Ending Medical Complicity with Skilled-Nursing Facility Discrimination Against People with Opioid Use Disorder
By Cohen SM et al, Annals of Internal Medicine, 7 February 2023, IN PRESS
https://www.stopstigmanow.org/wp-content/uploads/2023/03/art-Cohen-SNF-discrim-Annals-3-2023.pdf Skilled Nursing Facilities (aka ‘nursing rehab facilities’ or ‘nursing homes’) still commonly refuse to admit patients with opioid use disorder (OUD), often specifically because they are treated with medications for OUD. This type of discrimination remains widespread despite of the fact that it violates federal law according to the U.S. Justice Department, and individual nursing facilities have paid penalties of up to $60,000. The article provides detailed steps that patients, families and the public can take.
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PEW: State Opioid Treatment Program Regulations Put Evidence-Based Care Out of Reach for Many
October 31, 2022
EXCERPT:
Opioid treatment programs (OTPs) are the only health care facilities that can offer patients all three forms of medication for opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone. No other setting is permitted to provide methadone. These facilities are critical to reducing overdose deaths and providing lifesaving addiction treatment. But too often, access to high quality OTP care is curtailed by federal and state rules that are not based in evidence . . .
State policymakers have the opportunity to act now to improve access to this medication and the quality of OTP services . . . Pew reviewed OTP regulations across all 50 states:
DATA VISUALIZATION TOOL (Select a state or regulation):
20 STATES
Require a new OTP to seek state approval based on demonstrating a need for services before opening
7 STATES
Place restrictive zoning rules on OTPs that don’t apply to other health care facilities
10 STATES
Don’t allow clients to take medication home in the first 30 days of treatment
48 STATES
Allow OTPs to terminate patients for not being abstinent from opioids or other substances
23 STATES
Specify a counseling schedule — rather than providing
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Opinion: We have a way to end the opioid epidemic, but not the will. By Beth Macy. September 28, 2022
https://www.washingtonpost.com/opinions/2022/09/28/opioid-crisis-solution/
EXCERPT:
“Even though ending the crisis sometimes seems like a hopeless cause, the solution is strikingly simple: Make treatment easier to obtain than the dope itself. . . In other words, offer free treatment on demand for people who can’t afford it. Congress did that for those with HIV/AIDS in 1990 . . . Methadone and buprenorphine are the antiretrovirals of the overdose crisis. They curb cravings and stave off withdrawal, making individuals 82 percent less likely to die than those not on the medications. . . But these medicines are scandalously difficult to obtain; only 5 percent of people with opioid use disorder managed to get them in 2020.”
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The Indiana State Board of Nursing is now required to allow nurses to remain on medication to treat opioid use disorder (OUD) while enrolled in the Indiana Professional Recovery Program. Sep 2, 2022
https://www.heraldbulletin.com/news/nurse-denied-treatment-for-opioid-disorder-leads-state-to-revise-policy/article_fc80d18c-2af6-11ed-a092-0faaa8b60b74.html
(Nurses are often required to enroll in the program in order to maintain their license or have one reinstated). The reform occurred when the Department of Justice intervened after a nurse, who described her treatment with buprenorphine as “lifesaving,” had been told that continuing buprenorphine was not permitted in the recovery program.
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Press Release
Department of Justice Finds PA Court System Violated Federal Law By Banning Medication for Opioid Use Disorder. February 3, 2022
- Philadelphia, PA – The U.S. Department of Justice (DOJ) has found that Pennsylvania’s state courts violated the Americans with Disabilities Act when its courts prohibited or limited access to medications for opioid use disorder – specifically methadone, buprenorphine, and naltrexone.
- The DOJ’s investigation was initiated after a complainant represented by the Legal Action Center (Complainant A) was forced to taper off of buprenorphine under the Jefferson County Court of Common Pleas policy prohibiting “any opiate based treatment medication
- Complainant A shares, “I feel vindicated. . . When I first heard this news, I got choked up because I would have been dead. Suboxone saved my life – there’s no doubt in my mind. There are so many people that need the same help and would benefit from medication for opioid use disorder. We don’t need to bury anyone else.”
- “With a record 100,000 overdose deaths in the last year, it is crucial that courts facilitate, rather than hinder, access to life-saving medications for people with opioid use disorder.
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OPINION: Experts Say We Have the Tools to Fight Addiction. So Why Are More Americans Overdosing Than Ever?
By Jeneen Interlandi, member of the editorial board, June 24, 2022
More people are dying of drug overdoses in the United States today than at any point in modern history. The number of yearly overdose fatalities surpassed 100,000 for the first time ever in 2021. Halfway through 2022, the rate appears to be rising even further (the latest numbers come out to about 300 people per day, or 12 people every hour, on average).
Our failure to treat it as consistently or as rigorously is not an accident. It is a choice.
Most people continued to addiction it as a failure of morals or of willpower, a problem to be worked out with one’s priest or probation officer.
In June of 2012, the National Center on Addiction and Substance Abuse at Columbia University published a damning critique of the addiction treatment system. It was actually a “nonsystem,” the authors wrote … primitive and dysfunctional… It was clear that anti-addiction medications could nudge people into long-term sobriety, especially when combined with talk therapy. But . . . a large majority of people who suffered from substance use disorders were still not receiving any care at all. For those who were, that care was haphazard at best, more likely to be ordered by a judge than by a doctor or therapist, not bound to any standards of quality or professionalism and rarely based on evidence about what worked and what didn’t.
A decade later, critics say that very little has changed. “We’ve known for a long time what works, but it looks nothing like what’s actually happening.”
[Stephanie Marquesano founded a prevention program — Co-Occurring Disorders Awareness, or CODA — to promote evidence based treatment that integrates mental health and substance use treatment and prevention].
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New Resource on Medication Discrimination in Recovery Housing:
Feb 2022.
www.lac.org/assets/files/Recovery-Home-MOUD-Info-Sheet-Feb-2022.pdf
The Legal Action Center has posted a new resource explaining that people with opioid use disorder (OUD) are often denied admission to recovery residences because they take methadone or buprenorphine, and that anti-discrimination laws – including the Americans with Disabilities Act (ADA), the Rehabilitation Act of 1973, and the Fair Housing Act (FHA) – make it illegal to deny someone access to a recovery residence because they take MOUD.
Signs of discrimination include:
• Residence has a policy not to admit people taking methadone or buprenorphine
• Residence limits the number of people in the facility who can take MOUD, e.g. having designated
“MAT beds”
• Residence requires people to taper their dose of methadone or buprenorphine
• Residence only admits people who take under a certain dose of methadone or buprenorphine
• Residence otherwise restricts access to methadone or buprenorphine
Press Release:
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Press Release
Department of Justice, U.S. Attorney’s Office, District of Massachusetts
Friday, December 17, 2021
BOSTON – The U.S. Attorney’s Office for the District of Massachusetts has reached an agreement with the Massachusetts Parole Board to resolve allegations that the Parole Board violated the Americans with Disabilities Act (ADA) by discriminating against individuals with Substance Use Disorder (SUD).
The agreement resolves complaints that the Parole Board discriminated against parolees and prospective parolees with SUD taking Medication for Opioid Use Disorder (MOUD). MOUDs include buprenorphine (Suboxone), methadone and naltrexone (Vivitrol). According to the complaints, the Parole Board required certain parolees with SUD to take a specific form of MOUD as a condition of parole instead of requiring them to comply with their health care provider’s recommended treatment. In addition, the Parole Board had a prior practice of requiring certain prospective parolees with SUD to take prescription Vivitrol without conducting individualized assessments to ascertain the efficacy or appropriateness of Vivitrol for that person and without considering whether other forms of MOUD might be more appropriate or effective.
A new issue brief from The Pew Charitable Trusts offers the following recommendations for federal and state policymakers so they can reduce these barriers.
July 16, 2021
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The most effective treatments for opioid use disorder (OUD) are the three FDA-approved prescription medications: methadone, buprenorphine, and naltrexone, that are proven to increase a patient’s treatment retention, reduce illicit use and, [in the case of methadone and buprenorphine,] reduce the risk of overdose. The only facilities legally able to offer all three medications are opioid treatment programs (OTPs), a critical component of the U.S. substance use treatment system . . .
[However,] federal, state, and local jurisdictions restrict the availability and accessibility of medications for opioid use disorder (MOUD) at OTPs . . .
State and federal policymakers can take the following steps:
Eliminate burdensome restrictions on the establishment of new OTPs.
Improve OTP integration into broader initiatives to reform health care delivery.
Facilitate the adoption of new OTP models that bring medications to underserved populations and reduce barriers for initiating methadone.
Expand take-home dosing and treatment in new settings.
Improve OTP access for patients with Medicaid or Medicare.
