A look at Californians’ uneven access to the gold-standard treatment for opioid addiction

When Christy and I talked last year, she was 30 years old and had been abusing prescription painkillers since she was a teenager. Like many people with addictions, she’d tried rehab many times. At first, she went to treatment centers that taught her that if she took medication, she wasn’t clean. “I struggled with that,” she said. At the time we talked, she was taking buprenorphine, which is an opioid like the Lortabs she’d misused, but which is designed to reduce cravings without getting folks high. With the help of buprenorphine and counseling, Christy hadn’t used illicit drugs in more than a year. She was also parenting her 4-month-old, Ryleigh, a major goal of hers after she lost custody of her firstborn, eight years ago. “I’ve grown up a lot and I’ve been through a lot in my addiction,” she says. “I just didn’t want that to happen again.” 

Christy's treatment — medicine plus counseling — is technically called “medication-assisted treatment.” The “medication” part of MAT may be buprenorphine, methadone or naltrexone, the three Food and Drug Administration-approved drugs for this purpose. Whatever doctors and patients choose, MAT is considered the gold standard for treating addictions to opioid painkillers, heroin and fentanyl. Although some folks want to and do successfully overcome opioid addictions without medicine, studies show that methadone and buprenorphine keep people in treatment and reduce their illicit opioid use. Those who don’t get MAT are more likely to die, often because they relapse and overdose. The American Society of Addiction Medicine recommends MAT, as does the federal government’s Substance Abuse and Mental Health Services Administration.

Nevertheless, there remain opioid treatment clinics that don’t offer MAT. Some, like the ones Christy encountered in Kentucky, are philosophically opposed to methadone and buprenorphine, which are both opioids, because they believe it’s substituting one addiction for another. Other facilities may support MAT, but don't feel they have the resources to provide it. Buprenorphine and methadone can get users high if they’re used inappropriately, so they’re tightly regulated and prescribers are subject to extensive training and reporting rules. Naltrexone, meanwhile, isn’t an opioid, doesn’t provide a high, and anyone with prescribing authority can write scripts for it. But it's not for every patient: Users have to be willing to detox for at least a week before starting on it, whereas methadone and buprenorphine-takers never have to undergo extended withdrawal. In short, MAT can be hard to do.

That's why, for my 2018 Data Fellowship project, I want to find publicly funded opioid addiction treatment centers in California that don’t offer MAT, and learn more about why and what would help them to expand lifesaving access to MAT. The Substance Abuse and Mental Health Administration does already have a lookup tool that offers some of this information, but I'll be double-checking it against other databases.

By identifying and learning more about these centers, I hope I’ll learn more about several important points: The stigma that MAT and its users face, despite official support for this treatment. The tradeoffs that providers in rural areas, which are the least likely to offer MAT, are forced to make in the face of limited resources. And how well California's current efforts are faring in closing the MAT gap for all Californians.