Cash is king in opioid treatment centers, new Vanderbilt policy center finds

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The debut pilot study from the new Vanderbilt Center for Child Health Policy spotlighted the challenge in finding an opioid use disorder treatment that doesn’t require self-pay in four states, including Tennessee, particularly for pregnant women.

The preliminary findings point to an obstacle for people with opioid use disorder who are looking for medication-assisted treatment: cash is king.

Only half of the providers in the survey accepted any form of insurance, but all of them took cash. In Tennessee, less than half took private insurance and roughly 15 percent accepted Medicaid, or TennCare.

Researchers wanted to know if there were structural issues that kept people from getting treatment since only a fraction of people receive the treatment they need.

“That did surprise us, that cash payments were preferred. Access to treatment can be pretty expensive,” said Dr. Stephen Patrick, director of the new Child Health Policy center.

Getting opioid agonist therapy, which uses a medicine such as buprenorphine or methadone, is even more challenging for pregnant women in Tennessee, Kentucky, North Carolina and West Virginia — even though medication improves pregnancy outcomes, he said.

He knows from practicing that women have a hard time accessing treatment, and the study, which he said is a pilot with a “reasonable sample” points to a trend in these states. Opioid use during pregnancy can lead to neonatal abstinence syndrome, in which the baby is born dependent.

Providers with addiction medicine expertise may not be comfortable treating pregnant women while few obstetricians treat addiction as well, he said.  He treats babies with NAS and said that improving access to this treatment would be part of a comprehensive approach to combating the opioid epidemic.

New center to spotlight policy impact on kids 

The study is the first released from a new policy center that’s going to be a research hub on information and data about policy impact on pregnant women and children, he said.

Often the impact from public policy or funding allocations on children is overlooked in the debate, said Patrick, but decisions ranging, for instance, from the certificate of need program to e-cigarettes affect them.

“One of the goals is to get into the weeds a bit. There are a slew of issues that come up that impact kids — it matters,” Patrick said.

The center will have a rapid response team to quickly hop into discussions of the moment with information and research to engage with the public, do polling and be an independent source for child health policy issues, he said.

Researchers and clinicians will also be tackling obesity, barriers to accessing healthcare and food insecurity.

“We want to engage the public more to translate the data. If it just sits there on PubMed it doesn’t do anyone any good,” he said.

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