It seems one can read stories from many different sources of print and social media that are reporting on a daily basis about the Government’s Medically Assisted Treatment (MAT) solution to the heroin and opiate crisis. 12 step programs are cast as failures for their alleged low success rates. Of course try telling that to the tens of thousands of patients who have successfully completed 12 step programs and are now sober, clean and living productive lives.
What is starting to become clear about this push toward the MAT solution is the underside that is not reported and few want to discuss. This underside is the growing number of patients currently on MAT programs who want to get off these programs. What’s the problem with this? Simple. Many of these patients are running into a pushback by the Doctors who prescribe buprenorphine (suboxone) and from the Public and Private entities who are funding these programs.
Why would this be? Currently, Doctors are giving answers ranging from “it would not be in your best interests” to “it will take a very long time”. On the face of it these are plausible answers. This misses the point.
What’s the point? The point is, do patients have a right to decline to be placed on a MAT program? Better yet, suppose a patient willingly decides to go on a MAT program and subsequently decides they want to come off of it. Do they have the right to change their mind? Patients who are paying cash, as many are, and who have the financial wherewithal to pay for a program that will detox them from a MAT program won’t find this a problem. Unfortunately many do not have these financial means. Do those that rely upon public funding for their heroin or opiate dependency treatment have the right to request the type of treatment they believe is best for them?
What happens if a funding source declines to allow a patient to come off a MAT program? Specifically, this means that the funding source would decline to authorize or pre-certify their admission into an abstinence-based program.
So questions arise. Should a patient have the right to decide which type of treatment program they want to enter? Does a patient give up their right to decide whether or not to come off of a MAT program? What are their options if their Doctor or Funding source declines to allow them to change their type of treatment? Is the Federal Government issuing Standards of Care and Regulations regarding this issue? Do current standards exist as to dosage and duration? Or is this still being discussed in Government committees, if at all? Perhaps the short course that Doctors must take to qualify to dispense suboxone is sufficient. Has anyone even thought about these points? Someone should because patients are starting to raise these issues.
Substance abuse treatment centers are starting to face these questions and issues. Right now there is a distinct lack of understanding regarding these finer points of MAT programs. Why has no one thought to develop regulations on these programs? Is this because of the amount of dollars involved? Is it just the rush to force feed this treatment, in response to the heroin crisis, as the newest solution before standards of care are developed?
Both patients and the treatment community need guidance on these points.