SAMHSA’s New Medical Director Will Focus on Medical Treatment of Addiction

Edit-Dr.M-KElinore McCance-Katz, MD, PhD, the first medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), shared with AT Forum her view of her new role in an interview in late June. She focused on opioid treatment programs (OTPs) in our discussion, but she is bringing to the agency a renewed concentration to medical treatment of serious mental illness and addiction in general. She was hired effective June 3.

My role at SAMHSA is one of providing input on medical and psychiatric issues related to the treatment of substance use and mental disorders,” Dr. McCance-Katz said. She has extensive experience working in large research programs based within OTPs, most recently with the development of buprenorphine treatment under SAMHSA, and with the National Institute on Drug Abuse, as the Drug Abuse Treatment Act of 2000 was implemented. And with health care reform on the near horizon, she sees OTPs providing treatment not only for substance use disorders (SUDs), but also for primary medical care on site, an important link for this population. “We’re going to have literally millions of people coming into the health care system,” she said.

We asked Dr. McCance-Katz, an ardent supporter of medication-assisted treatment (MAT), what SAMHSA’s role should be when states and insurance companies try to restrict access to medications like methadone and buprenorphine for treatment for opioid addiction. “I believe in individuals being offered all treatment options, and I believe methadone is an appropriate treatment for many individuals,” she said. “Having said that, that’s pretty much the extent of what I can do, from the perspective of a government agency.” However, she said that she thinks she will be able to advocate for MAT. If states asked for her opinion, she would say that methadone needs to be available and accessible to patients.

One of the main distinctions between physicians prescribing buprenorphine and OTPs dispensing methadone is the required ancillary services for OTPs, particularly counseling. Dr. McCance-Katz said SAMSHA already strongly advocates for counseling, whether the medication is buprenorphine or methadone. “Look at TIP 40,” she said, referring to the SAMHSA publication, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. “It’s very clear that prescribing physicians are advised strongly” to refer patients to counseling. “In our buprenorphine trainings, and I can speak to this very well, there’s a huge focus on the counseling piece,” she said. “To get the waiver to prescribe, they have to say that they will evaluate and refer for ancillary services if they’re not going to provide them themselves—that’s been SAMHSA’s view from the start.”

She said that OTPs could provide counseling to buprenorphine patients, but was unclear about how they would be reimbursed for this. OTPs have expertise in counseling, and many physicians don’t know where to refer patients for counseling, she said. In addition, drug testing, which Dr. McCance-Katz called “the backbone of treatment,” could be done by the OTPs. “Somebody has to do the drug testing, either the physician prescribing the buprenorphine, or the OTP.”

In addition to advocating for MAT, Dr. McCance-Katz will be focusing on treatment for severe mental illness and other disorders related to behavioral health care. She has a background in general psychiatry, is board certified in addiction psychiatry, spent most of her career in addiction medicine, and most recently was medical director of California’s Department of Alcohol and Drug Programs (which ceased to exist on July 1). She was also on the faculty of the University of California, San Francisco.