Keli McLoyd, Associate for Policy Research and Analysis at the Philadelphia-based Treatment Research Institute, holds a fixed view on medication-assisted recovery. “They work, period,” she said firmly. “They save people’s lives, period.” McLoyd drew comparisons of recovery from addiction to Hypertension and Type 2 Diabetes. “You wouldn’t ask a Diabetic not to take their insulin, or ask them to try four medications before trying insulin,” she challenged. McLoyd highlighted the two diseases as having similar onset signs and relapse rates, and said the similarities were enough to illustrate the absurdity in roadblocking medicine-assisted recovery to addiction.
The debate on the role of medication in recovery from addiction is a highly contested one. McLoyd challenges the oft-touted opinion that drugs like methadone, buprenorphine, and Naltrexone act as diversion risks by looking at the science. She works with research scientists at the Treatment Research Institute in order to develop policy platforms that encourage rather than discourage the prescription of medications used to treat opioid use disorder. McLoyd noted that while all doctors are able to write prescriptions for OxyContin, there are limitations placed on the prescription process for treatment. To prescribe a buprenorphine like Suboxone, a doctor must obtain a special waiver through a training course, and may only write scripts that serve 100 patients with a buprenorphine prescription at a time. This creates a huge access issue, especially in small rural or suburban communities with heavy rates of opioid addiction that may only have one doctor licensed to prescribe buprenorphines.
Methadone offers a similar problem of access, due to the inability of a doctor to prescribe it as a medicine to treat opioid disorder. McLoyd said that doctors are able to write take-home scripts for people suffering from serious pain, but may only divert those suffering from addiction to an Opioid Treatment Program, which operate as clinics that require daily visits. The inability of someone suffering from addiction to take methadone at home creates the issue of transportation accessibility. Additionally, while the methadone may be covered by health insurance, it is highly recommended that methadone users supplant their medical treatment with a form of psycho-social therapy, a benefit not generally covered by insurance, according to McLoyd.
The last medicine McLoyd highlighted as an aid to opioid recovery was Naltrexone, administered either as a daily pill or a long-acting monthly shot through the brand Vivitrol. Obtaining a script for Naltrexone is simpler than gleaning one for a buprenorphine or methadone because doctors are not required to train for a waiver or limited by specific patient caseload, and are able to write scripts for home use. Yet the shot method of Naltrexone, while largely seen as more effective due to its long-acting nature, is almost certainly inaccessible to the general public due to it’s price tag. At $1000 per shot, it seems like medicine-assisted recovery is out of reach for people of low income brackets in search of effective recovery. Further, McLoyd expressed concern over protecting the addiction services-specific gains of the Obama administration under the Affordable Care Act.
“A repeal of the ACA will heavily affect our industry,” McLoyd said.
An additional 10 million people have been added to Medicaid as a result of individual ACA state expansions, many of whom would have been otherwise been blocked from coverage, according to McLoyd. These people and more benefit from Essential Health Benefits, which include substance use services as mandatory for state insurance coverage. With a repeal of the ACA on the tongues of lawmakers in Washington, however, McLoyd hopes to preserve the gains in access to addiction-related services made within the last eight years.