A recent study has found that while some opioid overdose death prevention policies may fail not because they are poor policies, but because they fail to address the real problem.
Published in the Journal of Health Politics, Policy and Law, the study looked at policies in New York state, where generous substance-use treatment policies exist, and yet those who need it report they have difficulty in accessing services. The authors interviewed 87 subjects who were either substance-users or those who work with substance-users. They attended local opioid task force meetings in Sullivan County, N.Y., to find common topics and themes.
What the study found was that while the state sees the reason for people not being able to access services as a lack of beds, those seeking services say they face real barriers in getting treatment because of the medical model of detoxification, the admissions criteria, staff shortages, and other complications.
According to the study, New York has removed many barriers to accessing treatment: requiring licensed facilities to provide services regardless of ability to pay; forbidding insurance companies from requiring preauthorization or limiting treatment to 28 days without the right to appeal; and creating an agency specifically dedicated to substance-use services – The Office of Addiction Services and Supports.
Yet, the study authors found that over and over again, both substance users seeking treatment and those who work with substance users said that there are difficulties accessing the services. The study authors found that it wasn’t that the policy was weak or ineffective, but that tools within the policy may be hiding the real problems.
“In the case of New York State, we find that a well-crafted and well-implemented policy solution, the New York State OASAS bed-locator tool, does exactly what it was designed to do: keep a tally of open treatment beds in the state,” the study said. “But the bed-locator tool does not actually fix the problem that people on the ground face: access to these open beds. Furthermore, the tool not only gives the impression that the state has addressed the problem, it also provides data to support state officials’ claims, effectively masking the real problem and thwarting efforts to address it.”
Further, the study found that there were, in fact, plenty of open beds, but that there were other barriers to obtaining services. The study highlighted an interview with one mother who spoke about trying to get services for her daughter. The daughter was turned away from the same treatment facility three times – once because she was on anti-depressants, once because she needed to detoxify from fentanyl before being admitted and the last time because she had gone to the hospital that the treatment facility sent her to in order to detoxify, but could not be admitted because the hospital treated her with methadone, which the treatment facility considered to be a drug rather than a medication.
These types of barriers, the study said, provide the “illusion of service” in the opioid epidemic.
From a lack of facilities offering withdrawal and detoxification services to a shortage of physicians who can prescribe medication-assisted treatment to a lack of mental health services providers to a lack of clinics open when people need them, the study found that the policies as written failed to address the real issues around getting access to treatment.
The study also pointed out that it’s easier to get an opioid than it is to get the medication used to treat it.
“Under existing law, physicians, dentists, veterinarians, physician assistants, nurse practitioners, and nurse midwives in New York can prescribe opioids, but MAT requires specialized clinics, trainings, and authorization. Methadone is a Schedule II drug, available only through highly regulated clinics, which patients have to visit daily when they first start methadone maintenance. Buprenorphine, a Schedule III drug, can be prescribed in physicians’ offices, but it requires practitioners to obtain a DEA waiver…” the study said. “Ironically, it is far easier to prescribe opioids than the medication-assisted treatment to help people stop using them. As one state official explained, ‘If you want pills, limp into the ER and when they ask you how much pain you have say seven and you’ll get it. But if you want methadone, it’s regulated as if it were weapons-grade plutonium. Clinics have to keep it in a huge safe. A vault. It prevents access.’”
To fix the problem, researchers suggested policymakers could look at the real issues – provide a detoxification facility with easy and open access in each county; address admissions criteria so that all who seek care can access it and address staffing needs to ensure that there is an adequate number of healthcare providers to treat addiction issues.
“Not being able to access services is a problem. But with opioids, the consequences are especially dire. Every time someone is turned away from a supposedly available bed, the community loses an opportunity to save a life,” the study said. “The illusion of services means that people who try—and fail—to access services are invisible to state officials making public policies. The state-run systems to track treatment services show open slots, whether or not people on the ground can actually access them. Policies may be well designed and executed, but they do not address—and in some cases exacerbate—a broader problem that policymakers wish to fix.”