New Guidelines for Treatment of the Nation’s Opiate Problem
The new guidelines by the Substance Abuse and Mental Health Services Administration (SAMHSA) are meant to help patients and practitioners better understand the protocols and standards surrounding treatment, but also to clarify what are requirements versus suggested best practices.
As opiate overdoses and abuse have skyrocketed, the labor force to treat people with addictions and other mental health disorders has been static, jeopardizing health care, experts say.
Worse yet, the country’s ballooning number of aging baby boomers face an acute lack of providers trained in substance abuse treatment or geriatrics.
Assessing the Future of Mental Health and Substance Abuse Treatment
So says Dan G. Blazer, MD, PhD, and head of a federal commission weighing the adequacy of workforce to handle health care and mental health treatment. According to Dr. Blazer, any effort such as SAMHSA’s to remedy the deficit should be praised.
“The role of health care professionals, other than physicians, will play in increasing role in the care of substance use disorders in the future,” said Blazer, author of several research studies on the topic.
But Blazer stressed the importance that “these professionals be trained well for this role. Substance use treatment is not always a priority in the general training of persons in these professions.”
Addiction treatment specialists are increasingly calling for more attention on substance abuse screening by general practitioners. George Koob, PhD, a neurobiologist and head of the National Institute of Alcohol Abuse and Alcoholism, noted that only about 10 percent of people with moderate to severe alcohol problems ever get any treatment. That’s partly due to doctors failing to detect signs of substance abuse.
“A big problem is physicians aren’t getting training in addiction in medical school,” Dr. Koob said in an interview. “My argument is this: You go into any emergency room on a Friday or Saturday night and you'll find that at least half the people waiting to be seen are there for addiction-related injuries or problems — a motorcyclist who ran into a utility pole and others from (impaired) driving accidents. You save enormous amounts of money if we treated addiction first.”
New Guidelines Help Clarify Treatment
“Although these documents aren’t mandatory, they’re still an important part of the entire process,” says Tamara N. Ward, a spokesperson for SAMHSA. “The use of a set of guidelines can really impact the entire system in a positive fashion.”
The health care industry continues to be understaffed overall, particularly as the population of Americans over age 65 balloons. Experts in the field of geriatrics and addiction treatment say substance abuse among older people occurs more frequently than the general public and primary care doctors know.
“In the case of the guidelines,” Ward says, “it’s inappropriate to say that they can be violated because guidelines mainly serve as a guide,” not a set of rules.
Federal Guidelines for Opioid Treatment Programs
Here are some highlights on the guidelines as well as what’s different:
- Overall, the Federal Guidelines for opioid treatment programs (OTPs) describe how programs can operate in compliance with federal regulations.
- Advanced practice nurses (APNs) and physician’s assistants (PAs) “play an important role in opioid treatment programs,” according to the new guideline summary. “Their role may include conducting the initial history and physical, making the diagnosis of opioid use disorder and determining whether the patient meets criteria for admission. APNs and PAs can also assess the patient’s response to medication and progress in treatment.”
- The federal regulations specify that a program physician must make all dosing and administration decisions, which hadn’t been clear enough in the earlier guidelines.
- It’s important to note that some states may impose limits on the role of APNs and PAs, either by a state’s specific opiate treatment regulations or by scope of practice, which is decided by each state’s licensing board.
“SAMHSA recognizes the high demand for treatment and the need to make maximum use of the available, appropriately trained, workforce including APNs and PAs,” said Ward. “SAMHSA will collaborate with individual states to work within the existing federal regulations to assure that OTP services are accessible and of high quality.”