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The ABCs of MAT (Medication-Assisted Treatment)

More than half a million Coloradans live in a county with few or no treatment options for people suffering from opioid addiction.

The nation is in the midst of an epidemic of opioid addiction and overdose deaths, and Colorado is no exception. Medication-assisted treatment, or MAT, is a proven way to fight this epidemic. It’s an evidence-based approach recommended by a wide range of respected scientific sources for the treatment of addiction to opioids, a category of drug that derives from the opium poppy and includes prescription pain pills as well as heroin.

MAT takes a holistic approach to the patient. The medication manages the symptoms of withdrawal and helps reduce cravings while counseling and other recovery support services address the psychological symptoms.

A new Colorado Health Institute analysis examines the state of MAT in Colorado.

The need for treatment is great. Overdose death rates for all drugs increased in every region of Colorado between 2002 and 2014, and the state reported 472 opioid-related overdose deaths in 2015 – up from 108 deaths in 1999.

Abuse or dependence on prescription opioids has begun to level off in recent years, but heroin is stoking the opioid epidemic. Rates of dependence on heroin increased five-fold between 2003 and 2014 in Colorado. Hospitalization rates due to heroin increased by 41 percent, and the rate of emergency room visits more than doubled from 2011 to 2014.

An annual average of 22,000 Coloradans reported abuse or dependence on opioids, while only 4,000 – or about one of five – received treatment annually at a specialty facility between 2011 and 2014.

Despite its effectiveness, many patients are not receiving medication-assisted treatment.

Patients and families may feel stigmatized by participating in a treatment program. The approach is not always widely available, and providers may not be aware of it or may lack proper training.

It can be difficult or too costly for many primary care practices, especially in rural counties, to recruit and retain the appropriate staff, including counselors. Regulations also limit the type of practitioners who can provide medication-assisted treatment and the size of the patient population they can treat.

CHI’s analysis reveals that 31 of the state’s 64 counties do not have a location that provides MAT. An additional 15 counties have just one location.

Ten of the 31 counties with no treatment locations had drug overdose death rates above the state rate in 2014.

The lack of access to opioid treatment in Colorado and nationwide has not gone unnoticed. Additional resources are coming to Colorado to help tackle the problem, and the General Assembly considered several pieces of legislation related to treatment this year.

The federal government has made several recent changes:

  • A regulation issued in July 2016 allows approved practitioners to treat a larger number of patients with buprenorphine.
  • The Comprehensive Addiction and Recovery Act passed in July 2016 allows nurse practitioners and physician assistants to provide buprenorphine with additional training. Historically, only physicians could prescribe buprenorphine. This change could have a significant impact on Colorado’s shortage of medication-assisted treatment providers, as nurse practitioners and physician assistants are more likely to work in rural areas than physicians.
  • Congress also passed the 21st Century Cures Act in December 2016, which dedicated $1 billion over two years to combat the opioid epidemic. Colorado is set to receive $7.8 million each year for the next two years. The funding will support medication-assisted treatment for uninsured and indigent patients and buprenorphine training for providers.

The state government is taking action, too.

The Colorado General Assembly passed Senate Bill 17-074, which creates a pilot program to expand access to medication-assisted treatment in Pueblo and Routt counties by providing grants to train nurse practitioners and physicians assistants.

State legislators also passed SB 17-193, which establishes a center for research into substance use disorder prevention, treatment and recovery strategies, and House Bill 17-1351, which requires the state government to come up with options for residential and inpatient substance use disorder treatment under Colorado’s Medicaid program.

And legislators will meet in a special interim committee this summer to examine prevention, harm reduction, treatment and recovery support strategies for opioid and other substance dependence in Colorado.

While there is significant activity underway to help address the epidemic, more work is needed to make sure everyone who wants treatment gets it.