Most people who need addiction treatment don’t get it. Still, many state laws restrict access | news
Federal data shows that most people who need treatment for an opioid use disorder do not get it. However, almost every state has laws restricting access to opioid treatment programs, such as a new report from the Pew Charitable Trusts.
Researchers say these government restrictions go against evidence-based practices and limit access to care.
Opioid treatment programs are facilities that can offer all three drugs approved by the US Food and Drug Administration to treat opioid use disorders: methadone, buprenorphine, and naltrexone. Methadone in particular can only be offered in opioid treatment programs, while the others, like other drugs, can be prescribed by doctors.
Pew researchers found that 19 states — including the Midwestern states of Indiana and Missouri — and the District of Columbia require facilities to produce a legal document, known as a certificate of need, stating that the services are required before starting a new treatment program is opened. Indiana also limits the number of treatment programs that can be opened.
Missouri, Indiana and Ohio have additional zoning laws that go beyond the regulations for other medical facilities and limit where an opioid treatment program can be opened. Federal laws require patients in these programs to be screened for drug use, and Indiana, Ohio and Kentucky also have laws requiring observation during urine sample collection, which can be uncomfortable for clients.
Kentucky and Ohio also require more than the state-recommended eight yearly urine tests. 26 states require more than eight screenings, and researchers say it can increase treatment costs.
In all states except South Dakota and Massachusetts, programs can force people to discontinue treatment if they use substances, although federal guidelines and research support continued treatment rather than an abrupt cessation of treatment in cases of continued drug use.
While American Society for Addiction Medicine‘s Guidelines for treating opioid use disorders state that “there is no recommended time limit for pharmacological treatment with methadone.” Eight states, including Missouri, Indiana and Kentucky, have rules that make drug cessation the goal of treatment. According to Pew researchers, these rules may encourage providers and patients to discontinue treatment if it’s still needed, potentially increasing the risk of overdose death.
The requirement for government ID may also present a barrier to accessing treatment for some. Illinois and Indiana are among eight states that require government-issued ID, which can be challenging for some, including undocumented immigrants, inmates and the homeless.
Research shows that opioid use disorder medications can be effective without counseling, and that strict counseling requirements can reduce treatment duration. Still, 23 states require a set counseling schedule to stay on treatment, which can affect a patient’s ability to take medication home. Some form of set counseling exists in Indiana, Kentucky, Ohio and Missouri.
Other obstacles are the regulations on the location of clinics in relation to the approval of take-away medicines and opening hours. In 41 states, opioid treatment programs do not have to be conducted outside of standard business hours, 8 a.m. to 5 p.m
Researchers say these restrictions limit access to care if opioid use continues to be the leading cause of drug overdoses. Corresponding Dates for 2020 by the US Centers for Disease Control and Prevention, 75 percent of the nearly 92,000 overdose deaths were linked to an opioid.