Curtailing Prohibitions on Medication-Assisted Treatment in Rehab
Some facilities exclude patients who are being treated with medications, but there’s a bipartisan move to end the exclusions
Residential facilities that treat or house individuals with substance use disorders could no longer exclude patients receiving so-called medication-assisted treatment under a bipartisan plan to “remove scientifically outdated barriers” to care that was advanced by New Jersey lawmakers on Monday.
The bill, which passed the Senate with unanimous support, is designed to ensure that patients under the care of licensed physicians using medication-assisted treatment would have full access to inpatient treatment, sober living homes, halfway houses, and other residences for those in recovery. MAT, which uses prescription medicines to block the high from opiates, while guarding against debilitating withdrawal symptoms, often involves methadone, buprenorphine or Suboxone, and naloxone, among other prescriptions.
has grown quickly in recent years, as addiction has become recognized as a pressing crisis in states like New Jersey. Clinicians have found it can be highly effective in treating some patients, particularly high-functioning addicts seeking to hold jobs and remain active with friends and family. But despite the growing evidence of its success, some treatment and residential facilities — particularly those based on the 12-step philosophy, which stresses full sobriety — remain uncomfortable including MAT patients in their programs.
‘Denying admission… is unjustifiable’
"Medication assisted treatment is a safe and effective strategy that combines behavioral therapy with medications to treat substance use disorders," said Sen. Joseph Vitale (D-Middlesex), who sponsored the bill with Sen. Diane Allen (R-Burlington). "Denying admission into a treatment facility simply because an individual is receiving medication assisted treatment is unjustifiable. It ignores evidence-based practices that have proven successful in treating opioid use and reducing the risk of overdose," he said.
The measure is part of New Jersey’s ongoing efforts to address the epidemic levels of opiate addiction that sent some 28,000 residents into treatment in 2015 and cost some 1,600 individuals their lives, according to state figures. Thousands more residents sought help, but were unable to access the care they needed.
Gov. Chris Christie has recently prioritized battling addiction, focusing on the issue in his Januaryaddress, and has stressed the importance of treating drug addiction like any other disease, not a moral failing. The governor called for up to six months of insurance coverage for addiction treatment and signed a law five weeks later that ensured MAT was included as a covered benefit. He has also pressed for additional treatment beds and sought to expand housing options for those in recovery, pledging to work with Vitale to create more community residential options for people trying to stay clean.
Christie’s message has echoed that of Dr. Vivek H. Murthy, the U.S. Surgeon General, who issued a 420-page report last year thatof evidence-based programs, like MAT, in addressing the disease of addiction. A by the National Institute of Drug Abuse found that half the patients treated with a buprenorphine were able to avoid opiates for 18 months and 61 percent were still not abusing drugs three and a half years later.
Over the years, Vitale, the longtime Senate health committee chairman, has led efforts to align state policy with clinical recommendations regarding medication-assisted treatment. In 2015,based on a Vitale bill to allow drug-court participants — non-violent offenders with substance abuse issues who are offered treatment instead of jail time — access to MAT programs. Last month, the state for physicians who oversee MAT in an acknowledgment of its importance.
Resistance to medication-assisted treated
Despite this growing awareness, Vitale said there remains some resistance to medication-assisted treatment, which involves regular doses of drugs that have addictive qualities of their own. Concerns are often focused on clinics that prescribe methadone, which usually involves a daily dose that patients must consume onsite. (Suboxone, however, can be prescribed by a private physician for personal home use.)
“The science of addiction medicine is increasingly finding that substance use disorders can be most effectively treated with a combination of counseling, peer support and medication,” the bill states. “Nonetheless, some substance use disorder treatment and aftercare programs operate with a philosophy that addiction to one substance should not be replaced with addiction to another… This philosophy, while earnest and well-meaning, has the unfortunate result of barring individuals receiving medically supervised medication assisted treatment from other recovery-related treatment, aftercare, and housing options.”
The bill specifies that medication assisted treatment includes, but is not limited to, methadone, buprenorphine, naltrexone, or any other medication approved by the Food and Drug Administration for the treatment of a substance use disorder, Vitale said.