Lawmakers Back Medication-Assisted Treatment, New Addiction Science

Push is on to move beyond total sobriety as only way to overcome substance-use disorders

Assemblywoman Nancy Munoz (R-Union)
New Jersey is moving toward requiring addiction-treatment providers to accept patients who use certain medications to reduce cravings, a clinical protocol experts said is often essential for long-term recovery.

While some treatment models have historically presented total sobriety as the only path to wellness, state lawmakers and providers said the new science of addiction has revealed the need for pharmaceutical options that can help those with substance-use disorders avoid relapse. But these more controversial medications are not reaching enough people, they said, and patients who do get a prescription are sometimes turned away from care facilities.

On Thursday, the state Assembly health committee passed a bipartisan bill designed to address one aspect of this issue by prohibiting residential and outpatient facilities from denying care, or admission, to patients receiving so-called medication-assisted treatment, or MAT; this typically involves a prescription for carefully formulated opiates in conjunction with other therapy.

Scientific advances

“The science of addiction has evolved over the past 25 years,” said Assemblywoman Nancy Munoz (R-Union), a nurse and lead sponsor on the bill, quoting from information provided by the Society for Psychiatric Advanced Practice Nurses, which is part of the New Jersey State Nurses Association. Addiction is “a chronic, relapsing disease of the brain,” Munoz added, one that involves cycles of health, but also regression.

These discoveries also underscore the important role of these prescriptions, explained Gail Mizsur, an advanced practice nurse and expert in addiction psychiatry, who represented SPAPN. “The actual science is that many will not remain abstinent after they’ve had inpatient or (outpatient) programs … without medication-assisted treatment,” she said.

To become law, the proposal, (A-4707), led by Munoz and Assemblywoman Annette Quijano (D-Union), must still pass the full Assembly and be signed by Gov. Chris Christie before the legislative session ends in mid-January. A Senate version of the bill, sponsored by Senators Joe Vitale (D-Middlesex) and Diane Allen (R-Burlington), passed with unanimous support in March.

Christie, who has focused intently on addressing addiction over his last year in office, has also come to embrace MAT. He has made it possible for drug-court participants to use these prescriptions — generally involving buprenorphine, methadone, and naltrexone — has doubled the rate of reimbursement for physicians who provide MAT, and signed a law in February that required it be covered by insurance. The governor also stressed the importance of this therapy in reports issued by the White House commission on opioid addiction, which he led.

Essential clinical tool

But Munoz and Mizsur said more must be done to ensure this life-saving therapy, increasingly recognized nationally as an essential clinical tool, is offered and embraced by providers throughout the addiction recovery system. In 2015, only one in five patients in treatment was offered MAT, they noted, and Mizsur recalled one patient — a small-business owner — who had cycled in and out of treatment 15 times already, but had never been offered prescriptions to help manage his disease.

“Nobody said, ‘maybe I needed medication so I can stay out of the hospital,’” Mizsur recalled the man saying. Sometimes providers are also hesitant to prescribe drugs to treat psychiatric issues, which are diagnosed in many substance-use disorder patients, she added.

“The situation with addiction is very critical. People are dying,” Mizsur said. “We can’t really afford to waste treatment facilities and treatment programs that refuse to accept people if they are on a psychiatric medication or on Suboxone (a buprenorphine blend). That is not scientific.”

Quijano said the legislation is designed to remove “outdated barriers” so individuals can get inpatient and outpatient care, and participate in sober-living options, while participating in legitimate MAT programs. Tens of thousands of New Jersey residents seek treatment for opioid addiction each year, but many more are unable to access proper care; in 2016, nearly 2,000 Garden State residents died from the disease.

Substituting addictions?

“Some treatment and aftercare programs operate with a philosophy that an addiction to one substance should not be replaced with an addiction to another, and therefore they object to medication-assisted treatment, instead emphasizing counseling and peer support,” Quijano said. “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 services.”

Assemblywoman Shavonda Sumter (D-Passaic) worried that the bill could actually force some treatment facilities to close, if they were unable to staff and manage MAT programs. She also suggested the prescription therapy could be a draw for some addicts who might undergo opiate detox in order to get the pills, but skip out on the long-term therapy and recovery process. But Sumter voted for the measure in the end.

Assemblyman Herb Conaway (D-Burlington), a physician who chairs the panel, said the discussion also underscored the larger issue: the growing need for treatment facilities in general. The problem is now facing the next Legislature and new administration of Gov.-elect Phil Murphy, a Democrat who will take office in mid-January, he noted, and it will require significant financial and other resources.

“Right now, we’re not paying for these services,” Conaway said. “And we can’t expect that somehow by magic we’re going to get the many people who have run afoul of this problem treated when they need it if we don’t commit to it as a society, and that commitment is not only with our words, but with our resources.”