Doctors slow to adopt drug- aided therapy
Research shows that medication- assisted treatment, or MAT, for opioid addiction is effective because it eliminates drug cravings, but the use of MAT in Connecticut is not keeping up with the epidemic, said Dr. David Fiellin, director of the Yale Program in Addiction Medicine, who works with the state to address the opioid crisis.
“We are, at some level, playing catch- up,” Fiellin said. “I think it’s going to take, unfortunately, a number of years” to meet the need for MAT in the state, he said.
Connecticut ranks in the top 10 of states with the highest rates of fatal opioid overdoses, according to the National Institute of Drug Abuse, which said the state rate more than quadrupled from 5.7 deaths per 100,000 people in 2012 to 24.5 in 2016. In 2017, 1,038 people died of opioid overdoses in Connecticut, up from 729 in 2015 and 917 in 2016, state medical examiner figures show.
There are no “reliable estimates” of the number of Connecticut residents with opioid use disorder, Fiellin said. Roughly 2 million people are addicted to opioids in the U. S., with 72,000 fatalities in 2017, according to preliminary figures from the Centers for Disease Control and Prevention.
Three drugs have federal approval for treatment of opioid use disorder. They are methadone, administered only in federally regulated sites; buprenorphine, for which medical professionals must be trained before prescribing; and naltrexone, for which training isn’t required, but is in limited use because patients must be drug- free for seven days before taking it.
Addressing opioid addiction with medication- assisted treatment reduces overdoses, illicit drug use, cases of HIV and criminal behav- ior, Fiellin said. The practice is endorsed by federal health agencies and the state government. Advocates contend that since OUD is a chronic brain disease, it should be treated with medication as other diseases are.
About 3,800 practitioners are licensed in Connecticut to prescribe buprenorphine, according to federal figures provided by the state Department of Consumer Protection. That number includes doctors, psychia- trists, nurse practitioners, and physician assistants who work in private practices, emergency rooms, health clinics and substance abuse facilities.
But state and local health officials say there’s a dearth of primary care physicians who treat opioid use disorder with MAT. Also, few residential treatment programs use MAT, opting for no- medication, an approach that increases overdose risk after discharge, Fiellin said.