By Lisa Rapaport

(Reuters Health) – Most people who check in to residential treatment facilities to recover from opioid use disorder won’t be given medicines proven to help combat addiction, a U.S. study suggests.

Doctors widely agree that the most effective treatment for opioid abuse includes anti-addiction medicines like naltrexone, buprenorphine or methadone. But only 15% of patients in residential drug treatment centers got these medicines in 2015, the study found.

“Patients entering these facilities are paying for a very high level of care, but might not be receiving the gold standard of treatment,” said study leader Andrew Huhn of the Johns Hopkins University School of Medicine in Baltimore.

“Medications for opioid use disorder have repeatedly been shown to reduce the rates of opioid relapse and overdose death, and residential facilities should be working towards expanding all treatment options to address the opioid crisis that is devastating this country,” Huhn said by email.

Perhaps not surprisingly, access to anti-addiction medicines was most limited in states with less coverage for residential treatment through Medicaid and in states with more restrictions on prescribing these drugs.

Starting in 2014, under the Affordable Care Act, some U.S. states expanded coverage through Medicaid, a joint federal and state insurance program for the poor. In these states, 18% of patients admitted to residential treatment programs got anti-addiction medicines, compared with 2% of patients in states that didn’t expand Medicaid.

Younger patients, people of color and individuals referred to treatment through the criminal justice system were less likely to receive anti-addiction medicines than older patients and white patients, the study also found.

While the study didn’t examine whether these differences in treatment changed patient outcomes, previous research has found that people are less likely to relapse, overdose or die from overdoses when they receive anti-addiction medicines, Huhn said.

Despite that evidence, abstinence-based treatment remains entrenched, said Dr. Michael Barnett, a researcher at the Harvard T. H. Chan School of Public Health in Boston who wasn’t involved in the study.

“Medications are also rejected in part because they have been stigmatized as not being truly ‘clean’ or ‘trading one addiction for another,’ which is a false representation of the role of medications for opioid use disorder treatment,” Barnett said by email.

Drug policy in the U.S. should promote anti-addiction medicines because they work best, and save lives, Barnett said. In the meantime, patients and families should do what they can to ensure that they only check in to facilities that embrace treatment with anti-addiction medicines.

“If patients and their families want evidence-based treatment, they must make sure they or their loved ones go to facilities that offer these medications,” Barnett said.

SOURCE: JAMA Network Open, online February 7, 2020.