A message from Dr. William Beecroft, medical director of behavioral health
Legislation removes barriers to using buprenorphine to treat people with opioid use disorder

The Omnibus Spending Bill, which passed in December, heralded a step forward in addressing the problem of opioid use disorder. It included the Mainstreaming Addiction Treatment Act, a historic bipartisan effort that will help prevent overdoses, increase access to treatment and reduce stigma.

The act removes many barriers in the prescription of medications used for medication-assisted treatment for opioid use disorder, specifically buprenorphine, which is the most commonly prescribed of the MAT medications. This medication, along with naltrexone and naloxone, is considered by many to be the principal tool in the treatment of OUD.

Of course, medications are only a part of the solution for treating people with OUD. Psychotherapy; contingency management, a therapy approach that aims to help a person decrease drug-related behaviors through positive motivation; family and social support systems; community resources and support programs such as Nar-Anon are important as well.

One main hallmarks of successful treatment is the patient’s continued engagement with the treatment program with no future use of the substance. OUD is a chronic illness, such as diabetes and heart disease, and needs to be addressed as such. Chronic case management can also be an effective tool in helping to ensure continued engagement, removing barriers to treatment and identifying nonadherence to treatment early so patients can get back on track more quickly.

Be sure to treat the patients in your practice with OUD — you do have them. Screen patients throughout your practice and monitor those who get opioid prescriptions from other doctors. Develop relationships with trusted colleagues or therapists who treat OUD so you can refer patients to them and work closely with them in the care of your patient.

Blue Cross Blue Shield of Michigan has various forms of MAT medications, including the long-acting injectable versions of buprenorphine and naltrexone, in its prescription drug formularies. These long-acting injectables can enhance adherence to treatment. Use of naltrexone blocks the mu receptor, the primary receptor in the brain where the opioids attach and exert their effect. As such, it decreases likelihood of death from overdose. With buprenorphine — a partial agonist of the mu receptor — overdose can still be an issue so close monitoring is advised when buprenorphine is used.

There are many protocols for addressing the needs of a person misusing opioids. MAT medications can help you initiate treatment immediately without the need for a patient to be admitted to a treatment facility for detoxification and therapy. This allows a patient to start medication and therapy as an outpatient while continuing to address the responsibilities of daily life, eliminating the excuse of not being able to take off time from work or other responsibilities. And initiating treatment as soon as the patient identifies the issue is the most effective way to be successful in stopping the disease from entering an acute phase.

For more information about the Mainstreaming Addiction Treatment Act — and what barriers have been removed by this legislation — see this document from the End Substance Use Disorder campaign website.*

William Beecroft, M.D., is medical director of behavioral health at Blue Cross Blue Shield of Michigan. He’s board-certified in general psychiatry and a Distinguished Life Fellow of the American Psychiatric Association.

*Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.