The ongoing opioid crisis has led to more Californian state officials and healthcare leaders promoting MAT, or medication assisted treatment. While research has shown that MAT increases positive outcomes for those living with substance use disorder (SUD), it comes with its own barriers.
MAT combines the use of medications with counseling and behavioral therapies to provide individualized treatment for those living with SUD, including opioid use disorder (OUD), and can treat those disorders while sustaining recovery. The primary use of MAT is for the treatment of addiction to opioids, including heroin and prescription pain relievers that contain opiates.
Medications prescribed under MAT stabilize brain chemistry, block the euphoric effects of opioids and alcohol, and relieve psychological cravings for substances. The medications—buprenorphine, methadone, and naltrexone— also relieve withdrawal symptoms, which can last upwards of 10 days.
A spokesman from the Department of Health Care Services spoke with State of Reform about some of the barriers individuals seeking MAT run into, as well as state efforts to address SUD.
“Barriers include limited access to medications for addiction treatment; stigma, which continues to pose barriers to referrals and engagement in treatment for individuals with OUD; and homelessness.”
— DHCS
The state is working through these barriers to encourage individuals living with SUD to receive MAT. DHCS’ has a “Choose Change California” media campaign, with the primary goal being to connect individuals to MAT services. In addition, the campaign works to educate the public about OUDs and stimulant use disorder, and combating stigma.
“Counties, including counties that participate in the Drug Medi-Cal-Organized Delivery System (DMC-ODS), provide MAT services to Medi-Cal members receiving DMC-ODS services,” DHCS said.
Counties involved in the DMC-ODS have to directly offer or have an effective referral system to clinically appropriate MAT services for individuals with SUD diagnoses. Medi-Cal beneficiaries who require MAT services cannot be denied treatment services. DMC-ODS participants offering MAT services are not allowed to discharge a member who refuses counseling services, and they are not allowed to deny access to medications.
“Rural communities face challenges with limited access to treatment, travel times to treatment facilities, lack of reliable transportation, and lack of family and community support,” DHCS said.
DHCS is working to expand access to MAT in rural communities through telehealth to allow for communities to increase prevention, treatment, and recovery activities.
“Finding a treatment center that offers a MAT specialized treatment approach can be difficult. People may be hesitant to try it as they don’t know much about it,” Jenni Busse, clinical director of Gratitude Lodge, a recovery center with locations in Orange and Los Angeles counties, told State of Reform.
Busse said the Gratitude Lodge medical team encourages the use of MAT through individual planning because addiction treatment isn’t a one-size-fits-all. With patients, the medical team works to determine the best form of treatment, and whether that includes MAT. One major barrier to medical care in the United States is health insurance coverage.
“Without insurance, it’s possible that someone may have to pay out of pocket for MAT.”
— Busse
According to Busse, if an individual wishes to receive MAT but cannot, the recovery process may be more difficult.
“In some cases, trying to detox without MAT can be dangerous. MAT is often utilized to assist long-term dependent individuals safely stabilize and begin working on a recovery plan while better managing intense cravings,” Busse said.
DHCS told State of Reform that the federal Substance Abuse Prevention and Treatment Block Grant allows for funding for all state counties so that everyone in need of SUD treatment services, including MAT, have access regardless of financial or health insurance status.
“Federal State Opioid Response grant funding is also provided in multiple statewide projects to supplement MAT providers to ensure all uninsured individuals have access to MAT services,” DHCS said.
Busse told State of Reform that Gratitude Lodge does not have available funding to assist low-income individuals with paying for MAT, but that they ensure those individuals are redirected to services that can provide assistance.
To assist individuals who are experiencing homelessness and living with SUD, California established the Behavioral Health Bridge Housing (BHBH) Program. The program provides a total of $1.5 billion to county behavioral health agencies and tribal entities to manage bridge housing settings, which address the immediate and long-term needs of those experiencing homelessness who also have behavioral health conditions, such as SUD.
Each grant recipient of the BHBH program must support participant access to MAT services and psychotropic medications for the treatment of mental disorders. The grant recipients must identify how they will provide MAT access to participants, and identify BHBH funding for supplemental needs that are not covered by other funding sources.
“Additionally, meeting the needs, including behavioral health services, of those experiencing homelessness to address their social drivers of health and improve their overall health outcomes is a top priority for DHCS.”
— DHCS