New report calls for expanding evidence-based treatment for opioid dependence

Access to heroin and opioid medical treatment should be expanded to reduce the harms associated with addiction, according to a new report from researchers at the BC Centre for Excellence in HIV/AIDS (BC-CfE).

The report, published in the August issue of Health Affairs, highlights increases in the prevalence and hazards related to the use of opioids, such as heroin and prescription opioids like oxycodone, in the United States and Canada, and the gap in treatment availability in both countries.

“Access to proven and effective opioid addiction treatment has been severely limited in the United States and Canada,” says Dr. Bohdan Nosyk, lead author, health economist at the BC-CfE and associate professor of Health Sciences at Simon Fraser University. “We should be looking at mechanisms that will expand access to treatment and discourage the use of ineffective and potentially harmful short-term (one to three month) detoxification treatment.”

Evidence shows that methadone and buprenorphine, two forms of opioid substitution therapy, are effective at retaining clients in treatment. Prolonged retention in treatment can lead to reductions in illicit drug use, overdoses, behaviors that increase the risk of contracting HIV, and criminal activity. As a result, treatment has been shown to be highly cost-effective.

The authors make several recommendations to expand access to evidence-based medical treatment, including:

– eliminating restrictions on methadone prescribing

– reducing financial barriers to treatment

– reducing reliance on opioid detoxification treatment

– integrating emerging treatments

In the U.S., there are approximately 2.3 million people with opioid dependence, and opioid overdose is now the second leading cause of accidental death. As a result of a limited number of substance abuse facilities, fewer than 10 per cent of people addicted to heroin or opioids receive treatment.

In Canada, there are an estimated 75,000-125,000 injection drug users (the majority of whom inject opioids) and an additional 200,000 people with prescription opioid dependence. The availability of methadone maintenance treatment, where methadone is prescribed and dispensed as an opioid substitute in approved clinical settings, is limited in many provinces, resulting in long waiting lists for addiction treatment.

“The abuse of opioids is pervasive around the world, however access to life-saving treatment is limited in the United States,” says Dr. Nosyk. “Further efforts are necessary to make treatment more readily available, particularly by eliminating the financial barriers faced by disadvantaged people, who are often the most complex to treat.”

The authors propose changes to federal and state laws to adopt methadone maintenance treatment in office-based settings such as private doctor’s offices, as well as policies to mandate addiction education in medical schools to ensure treatment is administered safely and effectively. In addition, they recommend public and private insurers provide universal coverage for opioid substitution treatment.

“There are serious medical harms associated with heroin and opioid injection, including the transmission of HIV and hepatitis C,” says Dr. Julio Montaner, senior author and director of the BC-CfE. “This research underscores the urgent need for scientific, evidence-based interventions to address these individual and public health harms.”

A copy of the report, titled “A Call For Evidence-Based Medical Treatment Of Opioid Dependence In The United States And Canada,” is available on Health Affairs website.