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[MM Curator Summary]: A tiny fraction of Medicaid members get residential treatment for opioid use disorder- but it the difficulty in getting non-residential treatments (ie MAT) is probably a bigger problem.
The United States is in the middle of an opioid crisis, yet new research shows that only about 7% of Americans on Medicaid who have opioid use disorder receive residential treatment.
This means that many people who could potentially benefit from what is more commonly known as “rehab” aren’t getting the care they need to help them with their addiction.
“We know residential care is important when it’s done right … and when it’s evidence-based. We know it’s incredibly important to engaging people in their recovery from opioid use disorder,” said study corresponding author Lindsay Allen. She is a health economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, in Chicago.
“And Medicaid is a major payer. It’s the biggest payer of opioid use disorder treatment nationally because so many individuals with OUD [opioid use disorder] are covered by Medicaid,” Allen continued.
Making direct comparisons of access to residential OUD treatment can be difficult because states code or define programs differently.
But the researchers used a research network that standardized data for nine states that represent about 14.9 million people, including 20% of all Medicaid enrollees.
Using an apples-to-apples comparisons of data, the investigators discovered that usage of residential treatment for OUD varied widely, depending on the state.
While some states provided residential treatment for up to 14.6% of Medicaid enrollees with OUD, others only allowed 0.3% to access rehab.
Allen said the differences were disconcerting.
Among the benefits of having standardized data is providing information about where and what policies need to be targeted, she said.
The states that were part of the study were Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia and West Virginia. Dr. Sarah Wakeman, medical director for substance use disorder at Mass General Brigham, in Boston.
Yet, there isn’t convincing evidence that residential treatment is best for treating OUD, she said, noting that many residential programs don’t offer medication to treat OUD, or even prohibit them.
What is best is treating a patient with an opioid agonist, such as methadone and buprenorphine, Wakeman said, comparing this to providing insulin to someone with diabetes. The medications are misunderstood and deeply stigmatized, she said.
“They restore normal functioning. They allow a person to feel well again, to not experience cravings or an urge to want to use opioids, to not experience withdrawal and to just get on with their life,” Wakeman said. “And they’ve been shown in literally hundreds of studies over decades to reduce the recurrence of opioid use disorder and reduce both overdose-specific mortality and all-cause mortality.”
Residential treatment may be helpful for someone who has experienced significant consequences from their opioid disorder, who has not successfully stabilized in an outpatient treatment setting or who is also addicted to other substances, said Dr. Larissa Mooney, director in the division of addiction psychiatry at UCLA’s David Geffen School of Medicine in Los Angeles.
However, even in residential treatment, medication for OUD needs to be offered, Mooney said.
“The most robust treatments for opioid use disorder are FDA-approved medications, which include buprenorphine, methadone and extended-release naltrexone,” Mooney said.
Managing co-occurring psychiatric disorders, such as depression or anxiety, is also an important part of addiction recovery, she said.
“With support and access to medication treatment, many people can achieve remission from opioid use disorder. Individual paths to recovery vary widely, so we need to ensure access to as many treatment options as possible,” Mooney said.
The U.S. Department of Health and Human Services has more on the opioid crisis in the United States.