'There is an access issue': Doctors say not enough providers are prescribing medication for opioid use disorder

From 2015 to 2020, overdose deaths from opioids doubled in Nebraska. Medications for Addiction Treatment, also known as MAT, can give those struggling with opioid use disorder a second chance at life.

But KETV Investigates discovered access to the three main medications to help get people off opioids is limited in Nebraska. It turns out more doctors could be prescribing one of those medications, but they aren't applying for a special waiver.

For people struggling with substance use disorder, Norfolk, Nebraska, is considered to be a recovery town.

"There's a lot of recovery facilities and... long-term treatment facilities as well," Midtown Health Center Dr. Allison Wallick said.

At the Midtown Health Center in Norfolk, doctors prescribe two medications to treat opioid use disorder, naltrexone, commonly called Vivitrol and buprenorphine, better known by the brand name Suboxone.

"It is a process. So, you have to go through a drug and alcohol (evaluation) and make sure that you're a candidate for the program first," Wallick said.

Wallick said Suboxone has really helped a lot of her patients get on the path to recovery.

The most recent data DHHS prescribes shows there were 45 doctors across Nebraska prescribing Suboxone, the majority in Omaha and Lincoln.

"The likelihood of abstinence-only, of just saying 'I'm never going to use an opioid again,' the likelihood of that working is, on its own is very low without medication," said retired North Platte Dr. Janet Bernard.

Bernard said she has prescribed Suboxone to her patients since 2008.

"There's no question that there is an access issue," Bernard said.

Although she worked in North Platte, Bernard said she had patients coming to her from other parts of the state like Kearney, Grand Island, and even Omaha.

"I've had a lot of people that I say, 'ok, you live in Omaha. You need to find a provider in Omaha; it's closer to you,'" Bernard said. "They can't get in. (Doctors told them) 'We're not taking new people, we're not doing this, we're not doing that.'"

KETV Investigates learned that since April 2021, providers who are treating 30 patients or less no longer need special training to prescribe Suboxone for opioid use disorder – they just need to request a special waiver. Yet, many Nebraska doctors, physicians, and other licensed health care providers aren't requesting it.

"I do think we need more (people prescribing Suboxone) in Nebraska, especially in more of the rural areas," Wallick said.

"You've got people that really want to get sober, but they don't have the help that they need," Shanda Kohler said.

Kohler said another medication, Methadone, is the reason she's been sober from opioids for a year.

"These medications are going to save so many lives because of the fact that they are going to alleviate a lot of the misery that goes along with getting off opioids," Kohler said.

But access to methadone can also be a problem. UNMC Addiction Medicine Dr. Kenneth Zoucha said that medication can only be provided by Methadone clinics. There are only three in the state, found in Omaha and Lincoln.

"Some of them have patients that will drive an hour or two one way to get their methadone on a daily basis," Zoucha said.

But Bernard said it is rare that a patient is able to take Methadone but not Suboxone.

"I think every person who directly cares for patients, knowingly or not, sees people who have trouble with opioid use disorder, and they should really become Suboxone providers," Bernard said.

Bernard emphasizes that using MAT for opioid use disorder is not substituting one drug for the other. Bernard and Zoucha say there needs to be better education when it comes to "how to assess for, how to screen for, how to talk to and how to treat folks that have substance use disorders."

Zoucha and the Nebraska DHHS say there is an initiative to provide support, training and mentoring for doctors when it comes to substance use disorder. It's called Project ECHO (Extension for Community Healthcare Outcomes).

Project ECHO is a remote program. DHHS said that can be especially helpful for practitioners in rural areas who treat opioid use disorder.