More Beds or More Chairs? Using a Science-Based Approach to Address the Opioid Epidemic
Authors: Jeanette M. Tetrault, David A. Fiellin
Journal: Annals of Internal Medicine (2017)

Editorials2 January 2018More Beds or More Chairs? Using a Science-Based Approach to Address the Opioid EpidemicJeanette M. Tetrault, MD and David A. Fiellin, MDJeanette M. Tetrault, MDYale University School of MedicineNew Haven, Connecticut (J.M.T.)Search for more papers by this author and David A. Fiellin, MDYale University School of Medicine, New Haven, Connecticut (D.A.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2854 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Addressing the opioid epidemic is a national public health priority with bipartisan support. Still, only 20% of the 2.4 million Americans with opioid use disorder received treatment in 2015, a percentage unchanged over the past 20 years (1, 2). Despite unanimous calls to increase access to treatment for patients with opioid use disorder, debate remains about where and how to provide treatment. Some stakeholders decry a lack of “beds” for “detoxification.” For example, the President's Commission on Combating Drug Addiction and the Opioid Crisis recommended waivers from federal Medicaid regulations to rapidly increase inpatient treatment capacity at the urging of ...References1. Fiellin DA, O'Connor PG. New federal initiatives to enhance the medical treatment of opioid dependence. Ann Intern Med. 2002;137:688-92. [PMID: 12379070] LinkGoogle Scholar2. Substance Abuse and Mental Health Services Administration; Center for Behavioral Health Statistics and Quality. Treatment episode data set (TEDS): 2005-2015. National admissions to substance abuse treatment services. Rockville: Substance Abuse and Mental Health Services Administration; 2017. Google Scholar3. President's Commission on Combating Drug Addiction and the Opioid Crisis. Final Report. Accessed at: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf on 11 November 2017. Google Scholar4. Volkow ND, Collins FS. The role of science in addressing the opioid crisis. N Engl J Med. 2017;377:391-394. [PMID: 28564549] doi:10.1056/NEJMsr1706626 CrossrefMedlineGoogle Scholar5. Office of the Surgeon General. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington, DC: U.S. Department of Health and Human Services; 2016. Google Scholar6. Nosyk B, Li L, Evans E, Urada D, Huang D, Wood E, et al. Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991-2012. Drug Alcohol Depend. 2014;143:149-57. [PMID: 25110333] doi:10.1016/j.drugalcdep.2014.07.020 CrossrefMedlineGoogle Scholar7. Krebs E, Enns B, Evans E, Urada D, Anglin MD, Rawson RA, et al. Cost-effectiveness of publicly funded treatment of opioid use disorder in California. Ann Intern Med. 2018;168:10-9. doi:10.7326/M17-0611 LinkGoogle Scholar8. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009:CD002209. [PMID: 19588333] doi:10.1002/14651858.CD002209.pub2 CrossrefMedlineGoogle Scholar9. Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550. [PMID: 28446428] doi:10.1136/bmj.j1550 CrossrefMedlineGoogle Scholar10. Brooklyn JR, Sigmon SC. Vermont hub-and-spoke model of care for opioid use disorder: development, implementation, and impact. J Addict Med. 2017;11:286-292. [PMID: 28379862] doi:10.1097/ADM.0000000000000310 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of MedicineNew Haven, Connecticut (J.M.T.)Yale University School of Medicine, New Haven, Connecticut (D.A.F.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2854.Corresponding Author: Jeanette M. Tetrault, MD, Yale University School of Medicine, 367 Cedar Street, Suite 305, New Haven, CT 06510; e-mail, Jeanette.[email protected]edu.Current Author Addresses: Dr. Tetrault: Yale University School of Medicine, 367 Cedar Street, Suite 305, New Haven, CT 06510.Dr. Fiellin: Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510.This article was published at Annals.org on 21 November 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California Emanuel Krebs , Benjamin Enns , Elizabeth Evans , Darren Urada , M. Douglas Anglin , Richard A. Rawson , Yih-Ing Hser , and Bohdan Nosyk Metrics Cited byFamilial perceptions of appropriate treatment types and goals for a family member who has opioid use disorderWomen, opioid use and addictionPreliminary evidence of different and clinically meaningful opioid withdrawal phenotypesDifferential adoption of opioid agonist treatments in detoxification and outpatient settingsMedication Treatment For Opioid Use Disorders In Substance Use Treatment FacilitiesImplementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment 2 January 2018Volume 168, Issue 1Page: 73-74KeywordsComputed axial tomographyHIVHealth careOpioid use disorderOpioidsOutpatientsPatientsPrevention, policy, and public healthQuality adjusted life yearsResearch design ePublished: 21 November 2017 Issue Published: 2 January 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...