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In traditional treatment programs for addiction, the majority of patients are not offered ongoing medical treatment. The minority who do receive medical care typically face intensive psychosocial service requirements that make access to medical treatment both burdensome and costly. Others face arbitrary limitations on medical treatment that are associated with increased risk for morbidity and mortality.
Medication First programs get persons with opioid use disorder maintenance medical treatment as quickly as possible and provide voluntary supportive services as needed. A patient’s access to medical treatment is not dependent upon psychosocial treatment compliance or unrealistic expectations about the course of treatment and recovery. The Medication First approach is supported by decades of research. It prioritizes client choice in both service selection and service participation. There is a strong consensus in the scientific community that expanding the Medication First or “low-threshold” medical approach to opioid use disorder will be essential to reversing the epidemic of opioid-related deaths.
Ned Presnall, LCSW is executive director of Clayton Behavioral treatment programs in St. Louis, an adjunct professor and senior data analyst at Washington University in St. Louis, and a consultant for Missouri’s State Targeted Response to the Opioid Crisis. He divides his time between clinical work, education, and research.