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By: Mark W. Parrino

Executive Summary

The increasing prevalence of opioid use disorder (OUD) in the United States has led to an ongoing public health crisis. At the present time, more than 150 Americans die each day of opioid-related overdoses. This epidemic of opioid overdose deaths, first characterized by prescription opioid misuse, has transitioned into heroin and fentanyl use.

Medication assisted treatment with methadone and buprenorphine has been shown to be effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone also is an effective medication for some opioid addicted individuals as well as for those with alcohol dependence.⁽¹⁾ The OUD crisis has led to an increasing demand for medication assisted treatment through opioid treatment programs (OTPs) and office-based opioid treatment via the Drug Abuse Treatment Act of 2000 (DATA 2000). Treatment capacity, however, must be further expanded to meet the growing demand, especially in rural and other underserved areas.

The American Association of Treatment of Opioid Disorders (AATOD) presents this policy paper to address some of the issues that impact the development of future policies in the use of medications in OUD treatment and the prevention of opioid overdose. These issues include:

1. Should treating OUD be viewed as a public health intervention with the principal component of care and treatment being the utilization of federally approved medications (methadone, buprenorphine, and extended release injectable naltrexone)?

2. Should resources be prioritized to treating OUD with medications and additional clinical services?

3. Should there be coordination to organize service delivery to treat this illness through a continuum of service delivery components?

4. Should there be a better connection/coordination between DATA 2000 practices and OTPs to address treatment capacity and facilitate interfacility referrals from one practice to the next?

This paper provides a historical perspective of the nation’s current policies for delivering medication assisted treatment for OUD. By understanding the system and principles of care that guide how medication assisted treatment is delivered today, policymakers can develop future policies that offer greater stability, are based on evidence, and reflect best practices.