The stress of social isolation is especially challenging for people battling an addiction to opioids — an estimated 2 million of them in the U.S. Health care providers worry that the pressure of lockdown, in many cases combined with loss of income or a higher-than-average risk of infection, will increase accidental overdoses and opioid-related suicides.
Some good news: Federal and state agencies have acted promptly to prevent such deaths of despair by making it easier for people in need to get the medications buprenorphine and methadone. This change was overdue, and it shouldn't be temporary.
Evidence shows that the most effective, lifesaving treatment for opioid addiction relies on medications that quell people's cravings and relieve withdrawal symptoms without causing euphoria or overuse. Such treatment has often been regarded with suspicion - even outlawed in its earliest days - under the false assumption that it merely replaces one opioid habit with another. Medications for opioid-use disorder continue to carry an undeserved stigma, and have been too tightly controlled. Methadone has been available only at federally certified clinics. Buprenorphine prescriptions could be written only in person by the small fraction of clinicians (less than 10 percent of primary-care providers) who have received special training.
This history largely explains why fewer than 1 in 5 people with opioid-use disorder are being treated with medications.
During the pandemic, in an effort to minimize the spread of the coronavirus between patients and care providers, prescribing restrictions have been eased: Federal regulators are allowing doctors to send out 14-day and 28-day supplies of methadone for "stable" patients to take on their own at home. And they're allowing providers to start patients on buprenorphine via video links such as Zoom and FaceTime or over the phone. States, for their part, are enabling Medicaid to cover such telehealth services.
These changes were needed before COVID-19 came along, and shouldn't be reversed when the pandemic goes away. The telehealth permission could be a permanent boon especially to rural Americans, almost one-third of whom live in counties where there are no buprenorphine prescribers at all.
States can and should do more. They all should eliminate requirements that Medicaid beneficiaries be preauthorized for addiction medications, and waive requirements that medications must always be accompanied by counseling. Although it's ideal for patients to receive both medication and counseling, there's good evidence that medications alone are a powerful treatment. States, along with the federal government, should also enforce the national requirement that health insurers cover treatment for substance-use disorders.
Congress can help too, by repealing the law that says clinicians need a special waiver to prescribe buprenorphine. Anyone authorized to prescribe opioids for treatment of pain should also be able to prescribe medications for treatment of addiction — and be trained to do so. Finally, states and the federal government alike should ensure that addiction treatment with medications is always available when people who need it enter hospitals, jails or prisons, and that these patients receive further treatment when they leave.
In short, medicines for opioid-use disorder should be an ordinary part of health care. For too long, the stigma attached to such treatment has helped sustain America's opioid crisis. Quite unexpectedly, COVID-19 has shown a better way to address the problem.
— Bloomberg Opinion