More beds are not the answer: transforming detoxification units into medication induction centers to address the opioid epidemic

Excerpt

Given extensive research evidence that pharmacotherapy is the most effective treatment for opioid use disorder (OUD), and the unabating rise in opioid overdose deaths, it is increasingly apparent that detoxification and “drug-free” treatment should be replaced by medication induction and long-term pharmacotherapy as the first-line standard of care. Nonetheless, calls for more “treatment beds” are heard in the political and public health discourse surrounding interventions to address the epidemic of opioid overdose deaths. States seek federal Medicaid waivers to expand treatment beds, and legislatures increase funding for state-sponsored beds. The term “beds” is usually shorthand for detoxification beds, short-term inpatient or residential beds, and may include outpatient treatment with beds in sober housing, but it usually does not refer to slots in opioid treatment programs or other settings that utilize effective medication treatment for opioid use disorder (OUD). To access these “beds”, patients with OUD first undergo detoxification, whether in an inpatient detoxification program, jail or hospital, and are then discharged to these settings where they receive monitoring, psychosocial support and counseling, but typically no effective medication. …