ONGOING VINDICATOR SERIES
By TIM RUDELL
Ohio is dramatically expanding the number of caregivers who can prescribe Suboxone and other drugs for medication-assisted treatment (MAT) of addiction. The effort is part of a broader strategy to address the opioid epidemic, but not everyone thinks it’s a good idea.
Alexis Graziano of Girard was recently half a year into recovery and in a sober-living facility. She said she has experienced MAT and found it ripe for abuse if not managed closely.
“There are 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!” she said.
Graziano is not alone. There are professionals in addiction services who see problems with the MAT approach, too.
“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,” said Lauren Thorp, who leads recovery programs for the Trumbull County Mental Health & Recovery Board. “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 good reasons for using MAT.
Years of research show that MAT works, both to get people off drugs and keep them off. National Institutes of Health studies in 2014 showed as much as a 61 percent long-term recovery rate for people addicted to prescription opioids in MAT programs.
“Medication-assisted treatment is one of the best studied treatment modalities that we have, and the effectiveness for all forms is really without doubt,” said Dr. Mark Hurst, medical director of Ohio Mental Health & Addiction Services. “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 does recognize the potential for abuse with MAT 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 to it. And it needs to be monitored appropriately,” he said.
Hurst said only 2 percent of Ohio’s doctors are now licensed to prescribe Suboxone and similar drugs – far too few to handle the need for MAT 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. To reach the most addicted people, the program is focusing the expansion on primary-care practitioners, where right now there are the fewest licensed MAT drug prescribers.
For all of the supporting research and promises of regulation, there are still those who question the concept itself of using drugs in addiction treatment. Graziano is an example. She survived her own drug use – barely, by her account – and has to work constantly to build on her sobriety. To her, MAT 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,” she said. “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. Ohio Mental Health & Addiction Services and the Ohio Department 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 MAT drug prescribers, augmented by continuing education through online courses and seminars.