Despite research that the use of Medication-Assisted Treatment (MAT) for opioid use disorder is extremely effective, stigma and misunderstanding leaves many without access to these often life-saving medications.
The Food and Drug Administration has approved three medications for treating those with an opioid dependency, Vivitrol, which is long-acting and most often given as a monthly shot; Methadone, which was first approved in 1970 and for which a person has to go into an opioid treatment program (OTP); and buprenorphine, for which a provider needs a waiver to prescribe. To get that waiver, a physician must complete an 8-hour training course and, for a variety of reasons, not many do.
The barriers for all of these are high, particularly in rural areas like Talbot County. Here in Maryland, a relatively new project from the University of Maryland School of Medicine, in partnership with the Maryland Department of Health, hopes to eliminate some of those barriers for buprenorphine prescribers.
“As far as I know, buprenorphine is the only prescription that needs a waiver, which almost creates an additional barrier,” said Eric Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine who consults for the new program, called ‘MACS’, or Maryland Addiction Consultation Services.
MACS launched in October 2017, with a three-tiered plan: operate a 40-hour a week warm line, where providers can call for information and support on MAT; conduct outreach and trainings on waivers; and provide in-office support for providers interested in MAT. As of April 30, 2019 the program has signed up nearly 400 providers, which includes doctors, nurse practitioners, physicians’ assistants and dentists. Here in Talbot, MACS has conducted several outreach events but hadn’t received any calls to the warm line, Weintraub said.
“There is a large percent of patients who need treatment across the country and aren’t getting it,” Weintraub said. “Rural areas are disproportionately impacted and we have good, evidence-based, life-saving treatments that are being underutilized.
“Primary care providers should be occupying the front lines in this struggle. We understand there is some discomfort and concern about utilizing these medications for a variety of reasons.”
MACS helps support providers in taking care of people who need these treatments. Weintraub said these medications can reduce overdose by up to 50 percent, and once a person is stabilized, any physician can provide these life-saving medications.
Sold under the brand name Subutex, buprenorphine is the sole MAT approved for use in a doctor’s office. As with all medications that treat opioid use disorder, buprenorphine is used as part of a comprehensive treatment plan that includes professional counseling, and social support. Buprenorphine helps lower cravings for opioids, helps diminish withdrawal symptoms and helps people reduce or quit the use of heroin or other opiates, like morphine.
Until about two years ago only physicians could prescribe buprenorphine and could only treat up to 30 patients at a time. Now, nurse practitioners also can prescribe, and the number of patients permitted at a time has increased to 275, said Weintraub.
Since MACS launched, Weintraub noted an increase in calls and said the program has expanded to include providers treating any type of substance use disorders, not just opioids. MACS also is expanding into consultations on chronic pain issues, he added.
If you are a provider interested in getting more information on how to offer MAT at your practice, please contact the MACS program at 855-337-MACS (6227). More information is available online at www.marylandmacs.org. Registration for the program also is available on the MACS website.
Not yet open for registration but scheduled is the first waiver training on the Shore, set for Nov. 6 in Easton. Call MACS for more information.