Thread by @StefanKertesz

1/When insurers *deny* coverage of buprenorphine for OUD care based on "lack of documented counseling", they ENFORCE a policy that is opposite to national recommendations. #addiction #OUD

https://twitter.com/DrEllenEaton/status/1559561788856758273

2/The @ASAMorg guideline (2020) for opioid use disorder lays out a strong case FOR "psychosocial treatment"
AND it ALSO declares that precluding bupe based on declining counseling puts the patient's life at risk …tefinitystorage.blob.core.windows.net/sitefinity-pro…

3/The reason is obvious. A patient with diagnosed OUD and loss of access to medication is at risk of use of illicitly sourced opioids and death.

Withholding the life-saving medication is a bad idea.

This doesn't mean "counseling is no good", but it's not "requirable"

4/There are 4 trials finding psychological counseling offered NO additional benefit beyond Bupe Rx for OUD, but data don't all fall one way.
Some behavioral treatments (contingency management) *do* confer additional benefit. A great review here: focus.psychiatryonline.org/doi/10.1176/ap…

5/Finally, I'll note that SOME state laws also require counseling, even if the evidence for that mandate is non-existent, as reported by @AndrakaBasia in J. Addiction Medicine this year :journals.lww.com/journaladdicti…

6/In short, if an insurer or state law urges withholding a medication in absence of documented "counseling", there is no evidence for that view and it is opposed by major national guidelines. Some forms of behavioral treatment may still be important and helpful /fin
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