The financial incentives within the addiction treatment industry have been misaligned. Treatment with buprenorphine can be conducted in an outpatient setting such as a doctor’s office. If a person receives oral buprenorphine from their doctor on a weekly basis, along with substance use counseling, individual and group therapy, and toxicology testing, the reimbursement rate for the services is roughly $1,000 per month. Historically though, addiction treatment has been delivered in residential settings which can cost on average $6,000-$20,000 for 30 days.
Therefore, the system of addiction treatment facilities is set up to deliver more expensive, acute care and has not been financially incentivized to deliver medications for OUD. Instead, they can continue to deliver the same treatments they always have and make significantly more money. What’s worse is that there is a higher rate of overdose associated with leaving residential treatment. If someone relapses, they often start over and pay again. This means that the system is also not incentivized to keep people well over the long-term.
There are prominent national organizations working on these issues. To advocate further for improved access to evidence-based addiction treatment, check out Shatterproof and Drug Policy Alliance.