Thursday, November 01, 2018

Medication-assisted treatment expands as stigma decreases and more states cover treatment under Medicaid

Methadone clinics in the U.S. (Stateline map; click here for the interactive version)
The opioid epidemic has been spreading throughout the U.S. for years, but the number of medication-assisted addiction-treatment clinics has not expanded much until recently. That's partly because methadone and the clinics that dispense it have been stigmatized, and met with skepticism from politicians and the public. That's changing: "The methadone treatment industry, which began in the late 1960s, grew more in the past four years than it has in the past two decades," Christine Vestal reports for Stateline. "Between 2014 and 2018, the methadone industry added 254 new clinics."

Stigma remains a powerful damper, though. Some people living near methadone clinics worry that drug-treatment centers attract crime, and dislike seeing a crowded parking lot of opioid addicts waiting for their dose. Unlike the other two medications approved to treat opioid addiction, methadone must be administered daily by a specially licensed doctor at a highly regulated clinic, Vestal reports. The regulatory hoops can discourage clinics from opening, but Vestal reports, "More states, including some that previously limited expansion of methadone treatment, are calling on the industry to set up new programs in opioid-plagued rural and suburban areas that lack adequate medication-assisted treatment."

Many states are opening dozens of new facilities in rural and suburban areas. They include Indiana, Maryland, New York, Ohio and Florida. "At the same time, Vestal reports, laws and regulations in at least six other states — Georgia, Indiana, Louisiana, Mississippi, West Virginia and Wyoming — still curtail licensing of new methadone clinics, even though people with opioid addictions in large swaths of those states live too far from the nearest methadone clinic to commute."

More opioid users can now get treatment too, since many states that expanded Medicaid under the Patient Protection and Affordable Care Act began offering reimbursement for methadone treatment in the past four years. That has given the treatment industry a major incentive to expand.

"Remaining states that do not allow Medicaid reimbursement for methadone treatment are Alabama, Arkansas, Idaho, Illinois, Iowa, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, Texas and Wyoming, several of which have among the nation’s highest rates of opioid addiction and overdose deaths," Vestal reports. Some states cover other types of medication-assisted treatment but not maintenance methadone; at least one, Kentucky, has proposed to include it as part of Medicaid changes under federal waivers that would also require able-bodied beneficiaries to work, volunteer, go to school or get drug treatment.

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