Medication Assisted Treatment for Opioid Use Disorders is the Standard of Care

OHMASEmail

Dear Healthcare Provider,

Opioid use, dependence, and their consequences continue to be a major public health issue in Ohio and across the United States. In response, Ohio has implemented an aggressive and comprehensive approach to expand prevention services, improve access and quality of treatment, and increase access to naloxone. These efforts have resulted in a six-year low in prescription-related deaths.

One of Ohio’s major treatment initiatives has been the expansion of Medication Assisted Treatment (MAT), and for good reason. Multiple studies demonstrate that a positive treatment outcome is as much as three times more likely in individuals treated with MAT, along with psychosocial treatment, than among those treated with psychosocial treatment alone. The United States Surgeon General, the Director of the National Institute on Drug Abuse, the Assistant Secretary of the Department of Health and Human Services and numerous other leaders in the field have emphasized the importance
of MAT as a standard of care. Recently, the state opioid response funding provided to Ohio by the Substance Abuse and Mental Health Services Administration precluded providing funding to health care providers that do not offer all forms of MAT directly or by referral.

There are currently three FDA-approved MAT options: Products containing naltrexone, products containing buprenorphine, and methadone. All three options have advantages and disadvantages for specific patients, and all three are demonstrated to improve treatment outcomes. There is no evidence that one form of MAT is more effective than the others. For all medical disorders, including opioid use disorders, providers should inform patients of the nature of their disorder and the options for treatment, including the likelihood of success and potential problems associated with each form of treatment, as well as the potential course of the disorder without treatment. For opioid use disorders, these treatments should include all forms of

MAT in combination with psychosocial treatment and psychosocial treatment alone. The patient then can use this information to make the best-informed decision and give his/her informed consent for a treatment approach best suited to them. OhioMHAS recommends that providers utilize the nationally developed educational materials for helping patients understand their opiate use disorder and treatment options.

Many providers cannot offer all forms of MAT, and some do not have the ability to offer MAT at all, but patients should be informed of the different options available and referrals made when needed. To assist, the Ohio Department of Mental Health and Addiction Services has partnered with the Emerald Jenny Foundation to provide a statewide treatment finder webtool to identify providers by service type (including MAT) in a location most convenient to the patient. Providers may also call the OhioMHAS toll free number at 1-877-275-6364 to be connected to someone who can help them find
a behavioral health treatment provider or MAT provider in a specific geographic location.

Please consider deploying enhanced efforts to treat those suffering from opioid use disorder. We have made great progress in improving access to evidence-based treatment for opioid use disorders, and further improvements can be made with your continued and dedicated efforts. For that, you have our most sincere gratitude. Thank-you.

Sincerely,
Mark Hurst, M.D.
Director

 

Appendix A – Research on MAT Outcomes

• U.S. Department of Health and Human Services, Office of the Surgeon General. Facing
Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.
https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.
Washington, DC: HHS; 2016.
• Substance Abuse and Mental Health Services Administration. Medication-assisted treatment for opioid addiction in opioid treatment programs. Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. SMA 12-4214. http://adaiclearinghouse.org/downloads/TIP-43-Medication-Assisted-Treatment-for-Opioid-Addiction-in-Opioid-Treatment-Programs-51.pdf.
Rockville, MD; 2005.

• Perry AE, Neilson M, Martyn-St James M, et al. Pharmacological interventions for drug-using offenders. Cochrane Database System Rev. 2013;(12).

• Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies—tackling the opioidoverdose epidemic. New England J Med. 2014;370(22):2063-2066.

• Mattick RP, Breen C, Kimber J, Davoli, M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database System Rev. 2014;2(2). Appendix B – MAT Training Opportunities and Resources for Talking with Patients about Treatment Options

• Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health ServicesAdministration, 2018. Retrieved from https://store.samhsa.gov/series/tip-63-medicationsopioid-use-disorders.

• Substance Abuse and Mental Health Services Administration. Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide. HHS Publication No. (SMA) 14-4892PG. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017. Retrieved from
http://www.valueoptions.com/providers/Network/NCOC_Government/Naltrexone-Guide-forTreatment-of-People-with-Opioid-Dependence.pdf.

• Substance Abuse and Mental Health Services Administration. Medication Assisted Treatment for Opioid Addiction: Facts for Family and Friends. HHS Publication No. (SMA) 14-4442. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Retrieved from http://www.ct.gov/dmhas/lib/dmhas/publications/MAT-InfoFamilyFriends.pdf.

• Substance Abuse and Mental Health Services Administration. The Facts about Treatment of Opioid Addiction. HHS Publication No. (SMA) 09-4443. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. Retrieved from
https://www.ct.gov/dmhas/lib/dmhas/publications/MAT-InfoFamilyFriends.pdf.