New reports suggest opportunities to increase utilization of medication-assisted treatment for opiate addiction in Allegheny County, Pennsylvania

Allegheny HealthChoices, Inc. (AHCI)¹ recently published two reports about the utilization of medication-assisted treatment (MAT) among people with opioid-related disorders who sought substance use disorder (SUD) treatment in Allegheny County, Pennsylvania during 2012 and 2013.

Purpose for the analysis

AHCI decided to investigate this issue due to the number of overdose deaths in January 2014 in Allegheny County (mostly in Pittsburgh) resulting from fentanyl-laced heroin labeled as “Theraflu” and other names. This highlighted the need for increased use of effective treatments, including medication-assisted treatment (MAT).

Evidence-based treatment for people who enter substance use disorder treatment with opioid-related disorders includes offering medications in addition to counseling. Scientific research has established that medication-assisted treatment of opioid addiction increases patient retention in treatment and decreases drug use, infectious disease transmission, and criminal activity.

These reports were designed to help system stakeholders understand the use of different MAT approaches and establish a baseline for a discussion about how to improve treatment services.

Information used for the analysis

AHCI looked at SUD treatment services that were paid for using County Base funds and HealthChoices or Pennsylvania Medicaid funds — both behavioral health services and physical health pharmacy services funds. Those who received MAT were defined as people who received methadone maintenance treatment or HealthChoices members who filled a prescription for one of the medications used to treat opioid addiction within 60 days of a SUD counseling service; medications included buprenorphine (i.e. Suboxone) or naltrexone (oral or injectable, i.e. Vivitrol).

Only new treatment episodes were considered because that was the most accurate way to assess how people access and utilize MAT, rather than including those who may have successfully remained on an MAT regimen since the prior year.

Results and discussion

In both 2012 and 2013, AHCI found that less than half (40%) of people with an opiate-related disorder who entered SUD treatment also accessed a medication that could assist their recovery process.

Access to MAT 2013About half of the people who received MAT received methadone maintenance therapy. The other half received either buprenorphine or naltrexone; after methadone, the buprenorphine and naloxone formula (either Suboxone film or its generic equivalent) was the most common treatment medication received. Between 2012, and 2013, however, there was an increase in the use of Vivitrol, the long-acting injectable form of naltrexone.
TypeMATAccessed 12v13

Of course, it is difficult to say whether this is exceptionally low, high or average because comparative rates are not easy to find with this and other SUD treatment system performance measures. What we do know is that every person with an opiate addiction who presents to treatment should receive education about various MAT options and what might work best.

This is difficult to assess from claims analysis alone. For example, SUD treatment providers may be offering medication options as part of a treatment plan; however, it was not possible to determine who was offered MAT, how it was offered, whether the person was provided assistance in locating a physician or prescriber, or the number of people who were offered but refused MAT. It’s also possible that people are accessing medications paid for by a source other than HealthChoices during their SUD treatment experience and this information was not available.

Therefore, a discussion with providers was essential.

Providers on interest, readiness, and other issues associated with MAT

In August 2014, AHCI led a discussion about the findings of this report with SUD treatment providers. Providers seemed to be at various stages of readiness to offer MAT and expressed an interest in learning more about Suboxone and other MAT treatment approaches. Some had been prescribing onsite for years and were interested in how to manage clinical issues associated with ongoing maintenance. Other providers did not yet offer MAT and expressed interest in receiving consultation about startup considerations.

One example shared by a provider representative focused on medical necessity for SUD treatment. Assessment for placement in SUD treatment requires meeting criteria on the Pennsylvania Client Placement Criteria (PCPC). This multidimensional assessment provides clinicians with a basis for determining the most appropriate care for people with drug and alcohol problems. This provider worked with a client who had achieved some success and stabilization of SUD symptoms with Suboxone yet began to describe experiences that suggested a primary mental health treatment need. The client no longer met criteria for placement in a level of SUD treatment and required a transfer to primary mental health treatment. The provider representative was interested to learn more about helping this person continue to manage his recovery with Suboxone and mental health treatment at a different clinic location.

Following a discussion with the County and Community Care Behavioral Health Organization (a behavioral health managed care organization), the next step will be to develop a survey to assess readiness to implement MAT and interests in training and technical assistance topics among the provider network.

This is an exciting opportunity to partner with providers and improve access to effective treatments for those struggling with an opiate addiction in Allegheny County.

Eric Hulsey, DrPH, is the Services Innovations Specialist with Allegheny HealthChoices, Inc. He can be reached at 412.325.1100 and ehulsey@ahci.org.

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1. Allegheny HealthChoices, Inc. (AHCI) is an innovative non-profit agency whose mission is to assure equitable access to quality, cost-effective behavioral health care that promotes positive clinical outcomes, recovery, and resiliency.  Learn more at www.ahci.org

Additional resources

Two comprehensive lists of resources: