Changes in State Laws Related to Coverage for Substance Use Disorder Treatment Across Insurance Sectors, 2006-2020.

OBJECTIVE: The authors assessed changes in state insurance laws related to coverage for substance use disorder treatment across public and private insurance sectors from 2006 through 2020 in all 50 U.S. states. METHODS: Structured policy surveillance methods, including a coding protocol with duplicate coding and quality controls, were used to track changes in state laws during the 2006-2020 period. The legal database Westlaw was used to identify relevant statutes within each state's commercial insurance (large group, small group, and individual), state employee health benefits, and Medicaid codes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definition of substance use disorders, and enforcement and compliance. Scores were calculated to reflect the comprehensiveness of states' laws and to interpret changes in scores over time. RESULTS: Comprehensiveness scores across all sectors (on a 0-9 scale) increased, on average, from 1.47 in 2006 to 2.84 in 2020. In 2006, mean scores ranged from 0.47 (state employee sector) to 2.80 (large-group sector) and in 2020, from 1.22 (state employee) to 4.26 (large group). CONCLUSIONS: Comprehensiveness of state insurance laws in relation to substance use disorder treatment improved across all insurance sectors in 2006-2020. The State Substance Use Disorder Insurance Laws Database created in this study will aid future legal epidemiology studies in assessing the cumulative effects of parity-related insurance laws on outcomes of substance use disorder treatments.

Exploring the Link Between Substance Use and Mental Health Status: What Can We Learn from the Self-medication Theory?

The high rate of co-occurring mental health issues and substance-use disorders has been well documented. The primary objective of this research was to evaluate the association between use of alcohol, marijuana, and other illicit drugs, and unmet mental health need and service use. A secondary aim of this research was to determine if the observed patterns of alcohol, marijuana, and other illicit drugs use and unmet mental health need and mental health service use are consistent with a theory of self-medication theory. On the latter view, people use psychoactive substances as a self-regulation strategy to alleviate distress. Research was conducted through secondary analysis of 2014 National Survey on Drug Use and Health (NSDUH) data. Overall, study findings supported the established correlation between mental health issues and substance use as well as a theory of self-medication. This study focused on people 18-25 years of age.

Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options.

Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care.