Access to Medication-Assisted Treatment for Opioid Use Disorder: Is Rhode Island Different, and Why?
The opioid epidemic is a national public health emergency that has hit Rhode Island especially hard. As of 2017, the state’s opioid-related overdose death rate was the 10th highest in the United States (among the 36 states that were ranked). Since 1999, over 2,600 Rhode Islanders have died of opioid-involved overdoses, and 277 of those deaths occurred in 2017. In August of 2015, Rhode Island Governor Gina Raimondo signed an executive order establishing the Governor’s Overdose and Prevention Task Force to combat the state’s opioid crisis. Consistent with this executive order, the Raimondo administration has prioritized the expansion of access to medication-assisted treatment (MAT) as part of a comprehensive approach to treating opioid use disorder (OUD).
Rhode Island is not the only New England state which has suffered disproportionately from the opioid crisis, nor is it the only state in the region to have taken concerted measures to address the opioid crisis. As of 2017, five of the six New England states were ranked among the top ten in the nation for deaths related to opioid overdoses. The only exception, Vermont, nonetheless in 2017 also experienced an opioid overdose rate that was above the national average. Vermont has attracted national attention for its innovative policies to expand access to high-quality treatment for OUD, including MAT. Massachusetts has also taken strong actions in recent years to promote access to MAT. In contrast, until recently New Hampshire devoted few public resources to the treatment of OUD (Manchester and Sullivan 2019), and according to some reports the state now faces an uphill battle in attempting to expand its treatment capacity rapidly enough to meet the growing demand fueled by this public health emergency.
MAT refers to a class of treatments for OUD involving three FDA-approved medications used either alone or in combination: methadone, buprenorphine, and naltrexone. The World Health Organization and the US Department of Health and Human Services both strongly endorse the use of MAT—in conjunction with psychological counseling---for combating opioid dependence, based on the method’s proven effectiveness in reducing opioid abuse, the risk of fatal overdose, and all-cause mortality. Nonetheless, the vast majority of OUD patients in the United States do not receive MAT; it is estimated that between 2004 and 2013, only 20 percent of individuals suffering from OUD received treatment of any kind, with or without MAT.
This paper assesses the prevalence of MAT among treatment episodes for OUD in Rhode Island during the period from 2000 through 2017 as compared with the five remaining New England states and with the United States as a whole. The analysis makes use of the Treatment Episode Data Set (TEDS), which tracks individual treatment episodes for all forms of substance abuse. (An episode is defined as the period between a patient’s initial entry into treatment and their subsequent discharge.) This paper contains the preliminary findings from what will be a multiyear project by the Federal Reserve Bank of Boston to recommend better policies to combat the opioid crisis, and is the precursor to a larger study using the Rhode Island All-Payer Claims Database. Since Rhode Island has been one of the more innovative states in formulating policies to deal with the opioid crisis, it makes a particularly good case study.