New Treatments for Addiction Behavioral, Ethical, Legal, and Social Questions (2004) / Chapter Skim
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3 Treatment, Financing, and Costs
3 Treatment, Financing, and Costs
Pages 23-36
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From page 23... ...
. The committee believes that new pharmacotherapies will only be effective to the extent that clinicians accept them in either specialty or primary care settings and their use is facilitated through adequate financing, organizational structures, and community support.
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From page 24... ...
Lastly, we briefly consider some cost and related economic issues. SPECIALTY ADDICTION TREATMENT SETTINGS Current specialty addiction treatment programs do not routinely provide extensive medical services, and when medical services are provided, they are ancillary to the central role of psychosocial behavioral treatment (Substance Abuse and Mental Health Services Administration, 2002)
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From page 25... ...
In order to provide immunotherapies and sustained-release formulations in specialty addiction treatment settings, substantial additional resources would be required to integrate medical services and medical personnel in these settings. Moreover, immunotherapies, particularly monoclonal antibodies, will need to be administered in a medical setting where emergency medical treatment is available.
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From page 26... ...
At all levels, research should explore barriers to the use of immunotherapies and sustained-release formulations in specialty addiction treatment settings. PRIMARY CARE SETTINGS Medical settings offer the possibility of engaging patients with substance abuse diagnoses earlier in the course of their addictions and providing services to those who cannot or will not seek specialty care (Stein and Friedman, 2001; O'Connor and Samet, 2002)
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From page 27... ...
Financing Differences in financing between general medical care and mental health and substance abuse treatment also will challenge the adoption of new therapies. The lack of insurance coverage parity between medical and addiction treatment complicates their integration, as many medical insurance programs limit funding for counseling and recovery support.
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From page 28... ...
In the primary care setting, practitioners may need to maintain two separate records for patients receiving general medical care and substance abuse treatment. Discrimination Treatment with immunotherapies, especially by active vaccination, has the potential to lead to long-term detectability because of markers in a person's blood or urine.
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From page 29... ...
Given the substantial barriers to implementation of these treatments, special consideration should be given to supporting research on the most effective ways to facilitate dissemination of immunotherapies and sustainedrelease formulations to medical and addiction treatment systems. In addition, health services research evaluating the effects of various organizational and financial models for delivering these new therapies will be necessary to understand how structural factors influence treatment access, cost, and outcomes.
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From page 30... ...
. The wording of the Addiction Free Treatment Act of 1999 also reflected an ideological bias against substitution therapy and, apparently, misunderstanding of the background, rationale, and substantial efficacy of long-term methadone and LAAM substitution treatment.
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From page 31... ...
The key to success appears to be an appropriate match between the medication and the behavioral intervention. Impediments to Alcohol Pharmacotherapies Naltrexone for alcohol dependence has different reasons for poor success, including many of the reasons detailed above for pharmacotherapy failure in general, including staff reliance on psychosocial treatment rather than medications, lack of medical personnel to prescribe the medication, and ideology.
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From page 32... ...
The application of new medications for addiction treatment must address the current clinical, organizational, and financial barriers that separate primary medical care and addiction treatment services. Research will have to address a number of questions and their policy implications related to adequate financing of the medications and associated psychosocial and behavioral services; improved linkages between primary care
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From page 33... ...
Consequently, it may be useful for NIDA to support health services research on how various public and private organizational and financing models for addiction medication delivery affect treatment access, cost, and outcomes. Recommendation 4 The National Institute on Drug Abuse should support studies of whether the potential for discrimination due to long-lasting markers in the blood or urine deters people with drug dependence from accepting immunotherapies.
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From page 34... ...
new substance abuse treatment medications in the past decade have been slow to be accepted for reimbursement by public treatment systems or private insurance carriers. There are only a very few monoclonal antibody immunotherapy products now on the market that are analogous to the proposed therapies; they appear to cost in the range of $1,500 to $2,000 per administration or infusion (Kosten and Kranzler, this volume)
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From page 35... ...
. Private and public insurance plans generally have limited coverage for substance abuse treatment therapies and medications.
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From page 36... ...
To date, such analysis has had few applications in treatment for tobacco and drug abuse. Particular challenges are posed by substance abusers and the nature of the disorder that will need to be addressed, which include the fact that illicit drug and tobacco use often occurs over a number of years, with some effects occurring during the use period, while others may be delayed by many years.
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