HHS Assistant Secretary for Health: Shortage of Residential MAT ‘Absolutely Unacceptable’

Expanding medication-assisted treatment (MAT) for opioid use disorder (OUD) and combating the resurgence of meth are currently top priorities for the U.S. Department of Health and Human Services (HHS), according to Admiral Brett Giroir, assistant secretary for health at HHS.

Giroir shared those goals and others during a Tuesday presentation at the 2020 CMS Quality Conference in Baltimore, Maryland.

On one hand, Giroir lauded the progress behavioral health providers have made to expand MAT access in recent years.

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MAT is often considered the gold standard for OUD patients, with studies suggesting it boosts treatment retention and reduces relapse risk for patients, among other positives. As such, a growing number of behavioral health providers are turning to the treatment modality in hopes of yielding better outcomes for patients.

Since January 2017, the number of data-waived MAT prescribers has doubled, with more than 111,000 providers today able to treat about 6.3 million patients, Giroir boasted in his presentation.

Part of that boom can be attributed to the Comprehensive Addiction and Recovery Act of 2017 (CARA), which expanded buprenorphine waiver eligibility to nurse practitioners and physician assistants. MAT-focused federal grants have also helped.

However, there’s still room for improvement, Giroir stressed sternly during his presentation.

He pointed to the dearth of MAT at residential treatment facilities as an example. While there are about 3,000 residential treatment facilities nationwide, only about 40% of those offer MAT, while about 60% do not.

“This is absolutely unacceptable,” Giroir said. “MAT is the standard of care. It may not be for every single individual, but it’s for most individuals, and we need to absolutely improve. … MAT needs to be offered to everyone who is in an opioid treatment program.”

Currently, HHS estimates about 1.3 million people nationwide are receiving MAT, while about two million people have OUD.

“We still need to get more people on MAT,” Giroir said.

It’s worth noting that becoming a MAT provider is easier in some places than others, even with CARA and new federal funding. For example, some states have more restrictive scope-of-practice regulations that limit the tasks nurse practitioners and other health care workers may perform.

Meanwhile, on the federal level, HHS is working on an initiative that would expand MAT availability in emergency rooms, Giroir said.

“CMS is helping to support that with potential new codes,” he noted.

HHS’ Meth Priorities

Combating the resurgence of methamphetamines is also high on HHS’ to-do list. In recent years, meth use has spiked, especially in the western half of the country, where it accounted for more overdose deaths than opioids such as fentanyl in 2017.

“Methamphetamine deaths six months ago overtook [deaths from] prescription opioids,” Giroir said. “Last month it overtook heroin, and it will overtake cocaine within the next month or two. … It is at the top of my list to directly address the resurgence of this, to support regions with rising mortality [and] to treat this like a real epidemic with real time public health interventions.”

Giroir stopped short of sharing details around how HHS would address the growing meth problem and support affected communities.