ICAAT: Barriers to Effective Treatment of Opiate Dependence

Abstract: Effective Medical Treatment of Opiate Addiction, National Institute of Health Consensus Statement 1997

Despite the fact that decades of clinical research have shown consistently that opioid agonist drugs like methadone are of considerable benefit to the lives of those who suffer from opiate dependence, access to these drugs is not available to the great majority of those who need them. Barriers to effective treatment services for opiate dependence exist everywhere in the United States, and take many different forms; they reflect social perceptions about these drugs, legal and regulatory constraints related to the consequences attributed to their use and abuse, and financial and program costs related to treatment. In particular, they also are a direct result of the "not in my backyard" ("NIMBY") phenomenon that leads communities to fight against the establishment of addiction treatment facilities.

Unlike other medical conditions like cancer and diabetes that do not bear the burden of moral condemnation by society, opiate dependence generally is not perceived as a true medical disease. Rather, it is seen as a sign of hedonsim and/or a deficiency of willpower to refrain from the compulsive, non-medical, euphoria-inducing use of opiate drugs.

In an effort to reduce or remove the many barriers to effective pharmacotherapies for opiate addiction such as methadone, and increase patient access to treatment, experts on the NIH consensus panel who have analyzed the situation have come up with the following set of recommendations:

Establish strong leadership within the U.S. Office of Drug Control Policy and other state and local agencies to go into communities to educate the public about the nature of opiate dependence as a treatable medical disorder.
Access to methadone maintenance treatment services should be increased by:
- Making treatment as cost effective as possible without sacrificing quality.
- Increasing the availability and variety of treatment services.
- Increasing the number of physicians and other health care providers with training in the diagnosis and treatment of opiate dependence. It also is suggested that federal agencies like the National Institute on Drug Abuse provide increased funding to improve the training of medical students in the treatment and diagnosis of opiate dependence.
- Providing additional funding for opiate dependence treatments and coordinating these services in conjunction with other medical and social services that patients need.

The experts suggest that current laws that regulate methadone prescribing be revised so as to eliminate the extra layer of government control over therapeutic use of schedule II narcotics. They argue that these regulations are for the most part unnecessary because methadone is a drug that is rarely diverted for recreational or casual use. They believe that deregulation of narcotic drugs like methadone would be cost effective and very beneficial to the expansion of treatment capacity, and would save money on redundant and/or unnecessary monitoring and inspection.

In addition, the NIH panel recommends that MMT programs develop greater cultural sensitivity and devote considerable effort and resources toward the targeting and inclusion of traditionally underrepresented minority groups and women. It also recommends the establishment of opiate agonist treatment in states it is not yet available. Finally, the panel suggests that because of the limited understanding of the genetic, physiologic, and psychosocial factors that influence opiate dependence, systematic pharmacokinetic and longer term follow up studies of methadone recipients are necessary. This is particularly true in the case of pregnant women with opiate dependence where the physiologic factors that influence optimal methadone doses are not clearly defined.