Opioid abuse treatments don't reach areas most in need
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Nearly 1 in 5 U.S. counties lacked opioid treatment programs or any office-based providers of buprenorphine, which reduces the risk of future overdoses, according to a federal review of whether drugs for opioid abuse are reaching areas of greatest need.
Why it matters: It's the latest sign that many Americans in the throes of the addiction crisis aren't getting access to potentially life-saving treatments.
What they found: In 2022, individuals seeking treatment — including those enrolled in Medicare or Medicaid — often face hurdles finding providers allowed to prescribe and dispense drugs for opioid use disorder, the Department of Health and Human Services inspector general's review found.
- Even in counties with services, providers often did not treat Medicare or Medicaid enrollees.
- Medicare Advantage prior authorization requirements, low Medicaid reimbursement rates and inadequate public information about provider locations all contribute to the barriers, per the review.
By the numbers: 597 of the 3,143 U.S. counties nationwide (19%) did not have any office-based buprenorphine providers or opioid treatment programs in 2022.
- 26% of counties in high need of services based on their overdose death rates had few or no providers.
- 32% of all U.S. counties and 19% of all high-need counties lacked providers that treated either Medicare or Medicaid enrollees.
The review found opioid treatment programs — the only provider type that offers treatment with methadone — were much likelier to treat Medicare and Medicaid enrollees than office-based buprenorphine providers.
- However, there are far fewer opioid treatment programs, and they are much less widespread across the country.
- Texas, Georgia and Kansas had the lowest percentage of office-based buprenorphine providers that treated Medicaid enrollees in 2022.
- Delaware, Iowa and the District of Columbia had the lowest percentage of office-based providers that treated Medicare enrollees.
Context: Policymakers have taken steps to expand access to treatments amid the worsening addiction crisis, including adding opioid treatment coverage to Medicare and requiring state Medicaid programs to cover all forms drugs for opioid use disorder.
- They also streamlined the process for prescribing or administering buprenorphine.
Federal officials and professional organizations told the inspector general that the large number of Medicare Advantage plans with different administrative requirements may hinder providers' ability and willingness to treat Medicare enrollees.
- Pre-approvals for treatment were a factor: An analysis of 2022 data showed 85% of Medicare Advantage enrollees needed prior authorization for opioid treatment program services and 83% percent were required to obtain prior authorization for outpatient substance abuse services.
