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Georgia's opioid crisis, part 2
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One of the issues sure to be on the front-burner of the 2018 General Assembly will be the treatment and prevention of Opioid abuse. Last week this column looked at Georgia’s ongoing crisis that is affecting an estimated 180,000 Georgians. A November, 2017 State Audit identified the scope of the crisis and outlined some issues with MAT or Medication Assisted Treatment. The three medications utilized in MAT are Methadone, Buprenorphine and Naltrexone.

Access limitations medical assisted treatment
The audit identifies limitations to access to MAT in Georgia in four broad categories.
1) Less capacity
2) Lack of familiarity with MAT
3) Cost
4) Inconsistent state policies
First, Georgia has less MAT capacity than many states. Georgia has 72 federally and state licensed Narcotic Treatment Programs (NTP) which provide methadone and provide required medical, counseling, and other services. Georgia has 764 physicians who have earned a federal waiver to prescribe buprenorphine. These physicians represent a capacity to serve 50,000 patients. There are an estimated 180,000 Georgians with opioid use disorder. However, only about 60% of those physicians wrote a prescription for buprenorphine in FY2017, serving only 16,800 patients.

Rural barriers
Most Georgians live within 20 miles of MAT services. However, rural Georgians generally must travel further, a barrier to patients early in their methadone treatment protocols which require daily travel to their NTP for medication administration. Only half of Georgia counties have at least one buprenorphine prescriber.

Awareness training needed
Second, the lack of familiarity with MAT coupled with low awareness of what resources are currently available results in a lack of referrals to MAT services. Frontline professionals need training to identify opioid use disorder as well as better access to a comprehensive list of MAT providers in order to successfully refer individuals to Medicated Assisted Treatment.

Cost barriers
The third limitation in access to MAT identified by the audit is cost. MAT costs several thousand dollars per year for the uninsured.
For Medicaid recipients, all three medications are covered, but NTPs are often not included in provider networks. The privately insured will still have to pay the full cost of methadone and NTPs are not included in GA insurance networks. The state can do more to evaluate network access to MAT ensuring adequate statewide access.

Inconsistent policy
Lastly, there are inconsistent state agency policies limiting MAT participation. Some agency policies do not accept MAT as permissible treatment. Adult felony drug court judges, community supervision officers, and DFCS caseworkers have not widely received training on MAT and may prohibit individuals from utilizing MAT. State entities should clarify policies related to drug screens to explicitly indicate that MAT medications are permitted when prescribed.

Current efforts
A Georgia Public Health, Centers for Disease Control and Prevention funded project, which began in March 2017, will form the anchor of Georgia’s statewide plan. Last session, the General Assembly passed legislation on opioid prescribing (HB249), opioid reversal drugs (SB121), and regulation of NTPs (SB88). In May 2017, Georgia received a two-year $23.6 million federal grant for prevention and treatment initiatives including approximately $9 million annually for treatment activities including MAT.

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