Making Addiction Treatment Accessible to All

Although substantial gains are being made to increase access to treatment for adults struggling with opioid addiction, access to youth remains a significant challenge. Physicians face barriers to providing care and cannot prescribe medications such as buprenorphine without special waivers from the United States Drug Enforcement Administration (DEA). Boston Medical Center is aiming to be the first hospital in the state to offer specialized training for its physicians who care for adolescents with opioid use disorders, making them eligible to prescribe treatment.

A recently released study unveiled that only eight percent of Massachusetts adolescents who experienced a nonfatal overdose from 2012 to 2014 were prescribed a treatment drug like methadone, buprenorphine or naltrexone.

“Timely treatment is important to improving outcomes for these teens,” says Sarah Bagley, MD, director of BMC’s CATALYST Clinic and a senior author of the study. “Evidence suggests that treatment improves abstinence, reduces the risk of overdose and help youths to make substantial gains by breaking free from the destructive cycle of addiction.”

Methadone clinics have been a traditional resource for patients seeking treatment for opioid use disorder, but successful treatment requires daily transportation to and from the clinic and a significant amount of time out of patients’ daily lives. For some patients, this structure is critical to their recovery, however federal regulations make methadone extremely difficult to access for patients younger than 18 years old. On the other hand, buprenorphine treatment can be administered through prescription and taken at home with close follow up. The medication is approved for people 16 years and older, making it a much more accessible option for young patients. As straightforward as it is to prescribe opioid drugs for pain, federal law prohibits physicians to prescribe medications that specifically treat addiction without additional training.

Bagley and Scott Hadland, MD, MPH, MS, are leading the initiative to waiver-train BMC pediatricians including emergency department pediatricians, hospitalists, infectious disease specialists and adolescent medicine doctors. After completion of the training, providers will be able to apply to the DEA for a special waiver permitting them to prescribe buprenorphine. The eight-hour training is taken through the Substance Abuse and Mental Health Services Administration and will be tailored to address the unique needs of adolescents and their families. Physician assistants and nurse practitioners seeking waivers will undergo an additional 16 hours of training.

“Waiver training allows physicians to treat addiction as a disease and provide a treatment protocol like any other illness instead of disrupting their patient’s course of care,” concludes Bagley. “Having our pediatricians waiver trained is one more step to ensure that our young patients can receive this important medical intervention if they need it.”