Patients with opioid addiction face barriers to treatment argue addiction specialists

Project IMPACT is a group of addiction medicine specialists from Oregon Health & Science University who often meet patients in the hospital who seek addiction recovey. The team advocates for patients in need of treatment to get individualized care as they often are forced to navigate a punishing gauntlet to get the care they need. Credit: OHSU / Christine Torres Hicks

As the opioid epidemic continues to ravage the United States, patients in need of treatment for opioid addiction are facing significant barriers to accessing care, according to a group of addiction medicine specialists from Oregon Health & Science University. In a perspective published in the Journal of General Internal Medicine, the authors describe the current system for treating opioid addiction as "maximally disruptive care."

To access medication for opioid use disorder, the most effective form of treatment, patients must navigate a complex and often burdensome process. This often involves daily visits to methadone clinics or finding a clinician with a federal waiver to prescribe buprenorphine. Patients with complicating medical conditions, such as a high-risk pregnancy, often find little support and are faced with enormous treatment burdens.

"Most people who need and want treatment for opioid addiction cannot access it," the authors write. "Maximally disruptive care for opioid addiction is not an accident. Rather, demands on patients are part of the treatment paradigm. Patients must 'earn' methadone take-home doses or 'work the steps to be worthy of treatment."

These barriers to treatment come at a time when the opioid epidemic is reaching unprecedented levels. Last year, a record 107,000 Americans died of fatal drug overdoses. The authors argue that the current system for treating opioid addiction must be reevaluated and redesigned to better support patients in need of care.

"We must shift our focus from punishment and containment to care and support," they write. "We must also recognize that addiction is a chronic illness, not a moral failing and that individuals with addiction deserve the same access to care as those with any other chronic illness."

In a new publication, a group of addiction medicine specialists from Oregon Health & Science University argue that patients in need of treatment for opioid addiction face significant barriers to accessing care. These barriers, the authors argue, are a result of the current system for treating opioid addiction, which they describe as "maximally disruptive care." To access medication for opioid use disorder, the most effective form of treatment, patients must navigate a complex and often burdensome process, such as daily visits to methadone clinics or finding a clinician with a federal waiver to prescribe buprenorphine.

The authors highlight the case of a recent patient who was admitted to OHSU Hospital with a high-risk pregnancy and an addiction to fentanyl. The patient was highly motivated to stop using the drug and needed methadone to reduce cravings and treat her opioid use disorder. However, because of federal regulations, she would have to travel to a methadone clinic 45 minutes from her home to receive treatment after being discharged from the hospital. This requirement was insurmountable for her because she did not have a car.

To address these barriers to treatment, the authors call for a minimally disruptive approach that would create more flexible, individualized, and holistic options for treating opioid use disorder. They argue that programmatic and policy changes could "begin to address disparities and inequities, and save lives."

Journal Information: Honora Englander et al, Envisioning Minimally Disruptive Opioid Use Disorder Care, Journal of General Internal Medicine (2022). DOI: 10.1007/s11606-022-07939-x