“It is a topic that has invoked a very heated discussion,” said Basia Andraka-Christou, a practicing attorney licensed in Florida and a Ph.D. Candidate in the Indiana University Maurer School of Law.
Andraka-Christou is researching the underuse of evidence-based addiction treatment for her dissertation.
Over the course of her studies, she has found medication-assisted treatment is the most effective treatment for opiate addiction according to the U.S. Department of Health and Human Services, the World Health Organization and the American Society of Addiction Medicine support.
Opiates are a class of drugs that include heroin and prescription medications like Oxycodone.
Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin, according to a study conducted by the American Society of Addiction Medicine.
According to the study, 18,893 people in the United States died from overdoses related to prescription pain relievers in 2014, and 10,574 people died of overdoses related to heroin.
On Monday, Andraka-Christou presented about the underuse of medication-assisted treatment, or MAT, for opiate addicts as a part of The Poynter Center’s Healthcare Ethics Seminars.
MAT combines Food and Drug Administration-approved addiction treatment medication with extensive counseling. Despite its effectiveness, it’s not adequately used, Andraka-Christou said.
Many roadblocks stand in the way of MAT including stigma, limited Medicaid coverage, restrictive laws, lack of knowledge among physicians and a history of abstinence-only treatments, Andraka-Christou said.
About 50 percent of drug courts nationwide completely ban MAT, she explained, and she has seen the same numbers in Indiana.
“It’s really underused and heavily stigmatized,” she said. Meanwhile, deaths from opiate overdoes have quadrupled in the course of the last ten years, she added.
For example, attention has been brought to Austin, Indiana, she said, where an HIV outbreak fueled through intravenous drug use ravaged the small town last summer.
But while the problem of opiate abuse increases, drug-based treatment is often unavailable to addicts in Indiana’s drug courts.
“They are told you are not really sober, or that it is just another drug,” Andraka-Christou said.
Instead, she found in interviews with over 20 Indiana drug court judges, that primary treatments are a program through Narcotics Anonymous and counseling.
“You don’t have a physician working in a drug court,” she pointed out.
The three medicines most commonly prescribed for MAT – methadone, buprenorphine and naltrexone according to the U.S. Department of Health and Human Services – aren’t without their flaws, she acknowledged.
For example, the first two drugs have addictive properties that can be abused, though the risk is low. Because of this, they have a considerable street value and could be sold by addicts.
“In a lot of what I have found, addiction treatment is not really an area of ideals,” Andraka-Christou said. “This is a very messy grey area sort of situation.”
A key issue is a shortage of trustworthy providers, she explained. She knows of five providers of the MAT drug buprenorphine in Bloomington, three of which are cash only even though the drug is covered through Medicaid. One had a waitlist the last time she called.
Almost half of counties across the country lack a buprenorphine provider, Andraka-Christou said.
“In Indiana I do not see a very big push in supporting MAT from the state level,” she said.
She sees some steps toward MAT expansion, however. Last year, the U.S. Department of Health and Human Services said it would cut funding from drug courts that refuse to offer MAT. Though drug courts are primarily state funded, it’s a sign in a change of attitude, that could potentially bode well for the future adoption of the treatment she said.
Attendees at the talk included IU faculty and students, an intern for Rep. Todd Young, R-Ind., and recovery coaches from Centerstone, a provider of behavioral health services in Bloomington.
Chris Abert with the Indiana Recovery Alliance said the talk both answered and raised new questions about why MAT is so limited. IRA is a Bloomington organization that provides services for the health and well-being of its members, including injection drug users.
Addiction treatment should be on an individual basis, Abert said.
He sees firsthand the stigma of drug treatment to treat a drug addiction in his work.
“But it’s lessening,” he added.