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In a recent Journal of General Internal Medicine article, addiction researchers from Oregon Health & Science University write that treatment for opioid use disorder (OUD) in this country is a clear example of “maximally disruptive care.” They believe the systems and policies that guide addiction treatment “create unwarranted, inflexible, and punitive practices that create life-threatening barriers to care.”
As an addiction psychiatrist that experiences all this from the inside—I’m the chief medical officer of an addiction treatment center based in Florida—I agree with that assessment in many ways. We can and should be doing much better for our people in need.
But it's also important to acknowledge improvements in care—and share those successes. Here are key areas where we are making progress.
5 Ways We're Lowering Barriers to Addiction Care
1. Telehealth visits have made care more accessible.
Seeing your doctor or therapist via videoconference was already becoming more common before COVID, and the pandemic accelerated the trend. This has lowered the treatment barrier by offering the following benefits:
- Increased access to providers whose practices may be far away.
- More convenience, as care can be provided in the comfort of one's home.
- Less time off work or school needed for a virtual visit.
- Reduced stigma when accessing treatment from home.
2. There’s less stigma regarding addiction and addiction treatment.
Why is this changing? More people now understand that OUD and other addictions are treatable brain diseases, not evidence of bad character or moral weakness. The scientific evidence has proven this time and again, and people are getting the message.
Another big factor is that people are simply talking about addiction more, and they’re more open about their struggles. Celebrities, athletes, people from all walks of life—so many are coming forward to tell their stories.
This reinforces the point that, yes, addiction can happen to my son, daughter, partner, or me, so let’s stop demonizing and ostracizing people for having a mental illness, and help them get the treatment they need and deserve.
3. Medication-assisted treatment (MAT) is now more accessible than ever.
MAT is an addiction treatment protocol that combines psychotherapy (talk therapy) with medications that lower cravings and/or block the effects of drugs or alcohol.
For people with OUD, for example, buprenorphine is an effective medication within the MAT protocol. Among its other effects, buprenorphine helps block the neurochemical action of heroin and other dangerous opioids on the brain. At the end of 2022, physicians no longer need the so-called X-waiver to prescribe buprenorphine, so in theory, it will be easier for doctors to prescribe this drug to those with OUD.
Quick caveat: I say “in theory” more people will access it, but just because more doctors will be able to prescribe buprenorphine doesn’t mean they will.
Partly what’s at play here is that many doctors and medical professionals receive little to no addiction training in medical school. As a result, they are uncomfortable treating patients with addiction. This also makes them wary of prescribing MAT medications such as buprenorphine and naltrexone. Over time, however, I believe the use of these MAT medications will continue to increase, and that’s a good thing.
4. Health insurance coverage of OUD treatment is getting more robust.
The Mental Health Parity and Addiction Equity Act of 2008 requires health insurance companies to cover mental health at the same level they cover physical health. The law has been strengthened since then, but it still lacks the proper “teeth” to force health insurance companies into compliance.
That said, mental health coverage and addiction coverage are more robust than they were even a few years ago. This has lowered the cost barrier to care.
In my own experience, for example, I’ve found that health insurance companies are more willing to cover their members for prescription medications they receive for their MAT care. Insurers are also more open to covering longer rehab stays for patients who need that—and many do.
5. More people are entering addiction treatment when they need it most: straight from the ER.
There is something of a national movement in this area. It’s long overdue, and it's creating a new path to urgently needed addiction care.
In the past, and to this day, far too many people suffer a non-lethal overdose, they're brought to the ER, they receive treatment, and they get released days or even hours later. These patients are sometimes in active withdrawal when they leave the hospital, and thus are at maximum risk of relapse. They often do relapse, and the cycle continues.
This is now changing in many parts of the country. Where I’m based in north Florida, systems are in place whereby many people who come into ERs suffering from a drug or alcohol event can be transferred (if they so choose) to treatment immediately upon discharge. In some cases, patients can get a ride directly to a rehab facility to begin their recoveries.
Final Thoughts
To recap, I agree with the OSHU authors I mentioned at the beginning of this piece who believe our addiction treatment system is “maximally disruptive.” We make it far too difficult for far too many people to access the sustained, personalized, effective addiction care they need—or any kind of mental health care they need, for that matter.
With this blog post, I simply wanted to highlight a few areas where things are improving. We need to keep pushing. We’re at the point where we have a far better understanding of addiction, and we have treatments that work. The problem is accessing them. That has to change.
To find treatment near you, visit the Psychology Today Therapy Directory.
References
Englander, H., Gregg, J., & Levander, X. (2022) Envisioning Minimally Disruptive Opioid Use Disorder Care. Journal of General Internal Medicine.
