More than 350 Nevada Medicaid providers have been encouraged by the state to offer medication-assisted treatment for opioid addiction but only a fraction are.
Nevada is taking steps to increase that number as part of the state’s ongoing efforts to combat what health care professionals prefer to call “opioid use disorder” because it comes with less stigma.
Administrators from the Department of Health and Human Services told lawmakers on an interim legislative committee last week that a recent survey of 343 Nevada Medicaid providers found that only 23% are currently prescribing medication-assisted treatment. This is despite the state granting those providers the ability to prescribe buprenorphine, one of the three common medications approved by the US Food and Drug Administration for treating opioid use disorder. (Methadone and naltrexone are the other two FDA approved medications.)
The survey also found that nearly three-fourths (73%) of 80 providers who are prescribing medication-assisted treatment aren’t prescribing to the capacity they are allowed by the state.
Even with only a fraction of providers embracing medication-assisted treatment, the effort is “having a significant impact on the state,” DHHS Deputy Administrator Antonina Capurro told the lawmakers. The number of people undergoing medication-assisted treatment has slowly risen since formal policies and procedures were implemented by the state in the summer of 2020.
According to a state presentation, in June 2020, 5,125 Medicaid recipients were receiving medication-assisted treatment. By December of that year, 5,690 were.
So why not more?
Two-thirds of survey respondents identified a lack of organizations that providers can refer patients to for related drug and behavioral therapies, which should be done in conjunction with the prescribed medication. Other barriers identified included the lack of Medicaid reimbursement for offering medication-assisted treatment, lack of supportive services like mental health treatment for patients, and a lack of buy-in from the providers, sometimes over concerns that embracing medication-assisted treatment will change their clientele or the perception of their practice.
A majority of providers said they would be supportive of medication-assisted treatment if barriers, particularly the reimbursement component, were addressed.
Nevada Medicaid covers 39% of opioid-use dependent adults, according to the state, making the public program the largest single insurer of addiction treatment within the state.
Nevada is one of 11 states where opioid treatment programs accept Medicaid, according to a recent analysis by the Pew Charitable Trusts.
There were more than 90,000 drug overdose deaths nationwide in 2020, according to the Centers for Disease Control and Prevention. Preliminary data from 2021 suggests an even higher number of people died last year.
Nevada recorded a 55% spike in overdose deaths in 2020. According to the State Unintentional Drug Overdose Reporting System, 788 people died from accidental drug overdose in 2020 compared to 510 in 2019.
The Substance Abuse and Mental Health Services Administration estimates Nevada’s rate of substance use disorder to be 9.5% — higher than the regional rate of 8.1% or the national rate of 7.4%.
Stephanie Woodard, the senior advisor on behavioral health at Nevada DHHS, told lawmakers they may want to shore up policies regarding medication-assisted treatment for people incarcerated within the state’s prisons and jails.
State administrators emphasized that managing withdrawals at correctional facilities does not constitute “a complete episode of care” and that inmates have an increased rate of overdose and death by overdose after incarceration.
Of Nevada’s 14 opioid treatment programs within Clark, Washoe and Carson City, only one is within a correctional facility — Washoe County Detention Center.
Assembly Minority Leader Robin Titus, a rural doctor, said she wanted to see additional data on how many incarcerated people within the state are receiving treatment for addiction and related issues like mental health: “Are all of them who’ve been identified as having substance abuse being offered treatment?”
Woodard said she didn’t know have data on hand but the short answer: No.
She continued on to say that lawmakers might want to reconsider policies regarding prison health care and treatment options.
“Is something like (medication-assisted treatment) an essential service that everyone has a right to have access to while incarcerated?” she asked rhetorically. “There’s been different interpretations.”