ImprovIng CommunIty HealtH tHrougH polICy researCH Opioid Treatment Programs in Indiana – The Use of Medication in Addiction Treatment

Opioid Treatment Programs in Indiana – The Use of Medication in Addiction Treatment Addiction to opioids (e.g., heroin, morphine, prescription pain relievers) is a serious health problem with wide-ranging social and economic implications. In 2010, more than 2 million Americans were affected, with 1.9 million U.S. residents addicted to prescription opioids and 359,000 addicted to heroin. Abuse of opioids, particularly heroin, has been associated with unintentional overdoses and transmission of hepatitis, HIV, and sexually transmitted diseases [1]. Interventions that have been found effective in patients with opioid dependence include opioid treatment programs (OTPs). OTPs are medication-assisted approaches that use pharmaceuticals (primarily methadone and buprenorphine), in combination with counseling and other supportive services to treat severe, chronic, and long-term opioid addiction; this may include detoxification from short-acting opioids, medically supervised withdrawal treatments, and pharmacotherapy to stabilize patients [2]. Since controlled substances are dispensed as part of the program, OTPs are highly regulated by federal as well as state agencies [3]. The use of medications to treat addiction is controversial, because many view addiction not as a disease, but as a choice made by the user, and also because of the belief that this type of treatment represents trading one addiction (e.g., heroin) for another (e.g., methadone) [4]. OTPs are often further stigmatized because they are thought to “bring down” the area around them by attracting “undesirable” people, which will subsequently increase crime and drug dealing rates [4, 5]. Currently, there are 1,200 OTPs in the United States, with the heaviest concentration found in the Eastern regions [6]. In Indiana, there are 13 OTPs under the state’s supervision. The number of patients treated in Indiana’s programs quadrupled from 3,646 in 1998 to 14,269in 2011 (this excludes the Richard L. Roudebush Medical Center, which is operated by the U.S. Veterans Administration). Historically, patients entering Indiana’s OTPs were predominately males and non-Hispanic whites; most were Indiana residents, but services were also provided to patients from surrounding states [3, 7]. OTPs are highly regulated in the United States and must be registered with the Drug Enforcement Administration (DEA) [8, 9]. Additionally, addiction treatment providers in Indiana have to be certified by the Family and Social Services Administration’s Division of Mental Health and Addiction [9]. Indiana law currently prohibits the establishment of new OTPs in the state [3, 10]. The focus of this policy brief is on methadone and buprenorphine in the treatment of opioid addiction and not on their use in pain management. Though some physicians still utilize these analgesics to relieve patients’ pain, the drugs are primarily used in OTP settings [11, 12].