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Opioid addiction is a national crisis, and Texas has not escaped it.
As a specialist in addiction psychiatry at Baylor College of Medicine, I have devoted my professional life to studying addiction, including opioid addiction, and developing medical treatments that help patients fight it. Texas can do far more to combat this scourge that has afflicted so many families and communities across the country.
The best first step would be to allow people on Medicaid to access the full range of medication assisted treatments to help them beat their dependency.
On Oct. 26, the state’s Medicaid Drug Utilization Review Board will consider giving preferred status to additional medications for the Medicaid program. Right now, there is an entire class of medications that simultaneously reduce the cravings for opioids and ease the nausea and other withdrawal symptoms that drive people back to addiction.
Yet, only one of these medications, Suboxone, has been given preferred status by the DUR board. Additional options would better serve many of Texas’ most vulnerable patients, but the state forces physicians to jump through numerous hoops to provide those alternatives. As a result, patients often suffer delays and interruptions to treatment.
The DUR board should take this opportunity to exert leadership during this epidemic and lift unnecessary medical authorizations for MATs. Then, next year, the Legislature should pass a bill to codify that policy.
Opioids are responsible for about half of Texas’ drug overdose deaths, claiming the lives of nearly four Texans every day. The state has four of the top U.S. cities for opioid abuse — Texarkana, Odessa, Longview and Amarillo — according to the health care information company Castlight. And drug overdoses, primarily from opioids, were the second-leading cause of maternal death in Texas, according a report by a state task force created in 2013 to address that growing problem.
The medical impact of opioid dependence treatment delays can be insidious. Accessible treatment must be the core policy goal in Texas’ statutes and within state agencies. The window for treating patients with this disease is narrow; often, relapse is driven by a sudden seminal event such as an arrest, accident or overdose.
It is essential to eliminate delays and access bottlenecks wherever possible, including by providing access to needed medications. If people seeking treatment are not immediately engaged, they will revert to addictive behaviors that drive the continued use of drugs. That hurts them, and it hurts our communities.
Many others share this concern about limited access to MATs. Experts in the field — as represented by the Substance Abuse and Mental Health Services Administration, American Society of Addiction Medicine and American Medical Association — have long held that physicians and their patients should be able to make joint decisions about available treatment options.
These sentiments were recently endorsed in the final report of the Trump Commission on Combatting Drug Addiction and the Opioid Crisis, which stated: “Choice of medication should be made by a qualified professional in consultation with patient, and based on clinical assessment.”
Asking third parties to intervene in these decisions severely undermines a central tenet in treating drug addiction and other epidemics: Treatment on demand. Failure to provide this basic need will continue to hamper the state’s ability to treat friends, family members and fellow Texans on the front lines of the opioid epidemic — and it likely will contribute to Texas’ ever-growing list of overdoses and deaths.
I urge the state, starting with the DUR Board this month, to expand vulnerable Texans’ access to this group of opioid addiction treatments — beyond the one currently preferred product — so that patients can gain access to their best treatment option when and where they need it.
Kosten is JH Waggoner chair and professor at Baylor College of Medicine in Houston and is adjunct professor of psychiatry and epidemiology at MD Anderson Cancer Center.
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