The current opioid epidemic spurred questions about the capacity of the workforce available to provide treatment to individuals with opioid addiction. Given the proliferation of what the federal government dubbed a “public health crisis,” all possible steps ought to be taken to stem the tide of this epidemic. One such step is medication-assisted treatment (MAT), which has been proven to be successful, yet its rates of implementation vary widely across the country. There are many reasons for this treatment gap, including cost, limited insurance coverage, low provider confidence in assessing addiction, provider availability and unwillingness to prescribe, lack of institutional support, reimbursement costs, and stigma. Several possible solutions have been proposed, such as creating better reimbursement strategies, providing remote substance use disorder treatment, and raising the limit on the number of patients who can be treated with buprenorphine.
This project was led by the National Council for Behavioral Health. It interrogated how scope of practice restrictions specifically affected the ability of a range of providers to implement MAT. Further, it explored the discrepancy between the large number of providers who are licensed to prescribe for MAT, and low numbers of actual prescribers to address a practice that is currently underutilized. SOP limitations for MAT -along workforce competencies and MAT regulations and restrictions – were also asked to analyze who was prescribing MAT, how they were trained, where gaps in training occurred, and the outcome of training.
Reasons for the underutilization of the use of medications in conjunction with psycho-social and recovery support services to treat substance use disorders (medication-assisted treatment; MAT) in behavioral health settings include: 1) financial constraints, 2) federal laws and regulations, and 3) workforce challenges. To improve the adoption and utilization of MAT, the following should be considered:
- Encourage higher education accrediting agencies and state certification/licensing bodies to adopt standardized training guidelines on the topic of addiction.
- Create mechanisms such as provider reimbursement for MAT as part of telemedicine and increased funding for mobile treatment services in rural populations to decrease geographic barriers.
- Develop technical assistance and guidelines to support providers in navigating the clinical, financial, and operational considerations for implementing MAT.
- Effectively integrate prevention, treatment, and recovery services across health care systems to improve access to and quality of treatment. Models that allow individuals to receive comprehensive mental health and substance use disorder services (e.g. Certified Community Behavioral Health Clinics) will increase access to care and improve outcomes.