Medications for Treating Opioid-Use Disorder Remain Difficult to Access: ' ... In the midst of the current opioid epidemic, many specialists believe the benefits of expanding lifesaving treatments, like methadone and buprenor-phine, outweigh the diversion risks of these medications and suggest that they be deregulated.'.

• Author: Ren, Jiacheng

A BUNDANT and compelling evidence has shown medication-assisted treatment effectively can decrease opioid use, opioid-related overdose deaths, and the risks of infectious disease transmission and criminal activity associated with drug use. Compared to patients receiving addiction treatment without medication, those who receive medication-assisted treatment are at least twice as likely to remain in treatment, maintain social functioning, and achieve long-term recovery. Nevertheless, effective medication-assisted treatment, especially methadone and buprenorphine--two standard treatments for opioid-use disorder--are underutilized in the U.S., causing a disconnect between the people who need help and the help that is available.

There is a shortage of certified buprenorphine prescribers and federally approved opioid treatment programs providing methadone. For instance, research found that, in 2012, nearly all states did not have sufficient treatment capacity to provide Food and Drug Administration-approved medications to most opioid-use disorder patients and only 60% of the patients could get methadone or buprenorphine treatments, even if the potential capacity was maximized. Specifically, if all waivered physicians prescribed to their capacity, the maximum number of patients who could be treated with buprenorphine was less than half of all individuals with opioid-use disorder.

It is even worse for methadone, for which less than one-seventh of patients with opioiduse disorder received the medication. As a response, the Federal government has devoted a great deal of resources to support the expansion of access to methadone and buprenorphine. By 2017, there were 1271 opioid treatment programs providing methadone and 56,000 licensed buprenorphine prescribers, according to the Sunstance Abuse and Mental Health Services Administration.

However, the shortage remains, and there are large geographic disparities. As of June 2019,39% of all U.S. counties had no licensed buprenorphine prescribers and nearly 80% had no opioid treatment programs, which often are referred to as methadone clinics. Among counties providing none of the opioid agonist treatments (38% of counties nationally), about half of them are classified as mral and primarily located in the Midwest and South.

New York fares better than the national averages. It has the second largest number of substance-use treatment facilities. Yet, even in New York six of the 62 counties do not have any licensed buprenorphine prescribers and 36 do not have methadone clinics. More than half of the state's 148 methadone...