Are Nursing Homes Rejecting Patients On Addiction Treatment Meds?

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Are Nursing Homes Rejecting Patients On Addiction Treatment Meds?

By Victoria Kim 04/19/18

Though it is illegal to turn away patients on medication-assisted treatment, some post-care facilities are doing just that.

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nurse comforting patient

Some residential treatment facilities are falling short of patients’ needs, by rejecting post-hospital care for people who are taking medication to treat opioid use disorder such as methadone and buprenorphine—i.e. medication-assisted treatment (MAT).

According to legal experts, this violates the Americans with Disabilities Act.

According to a report by STAT News, “many nursing facilities around the country refuse to accept such patients, often because of stigma, gaps in staff training and the widespread misconception that abstinence is superior to medications for treating addiction.”

Medication-assisted treatment—which involves both counseling and medication—is still fairly new to mainstream thought, but it’s touted as the best evidence-based treatment for substance use disorders.

“We know MAT is effective in reducing the number of overdoses and the number of relapses. It also enables people to ultimately live healthy and productive lives,” former Surgeon General Dr. Vivek Murthy said in a 2016 interview with The Fix

"Many people are suspicious of methadone and buprenorphine, and they think that such medication-assisted treatment drugs do not have a place in treatment. They believe in abstinence and abstinence only, but science tells us very clearly that there are multiple paths to recovery.”

Refusing care to people who use addiction meds who need additional short- or long-term care after being discharged from the hospital can have “dire consequences because pressure to stop these proven treatments could open the door to relapse and overdose,” STAT reported.

One Ohio trade group representing more than 900 care facilities said in a written statement that not one of its member facilities accepts patients taking methadone or buprenorphine for opioid use disorder.

“It’s so bad—you’re just begging and pleading with these places,” said a nurse case manager at Boston Medical Center who finds post-hospital care for patients. She said that only two nursing facilities in Boston accept patients on MAT, but otherwise, it can be “next to impossible.”

Legal experts say it is illegal to turn away patients on MAT, under the Americans with Disabilities Act (ADA).

“It’s well-settled in the case law that people with opioid use disorder have a disability as recognized under the ADA,” said Sally Friedman, legal director of the NYC non-profit policy and law group, Legal Action Center. “Opioid addiction is a chronic disease like any other, and nursing homes should be ashamed of themselves for excluding people who are receiving the most effective form of treatment for this chronic disease.”

Part of the problem has to do with facilities not being equipped nor having the expertise or resources to handle MAT patients. The issue may also stem from facilities that are unaware of what they can and cannot do in these circumstances, according to Dr. Sarah Wakeman, an addiction specialist at Massachusetts General Hospital. “There are facilities that do not understand that they are not allowed to do this,” she said.

But perhaps as stigma fades, and MAT becomes more widely available and accepted, the confusion will dissipate and patients will have equal access to care.

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