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Substance use disorders (SUD) are a major public health crisis impacting families, communities and society. Access to Medication-Assisted Treatment is an Urgent Need 20.3 million people needed treatment for SUD in 2018 but only 3.7 million received treatment 51.4% of individuals with co-occurring mental illness and SUD received neither substance use treatment nor mental health services and only 7.8% received treatment for both Only 7.9% of adults who had alcohol use disorder in the past year received treatment There are fewer than 1,700 programs providing methadone to approximately 380,000 Americans <7% of physicians have DEA waivers to provide MAT Only 13% of clinicians prescribe at or near the authorized waiver patient limit >50% of U.S. counties lack even one buprenorphine provider THE TREATMENT GAP 67,367 AMERICANS died from drug overdoses in 2018 nearly 47,000 of those die from opioids representing 185 each day people aged 12 or older suer from a substance use disorder people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the U.S. 20.3 MILLION adults with SUD have some form of co-occurring mental illness 9.2 MILLION Medication-Assisted Treatment (MAT) with methadone, buprenorphine and naltrexone XR can successfully treat opioid use disorders (OUD). MAT is highly eective and has been shown to: Reduce overdose deaths Improve retention in treatment Reduce opioid use and relapse Reduce infections such as HIV and hepatitis C virus from injection drug use 95,000 To use buprenorphine in SUD treatment, U.S. physicians and other approved professionals must have DEA waivers, also known as DATA or X-waivers. These requirements lead to significant gaps in access to treatment increasing harm and deaths. Psychiatric pharmacists have specialized training in SUDs with deep understanding of MAT as well as the commonly co-occurring psychiatric illnesses. They are an underutilized member of the SUD health care team who can: Policy Recommendations to Improve Access to SUD Care by Psychiatric Pharmacists There is urgent need to increase the workforce to expand access to treatment for SUDs. Psychiatric pharmacists can increase access to SUD care but until billing and reimbursement are addressed, health care systems and providers who want to employ psychiatric pharmacists have little incentive to hire them. CPNP recommends policymakers: Advise providers and waivered prescribers on the selection of appropriate MAT treatments including buprenorphine and naltrexone. Assist with buprenorphine inductions and dosing adjustments and monitor patient response to reduce adverse events including diversion. Assist with medication management for co-morbid psychiatric and substance use disorders providing benefits such as: • Improved patient adherence and success • Improved safety and impact through appropriate medication dosing and monitoring • Optimized outcomes • Reduced workload for providers thereby increasing access and reducing costs Recognize addiction treatment as part of medical care for all patients. Remove reimbursement and policy barriers to SUDs treatment including those that limit access to forms of FDA-approved MAT, counseling, first-fail protocols, and frequent prior authorizations. Require CMS and other payers to pay for services provided by psychiatric pharmacists. Remove the X-waiver requirement and allow buprenorphine to be utilized like other Schedule III drugs. In the absence of the elimination of the X-waiver, add psychiatric pharmacists to the list of providers allowed to obtain waivers to prescribe opioid addiction treatments like buprenorphine.

References

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  2. Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2011-2015 Alcohol-Attributable Deaths Due to Excessive Alcohol Use, All Ages. Available at: https://nccd.cdc.gov/DPH_ARDI/Default/Default.aspx
  3. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Available at: https://www.samhsa.gov/data/
  4. Kleinman RA, Morris NP. Federal Barriers to Addressing the Opioid Epidemic. J Gen Intern Med. 2020;35(4):1304- 1306. DOI: 10.1007/s11606-020-05721-5. PubMed PMID: 32076988.
  5. SAMHSA. Practitioner and Program Data. https://www.samhsa.gov/medication-assisted-treatment/training-materials-resources/practitioner-program-data
  6. Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2019. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020. Available at: https://www.samhsa.gov/data/sites/default/files/reports/rpt29389/2019_NSSATS/2019-NSSATS-R.pdf 
  7. Andrilla CHA, Moore TE, Patterson DG, Larson EH. Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5-Year Update. J Rural Health. 2019;35(1):108-112. DOI: 10.1111/jrh.12307. PubMed PMID: 29923637.
  8. Jones CM, McCance-Katz EF. Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder. Addiction. 2019;114(3):471-482. DOI: 10.1111/add.14436. PubMed PMID: 30194876.
  9. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63. Publication No. PEP20-02-01-006. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020. Available at: https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document/PEP20-02-01-006
  10. AMFAR. National Opioid Epidemic: Facilities Providing Some Medication Assisted Treatment. https://opioid.amfar.org/indicator/SMAT_fac