Opioid treatment is available, but even the insured aren’t getting it

The co-author of a new study in JAMA Pediatrics has a message for parents. "If you have a child struggling with opioid addiction, understand that there are medications that support and sustain recovery."

That seems straightforward, but the study found that many people may not realize there are effective treatments available for addiction to opioid medications like OxyContin, Vicodin and Xanax — even methadone, fentanyl and heroin. Unfortunately, it seems that most young addicts aren’t getting that treatment, even when they have good insurance.

The study considered the medical records of almost 21,000 opioid addicts between the ages of 13 and 25 who were insured through UnitedHealthcare. Even during the period of 2001 and 2014 when opioid addiction was skyrocketing, only 27 percent were prescribed buprenorphine or naltrexone, two medications recommended by the American Academy of Pediatrics.

Buprenorphine and naltrexone recommended by American Academy of Pediatrics for cravings

The two drugs work somewhat differently and require some watchfulness. Buprenorphine, commonly prescribed under the brand name Suboxone, is a daily pill or dissolving film that helps with cravings. It does require some special training for doctors and a government prescription waiver. It costs only about $100.

Somewhat more expensive is naltrexone, often prescribed as Vivitrol, costs about $1,000. It is given as a monthly shot and can only be given once a patient completely detoxes from opioids. Like buprenorphine, naltrexone helps patients deal with cravings while they work on other addiction issues in therapy or a drug treatment program.

It’s true that many doctors aren’t yet comfortable prescribing the medications, but most are likely seeing a substantial increase in addicted patients in their practices. They need to become comfortable with these medications or make sure patients see someone who is.

In his own practice, the study’s lead author sees many young people who are dealing with opioid addiction. Many have already completed multiple drug treatment programs yet tell him they have never been offered a medication option to help with cravings.

The study also found the treatment gap is larger for women, African-Americans and Latinos. It’s not clear why these groups are less likely to receive the medications even though they have the same insurance. It could be issues with access to care generally, or perhaps doctor bias.

The study’s authors are now planning to study access to these medications among young people in low-income families insured through Medicaid or state insurance programs.


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