Improving public health through access to and utilization of medication assisted treatment.

Thomas F Kresina,Robert Lubran

doi:10.3390/ijerph8104102

Abstract

Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best “one stop shopping” approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

Highlights

Drug abuse and dependence is a growing public health problem [1]
A third approach is coordinated care and treatment, where primary care, medication assisted treatment (MAT) and human immunodeficiency virus (HIV) services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations
Opioid abuse and dependence are chronic, relapsing diseases that can be successfully medically treated. They are complex physiologic, social, and behavioral disorders that often coexist with psychiatric illness, as well as, co-morbid medical infectious diseases such as the HIV, hepatitis virus infection or tuberculosis [5,6,7]

Summary

Introduction

Drug abuse and dependence is a growing public health problem [1]. Opioid abuse and dependence are chronic, relapsing diseases that can be successfully medically treated. They are complex physiologic, social, and behavioral disorders that often coexist with psychiatric illness, as well as, co-morbid medical infectious diseases such as the HIV, hepatitis virus infection or tuberculosis [5,6,7]. MAT, the use of effective medications in combination with behavioral therapies, is a highly effective treatment for opioid abuse and dependence [9]. MAT impacts public health through the reduction of opioid use, opioid overdose mortality and transmission of infectious diseases [10]

Opioid Abuse and Dependence and Injection Drug Use

Medication Assisted Treatment for Opioid Dependence

Integrated Models of MAT

Coordinated Care Models of MAT

Public Health and Recovery from Opioid Dependence

Conclusions