Region X Health Centers and Medication Assisted Treatment (MAT)
Friday, November 16, 2018
Posted by: Thomas Johnson
Posted by: Thomas Johnson
In the September issue of Northwest Pulse, I devoted this column to exploring how health centers have collectively responded to the opioid overdose crisis. In this article I'm going to focus on a substance use treatment option that many health centers have brought to their to their patients: Medication Assisted Treatment (MAT).
MAT refers to the practice of treating substance use disorder with a combination of counseling, behavioral health therapies, and medication that helps patients manage the withdrawal symptoms and prevent opioid overdose. Medications that fall within this category include Buprenorphine (and naloxone, which helps reverse the effects of overdose), Methadone, and Naltrexone. When combined with a treatment plan that includes counseling or behavioral help therapies, MAT.
Many patients struggling with opioid addiction prefer Buprenorphine because it can be prescribed by a qualified physician and self-administered in an outpatient setting (as opposed to Methadone, which must be performed in structured, clinical environment). Not all physicians are able to write prescriptions, however. Providers must receive a federally granted waiver that requires completion of an eight-hour course and limits the number patients that may be treated. In 2016, the federal government increased the number of prescriptions providers could write to 275 to help combat the opioid overdose crisis, but many patients still struggle to get prescriptions.
Starting in 2016, HRSA began asking health centers on their UDS report to record how many providers at their clinic are certified to prescribe Buprenorphine and how many patients those providers issued prescriptions to within the reporting period. The resulting data reveals that most health centers are expanding their services in this direction, encouraging more staff to complete the federally mandated training and increasing the patient volume at their MAT programs.
Last year most health centers in our region reported having MAT certified providers on staff. This rate is not evenly spread across the region. About threequarters of the health centers in Washington and Oregon, half of the health centers in Idaho, and only one-quarter of the health centers in Alaska employed MAT providers in 2017.
MAT refers to the practice of treating substance use disorder with a combination of counseling, behavioral health therapies, and medication that helps patients manage the withdrawal symptoms and prevent opioid overdose. Medications that fall within this category include Buprenorphine (and naloxone, which helps reverse the effects of overdose), Methadone, and Naltrexone. When combined with a treatment plan that includes counseling or behavioral help therapies, MAT.
Many patients struggling with opioid addiction prefer Buprenorphine because it can be prescribed by a qualified physician and self-administered in an outpatient setting (as opposed to Methadone, which must be performed in structured, clinical environment). Not all physicians are able to write prescriptions, however. Providers must receive a federally granted waiver that requires completion of an eight-hour course and limits the number patients that may be treated. In 2016, the federal government increased the number of prescriptions providers could write to 275 to help combat the opioid overdose crisis, but many patients still struggle to get prescriptions.
Starting in 2016, HRSA began asking health centers on their UDS report to record how many providers at their clinic are certified to prescribe Buprenorphine and how many patients those providers issued prescriptions to within the reporting period. The resulting data reveals that most health centers are expanding their services in this direction, encouraging more staff to complete the federally mandated training and increasing the patient volume at their MAT programs.
Last year most health centers in our region reported having MAT certified providers on staff. This rate is not evenly spread across the region. About threequarters of the health centers in Washington and Oregon, half of the health centers in Idaho, and only one-quarter of the health centers in Alaska employed MAT providers in 2017.
Despite the uneven spread, growth in MAT patient volume is considerable, with providers seeing 88% more of these patients in 2017 than in 2016. Alaska health centers experienced the biggest relative growth to their programs, with patient volume increasing by 175%, but Oregon and Washington health centers saw the largest increase in number of patients served. Collectively, the health centers in both states saw over 1,000 more patients in 2017, doubling their patient volume of their programs. The only state where health centers did not see more MAT patients was Idaho, where patient volume actually declined by 2%.
So far these numbers reflect state and regional totals. What does this growth look like at the health center to health center level? Of the 54 health centers with MAT programs, 83% experienced growth in those programs in 2017, on average seeing 30 more patients than in 2016. The growth for some health centers, however, greatly exceeded that number. One center, for example, increased their program from 67 patients in 2016 to 387 patients in 2017, making it the third biggest in the region. That's a huge increase given that the average size throughout the region is 69 patients (up from 36 in 2016).
A few health centers did not expand their program, with seven providing MAT to fewer patients in 2017 than 2016.
A few health centers did not expand their program, with seven providing MAT to fewer patients in 2017 than 2016.
Geographically speaking, an estimated two-thirds of the population in Region X live within the service area of a health center that employs MAT certified providers. Collectively these service areas account for only 13% of the entire land area in the region, suggesting that MAT providers are mostly situated in urban health centers. If this is true, it's especially unfortunate as drug overdose deaths are higher in rural areas than urban ones. This is an important topic, and we'll provide more information (including maps!) in a future article.
It's clear from the data that many health centers in Region X are seeking to include MAT as an available treatment option. NWRPCA is committed to helping health centers expand their substance use programs to address the ongoing opioid overdose crisis via MAT or other practices.
