Recovering from opioid addiction isn’t easy. The pull of the drug is strong. Asking for help to kick an addiction can be difficult for many people, in part because of the stigma associated with addiction.
One of the most effective means of beating an opioid addiction is to use a prescription medication, buprenorphine, which binds to the same receptor as opioids and reduces the craving for them.
But finding a clinician who prescribes buprenorphine can be a challenge. Some people ask their primary care physician for a reference. Others ask friends or acquaintances who they’d recommend. Many others, though, consult the Buprenorphine Practitioner Locator, a database curated by the federal government’s Substance Abuse and Mental Health Services Administration that lists clinicians who can prescribe buprenorphine.
But does the government ensure that the database is accurate? Does the database serve as a good starting point for someone looking to get evidence based treatment for their addiction?
Given what we had heard from patients over the years, we had our suspicions about the shortcomings of the database. So, along with several colleagues, we examined it.
We did this by identifying providers in the SAMHSA database within a 25-mile radius of the county with the highest death rate from drug overdose in each of the 10 states with the highest number of overdose deaths in 2015: West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, Massachusetts, New Mexico, Utah, and Tennessee.
This search turned up 505 providers. We then called each of them to determine whether they actually worked in the practice, had appointments available, and accepted insurance.
The number of providers listed in each county ranged from one to 166; five counties had fewer than 10 providers listed. Obtaining appointments was generally difficult and at times impossible: In three counties we were not able to secure an appointment at all, and in another three counties we were able to secure appointments with only two or three providers.
Of the 505 providers we called, we reached 355 providers on the first or second call, and were unable to reach 150 of them (30%). More than one-quarter of the numbers listed were incorrect. In addition, 26% of providers listed were no longer prescribing buprenorphine. Among those who were, 76% accepted private insurance and 63% accepted Medicaid. As we just reported in the Journal of Psychiatric Practice, we were able to secure an appointment for initiation of buprenorphine treatment just 28% of the time.
Opioid addiction is a scourge of our time. No segment of the U.S. is spared — rural regions are especially hard hit — and the number of overdose deaths is staggering. The kind of medication-assisted treatment that we were inquiring about greatly increases the odds of successful recovery from opioid addiction. For example, when people receive buprenorphine for treatment of opioid dependence, they are more likely to stay in treatment and are half as likely to die from a fatal drug overdose.
If buprenorphine treatment is so vital, why isn’t a database that is supposed to provide a pathway to accessing treatment for opioid addiction kept up to date? And why do so few of the clinicians listed in it actually offer appointments?
Sadly, this problem isn’t limited to buprenorphine treatment. Insurers’ lists of in-network psychiatrists are so replete with practices that aren’t accepting new patients, wrong numbers, and individuals who don’t return phone calls that they are often referred to as ghost networks.
SAMHSA needs to make its database of buprenorphine providers an accurate and helpful resource for individuals seeking help with opioid addiction and ensure that it correctly lists clinicians who are accepting patients for buprenorphine treatment.
The government also needs to remove federal policies limiting who can prescribe buprenorphine so all doctors can treat opioid addiction, not just those who engage in specialized training for buprenorphine prescribing. There must also be sufficient training in medical school and residency so doctors feel sufficiently prepared to treat opioid addiction.
Lives hang in the balance.
Lila Flavin, M.D., is a psychiatry resident at NYU Langone. J. Wesley Boyd, M.D., is a staff psychiatrist at Cambridge Health Alliance and the founder and co-director of its Human Rights and Asylum Clinic, as well as an associate professor of psychiatry and faculty member in the Bioethics Center at Harvard Medical School.