WASHINGTON -- For the first time, the federal agency responsible for most public funding of drug addiction treatment has added language to its grant applications designed to push the treatment industry away from the abstinence model.
Treatment for substance abuse disorders in the United States widely follows this model, which rests on the belief that abstaining from all drugs, including medications prescribed specifically for addiction, is the only acceptable route to recovery.
The new grant language from the Substance Abuse and Mental Health Services Administration encourages states to reject the status quo and to require the option of medication-assisted treatment in clinical settings.
The new language appears in SAMHSA's block grant application for fiscal years 2016-2017. The money available through these block grants is substantial; in fiscal year 2015, the agency had $1.8 billion to award. So while some treatment providers vehemently disagree with the federal recommendation, the suggestion will carry weight.
Among the medical establishment, medication-assisted treatment -- such as providing methadone or buprenorphine (which goes by the brand name Suboxone) -- is widely viewed as the standard of care for treating heroin and other opioid addicts. But the vast majority of rehabilitation facilities in the U.S. do not offer such care.
The block grant application now states:
There is a voluminous literature on the efficacy of [Food and Drug Administration]-approved medications for the treatment of substance use disorders. However, many treatment programs in the U.S. offer only abstinence-based treatment for these conditions. SAMHSA strongly encourages the states to require that treatment facilities providing clinical care to those with substance use disorders be required to either have the capacity and staff expertise to use MAT or have collaborative relationships with other providers such that these MATs can be accessed as clinically indicated for patient need. Individuals with substance use disorders who have a disorder for which there is an FDA-approved medication treatment should have access to those treatments based upon each individual patient's needs.
As the opioid epidemic has spiked -- the Centers for Disease Control and Prevention recently reported that heroin-related overdose deaths almost quadrupled between 2002 and 2013 -- the inadequacy of the U.S. treatment system has become all the more apparent. In January, The Huffington Post published an investigation that looked at the abstinence model's failure and how it led to more overdose deaths.
Shortly thereafter, federal drug czar Michael Botticelli said that the U.S. government would make drug court funding conditional on states being guided by the science on treatment, rather than ideology. He added that SAMHSA would be taking a similar approach, but needed to work through the details first.
"As the Huffington Post article pointed out, we have highly effective medications, when combined with other behavioral supports, that are the standard of care for the treatment of opiate addiction. And for a long time and what continues to this day is a lack of -- a tremendous amount of misunderstanding about these drugs and particularly within our criminal justice system," Botticelli said in February.
Anne Herron, director of the Division of Regional and National Policy for SAMHSA, recently told HuffPost that state policymakers offered positive feedback when a draft of the new grant language was introduced. But she added it’s still up to the states to spend the federal block grants how they see fit -- and that may not include funding for treatments like methadone or increasing access to Suboxone.
"We do encourage that they make available the full continuum," Herron said.
For some of its discretionary grants, Herron added, SAMHSA has started to include slightly different language that would actually tie federal funding to providing medication-assisted treatment access. "It's important to us to acknowledge that there are a variety of treatment options that provide great outcomes," she said.
Dr. Andrew Kolodny, the chief medical director for Phoenix House, a nonprofit rehab organization, is encouraged by the shift in federal policy.
"I don't think an addiction treatment program should be state-licensed if it's unable or unwilling to make buprenorphine available to opioid-addicted patients that need it," Kolodny said. "This move by SAMHSA helps move us in that direction."