This year’s meeting of the American Association for the Treatment of Opioid Dependence (AATOD) reflected the continuing evolution of the field, with prescription drug abuse, patient advocacy, and three medications taking top billing. And running throughout the meeting was the theme—recovery.
More than 1,500 attendees were at the conference, held in Center City, Philadelphia at the Downtown Marriott November 9-13.
Key events at this year’s meeting included the admission of Tennessee as a new AATOD member. This was an important addition, with Tennessee’s history as a state where opioid prescription drug abuse first took root a decade ago, with Oxycontin, referred to then as “hillbilly heroin.” Prescription drug abuse, the patient advocacy movement, and the increasing use of the medications Vivitrol and buprenorphine were recurring themes—in conference rooms, in the exhibit hall, and in the earnest conversations between attendees. Centerpiece of the meeting was the awards banquet honoring individuals for extraordinary service in the opioid treatment field.
Prescription Drug Abuse
On November 11, the evening session addressed prescription drug abuse, with the general recognition that this is a major public health crisis that has immediate implications for opioid treatment programs (OTPs) and others who treat opioid dependence. “This is an extremely serious public health issue,” said Mark W. Parrino, AATOD president. “People have all sorts of medicines in their medicine cabinet, and we have to protect those medications from being abused.”
For this reason, AATOD and others in the field support the recent decision of the Food and Drug Administration (FDA) to reschedule hydrocodone from Schedule III to Schedule II, the most restrictive schedule of legal medications on the Controlled Substances Act, said Mr. Parrino.
Doctors should participate in prescription drug monitoring programs (PDMPs), according to Mr. Parrino, who noted that AATOD encourages OTPs to access the databases, but not to provide confidential patient information to them, as per the directive of the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2011.
A growing presence at the conference and at AATOD in general is the OTP patient advocacy movement. Patient advocates like Walter Ginter, project director of Medication Assisted Recovery Services, Zac Talbott, director of the Tennessee chapter of the National Alliance for Medication Assisted Recovery, and Joycelyn Woods, executive director of the National Alliance for Medication Assisted Recovery, are “extremely articulate and forward-thinking,” Mr. Parrino said.
Mr. Ginter was a plenary speaker, on the dais with Mary Jeanne Kreek, MD, vice-president and head of the laboratory of biology of addictive diseases at The Rockefeller University in New York, and H. Westley Clark, MD, director of SAMHSA’s Center for Substance Abuse Treatment.
There were more patient advocates at the conference than ever, which really encourages Mr. Parrino. At the conference, these advocates could walk up to well-tenured administrators, pioneers in the field, and talk with them on their level—a great opportunity for what is the “lifeblood of future patient advocacy” for MAT, he said. It was also very much in keeping with the theme of the conference, which was recovery—these advocates are the spokesmen and spokeswomen for medication-assisted recovery.
Patient advocacy is still at its early stages, but will be increasingly powerful in the future, said Mr. Parrino. “It’s one thing for me to argue about why we should preserve patient confidentiality, but it’s an entirely different thing if patients do it themselves, because they’re talking about their treatment.”
The presence of three medications—buprenorphine, Vivitrol, and methadone—was obvious in the exhibit hall and throughout the presentations. “There are three medications for opioid dependence—we should use them to the benefit of patients,” said Mr. Parrino. While there’s a common belief that most OTP patients do not want Vivitrol, consider this: 80 percent of the patients who taper off methadone or buprenorphine relapse. “Perhaps we could use Vivitrol for the patients who say they no longer want methadone or buprenorphine,” he suggested.
AATOD’s appeal is now broader than ever, encompassing office-based physicians who prescribe buprenorphine under the auspices of DATA 2000, as well as the traditional OTPs that constitute the core of the group’s membership. “We have begun the process of inviting such individual practitioners to join AATOD as individual program members, should they wish to do so,” Mr. Parrino told AT Forum.
At the present time, however, he stressed that the AATOD Board of Directors and its 30 state member associations represent OTPs.
Another common theme at this year’s conference was the linkage to criminal justice. One important message referred to the need to better train OTP personnel on how to present the rationale for MAT to criminal justice officials. “It’s a matter of understanding the language of the criminal justice system,” he said. There needs to be funding, possibly through the Addiction Technology Transfer Centers, for training OTPs on how to explain the rationale for gaining access to treatment.
Open Board Meeting
The AATOD open board meeting November 9 included a very impressive presentation by SAMHSA’s Dr. Clark, one of the very few federal officials who have ever run an OTP. Among board members giving presentations: First Vice-President Janice F. Kaufman, RN, on why AATOD developed a guest medication policy (hurricanes, for example), and board member Brian McCarroll, DO, on the development of the naltrexone/Vivitrol guidelines.
Affordable Care Act
The closing plenary featured Paul Samuels, president and director of the Legal Action Center, on the complex implementation of the Affordable Care Act. In the end, this is going to be a state-by-state issue, with some states opting out. “The only solution is real advocacy, having programs unite as a group,” said Mr. Parrino. Also speaking at the plenary: Anne Heron, director of the Division of Regional and National Policy Liaison at SAMHSA, and John O’Brien, senior policy advisor of the Center for Medicare and Medicaid Services at the federal Department of Health and Human Services.
The centerpiece of the meeting, the awards banquet, honors individuals for extraordinary service in the opioid treatment field. The first recipients were Vincent Dole, MD, and Marie Nyswander, MD, in 1983. Presented by A. Thomas McLellan, PhD, CEO and co-founder of the Treatment Research Institute in Philadelphia, the Nyswander/Dole awards this year went to:
- Jim B. Graham, Maryland (from 2008-2012, president of the Maryland Association for the Treatment of Opioid Dependence, and Maryland’s representative to the AATOD Board of Directors);
- Belinda Greenfield, PhD, New York (director of Addiction Medicine & Self Sufficiency Services in the New York Office of Alcoholism and Substance Abuse Services, and the State Opioid Treatment Authority);
- John Hamilton, Connecticut (CEO of Recovery Network of Programs);
- Kate Mahoney, Illinois (executive director of Peer Services, Inc.);
- Joel Millard, Utah (executive director, Project Reality);
- Luis Duarte Baptista Patricio, MD, Portugal (clinical director, Unidade de Aditologia e Patologia Dual-Casa de Saude de Carnaxide-Portugal);
- Richard Rawson, PhD, California (associate director at UCLA Integrated Substance Abuse Programs, UCLA Department of Psychiatry and Biobehavioral Sciences in Los Angeles); and
- Jerome E. Rhodes, Pennsylvania (chief operating officer, CRC Health Group).
The Friend of the Field award, established by AATOD’s board of directors, went to H. Westley Clark, MD, director of the Center for Substance Abuse Treatment at SAMHSA.
The Patient Advocacy Award, named for Richard Lane and Robert Holden, went posthumously to Ira J. Marion, who prior to his death last winter was assistant to the university chairman and director—Government Relations Department of Psychiatry & Behavioral Sciences of the Albert Einstein College of Medicine. Mr. Marion’s work was key to reducing stigma and supporting the rights of patients.
The conference was co-hosted by the City of Philadelphia Department of Behavioral Health Intellectual disAbility Services (DBHIDS), and the Pennsylvania Department of Drug and Alcohol Programs (DDAP).