals, so they revive patients and discharge them without additional care.
Finally, studies show that harm reduction organizations, along with efforts to distribute and administer the drug naloxone to quickly reverse an overdose, can expedite the start of treatment for opioid use disorders. However, political opposition to these programs persists.
The research is clear: Medications for opioid use disorder offer a substantial return on investment, and I believe that states would save lives if they used money from legal settlements to make medications that treat opioid use disorders more widely available.
Elizabeth Chiarello is an associated professor of sociology at Saint Louis University. Distributed by The Associated Press.
