Q&A: How To Increase Access to Opioid Use Disorder Treatment

As the COVID-19 pandemic dominated public attention, the national opioid overdose epidemic continued to surge. Opioid overdose deaths in the United States reached record highs in 2021, increasing nearly 15% from 2020. The number of people needing substance use disorder (SUD) treatment outpaces the number of health professionals available to treat them.

To reverse these trends, the healthcare industry needs to find ways to increase access to opioid use disorder (OUD) treatment – through more providers, new treatment methods, and creative solutions.

Eric Bailly, LPC, LADC, has a clinical background in treating substance use disorder and focuses on SUD strategic response at Elevance Health; he shared his insights on methods to improve access to providers and treatments.

Q: How can we increase the number of OUD treatment providers?

A: Perhaps one of the more proactive ways to increase the number of treatment providers is to build up the pipeline by encouraging students to pursue careers in substance use disorder treatment. Financial incentives like tuition reimbursement and loan forgiveness programs would certainly attract a more consistent flow of diverse, talented professionals to the field.

A more immediate solution is expanding the types of healthcare providers who can provide treatment. Licensed mental health counselors as well as family and marriage therapists should be eligible for reimbursement as OUD providers under Medicare. Including these two groups would add 225,000 providers to the behavioral health workforce. This change has been proposed in the federal Mental Health Access Improvement Act.

Q: Are there other people who can help ease the opioid epidemic?

A: Yes, expanding the use of peer support specialists as part of an integrated care plan can help more people get the treatment they need. Peer support specialists have been well-established in mental health and substance use interventions. Since they have lived experiences with mental health and substance use disorders, peer support specialists increase connection with people in treatment and ensure care teams reflect the experiences of those they help.

Q: What about using telehealth to expand access OUD treatment?

A: Telehealth fundamentally changed the delivery of strong, clinically effective, outpatient OUD treatment. To continue capitalizing on telehealth’s success, cross-state licensing of providers can be expanded to allow the supply of treatment providers to better meet demand.

Medication for Opioid Use Disorder (MOUD) protocols involving a prescription for buprenorphine or methadone require an in-person visit with the prescribing provider. Eliminating this requirement for buprenorphine would allow telehealth providers to prescribe it as needed in MOUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) permits states to increase methadone take-home doses to a 28-day supply for those who are clinically stable and, if the provider approves, up to 14 days for those who are less stable under their Public Health Emergency provisions. SAMHSA also allowed clinicians to use telehealth to monitor those on methadone. Making these emergency use provisions permanent can increase the access to very effective treatment.

Q: Are there other access points that can ease the provider shortage?

A: Allowing consumers to enter the healthcare system through the access points they choose is critical to getting and keeping them engaged in their health and long-term recovery. During the first two years of the pandemic, providers were reimbursed for additional, proven effective treatments. Consumers appreciated the ability to access care through asynchronous care, texting, coaching, and as part of overall wellness services. Federal and state regulators should explore continuing to reimburse these access points for treatment as they would serve those with mild to moderate conditions well while freeing up in-office and inpatient treatment time for individuals' more intensive and complex needs. 

Q: What innovations are underway in OUD treatment?

A: Innovative ideas in OUD treatment and opioid overdose prevention include naloxone vending machines, mobile methadone vans, in-home private treatment, and implementation of harm reduction strategies. Finding ways to leverage these new tools can free up space in brick-and-mortar treatment centers.

Prescribing buprenorphine is an increasingly accepted evidence-based treatment that still requires healthcare providers to obtain a waiver from the Drug Enforcement Administration. Eliminating this requirement would increase the number of providers that could provide MOUD.