Make these two policy changes to improve access to treatment

September 29, 2022

Addressing the opioid overdose epidemic requires removing federal, state and local policies that block access to evidence-based interventions and implementing policies that will promote their use.

One challenge, though, is that policymakers may have difficulty in knowing which policy changes to prioritize. A group of researchers, led by Dr. Rosanna Smart from the RAND Corporation, just published a study to help with this very issue. The researchers first identified fourteen state-level policies that could affect engagement and retention in treatment for people with an opioid use disorder.

The researchers then worked with a group of over 60 experts (clinicians, social service providers, researchers, policymakers, advocates and persons with lived experience) to determine which policies were the most effective and implementable. After this initial vetting, the experts also assessed which policies would contribute to equity.

There was substantial agreement among the experts on the effectiveness and implementability of the various policies discussed. Two policies, in particular stood out as being highly implementable, effective and equitable:

• Facilitated access to medication for opioid use disorder requirements

Facilitated access to medication for opioid use disorder requirements mandate that all substance use disorder treatment programs in the state facilitate access to medication for opioid use disorder by: 1) directly providing the medication, 2) contracting with private prescribing professionals or 2) linkage agreements with other office-certified programs.

• Medicaid enrollment for individuals leaving jail or prison

Medicaid enrollment for individuals leaving jail or prison requires that correctional personnel initiate Medicaid applications or assist with Medicaid application information to individuals nearing release from incarceration, or that Medicaid managed care entities collaborate with correctional personnel to coordinate the discharge and transition of enrollees following release from a correctional facility.

Additionally, the panelists discussed policies that could have detrimental effects. In particular, coercive treatment policies were seen as ineffective, resource-intensive and potentially increasing inequities. Policies requiring counseling for people being treated with buprenorphine and drug toxicology testing were also seen as potentially counterproductive.

State policymakers should assess how their jurisdiction fares with these policies and make changes as needed. As outlined in Principle 2 on Using Evidence to Guide Spending, this will help more people start and remain in treatment and save lives.