A recent study in the journal JAMA Pediatrics looked into whether addicts are getting appropriate medications when receiving treatment for opioid medications. Somewhat surprisingly, only 21 percent of the nearly 21,000 patients studied had received buprenorphine or naltrexone, even though the two medications are recommended by the American Academy of Pediatrics.
The patients were between the ages of 13 and 25, and all had health insurance through a major insurer.
“Young people may be dying because they are not getting the treatment they need,” wrote one of the study’s authors.
The message for parents and addicted adults is that effective medications do exist that can help deal with cravings while the patient deals with their addictions in treatment.
Effective medications exist. Why aren’t they being prescribed?
It’s difficult to know. In his own practice, the study’s lead author says he routinely sees teens who have already attended more than one treatment program but have not been offered buprenorphine or naltrexone. There may be a number of reasons the drugs aren’t being offered:
Cost and lack of information
Buprenorphine and naltrexone are somewhat costly. Buprenorphine costs about $100 a month; naltrexone, approximately $1,000 a month. Even though those studied did have insurance, there may have been coverage issues of they may have been treated through programs that don’t offer the drugs.
Here in Massachusetts, for example, some may have attended Drug Court, which can be court-ordered in many situations for those suffering from addiction. Medication assisted treatment is available in Massachusetts drug courts, but they need to be offered more routinely to address the opioid crisis. Also, many people may assume the options are limited and that craving-suppression medication is not available through a state-sponsored program.
Lack of prescribing familiarity among doctors
The study’s authors suggest that many doctors aren’t familiar enough with how to prescribe these drugs or haven’t taken steps to get a DEA waiver to prescribe them. Prescribing buprenorphine does require some special training, and with naltrexone there are risks if the patient isn’t completely free of opioids.
However, the fact that some doctors hesitate to prescribe these drugs is not a sufficient reason to deny them to the patients who need them. Doctors who choose not to prescribe them should always refer the patient to someone who can.
Finally, access to the drugs was less common among women, Latinos and African-Americans. This could indicate unequal access to care or even physician bias.
If you or your child is addicted to an opioid, treatment can help. If you’ve been arrested, reach out to an attorney who knows how to pursue diversion or other options that can keep you out of jail.