Ohio is dramatically expanding the number of caregivers who can prescribe Suboxone and other drugs for medication-assisted treatment of addiction. The effort is part of a broader strategy to address the opioid epidemic. Not everyone thinks it’s a good idea.
A recovering addict
Alexis Graziano of Girard is an addict who's now half a year into recovery and in a sober-living facility. She says she has experienced medication-assisted treatment, MAT, and found it ripe for abuse if not managed closely.
“There’s so many doctors who will just take a cash payment and give you a month's worth. And then you’ll just go in the next month and give them, you know, another cash payment. And the people aren’t even taking the medication, they’re selling it, to continue using the heroin. I used to do it!”
Others with questions
Graziano is not alone. There are professionals in addiction services who see problems with the expansion, too.
Lauren Thorp heads recovery programs for the Trumbull County Mental Health and Recovery Board.
“I’ve heard, anecdotally, physicians working in the field said that they’ve been approached to get this certification because it is such a money maker. So, that’s a concern. As the opiate epidemic has really touched our area, we’ve seen a lot of new treatment agencies open who aren’t certified, and people that may be doing this for all the wrong reasons.”
But, advocates say there are also right reasons
Years of research show that medication-assisted treatment works, both to get people off drugs and keep them off. National Institutes of Health studies in 2013 and 2014 showed as much as a 61 percent long-term recovery rate for prescription-opioid addicts in MAT programs.
Dr. Mark Hurst is medical director of the Ohio Department of Mental Health & Addiction Services.
“Medication-assisted treatment is one of the best-studied treatment modalities that we have, and the effectiveness for all forms is really without doubt. There is less likelihood for the person to die from an opioid- related overdose. There is less illicit opioid use. There is less needle sharing. People are more likely to be employed. They’re more likely to stay out of jail.”
Hurst recognizes, though, the potential for abuse with medication-assisted treatment, but believes there are now checks in place to prevent it.
“There have been some rogue subscribers of Suboxone to be frank with this, the buprenorphine products. So about four years ago the medical board put in rules that limited dosage. It also established that everyone needs to get counseling in addition. And it needs to be monitored appropriately.”
Changing where treatment is centered
Hurst says only 2 percent of Ohio’s doctors are now licensed to prescribe Suboxone and similar drugs—far too few to handle the need for medication-assisted treatment in the current addiction crisis. So, the state is aiming to double the number of trained and certified prescription writers over the next 18-months.
And, in order to reach the most addicts, the program is focusing the expansion on primary care practitioners, the field where the fewest licensed MAT drug prescribers are now.
“As this was initially conceived, ... you should be able to go to your primary-care doctor and get treatment for your hypertension and your back pain and your asthma and your addiction, too. So that’s a lot better integrated way to do this.”
For all of the supporting research and promises of regulation and monitoring, there are still those who question the concept itself of using drugs in addiction treatment.
Recovering addict Alexis Graziano is an example. She survived her own drug use -- barely, by her account --and has to work constantly to build on her sobriety. She says, to her, medication-assisted treatment only delays facing up to the reality of what it will take to get better.
“So, when someone is taking Suboxone, or methadone, they’re still getting high. So, it drives me crazy; it frustrates me so bad because that’s not clean and sober. You’re still taking something to change the way you feel. I just really don’t agree with it at all."
Despite the reservations of Graziano and others, Ohio is moving ahead with certifying the new prescribers. The departments of Mental Health & Addiction Services and of Health are using part of a $26 million federal grant under the 21st Century Cures Act to pay for the program. It consists of a day and a half of live training for would-be medication-assisted drug prescribers augmented by continuing education through on-line courses and seminars.