By Alison Knopf
Mark Parrino, MPA, made no secret of his plan to double the number of opioid treatment programs (OTPs) within three years, from 1,400 to 2,800. He mentioned it at every opportunity during the recent conference of the American Association for the Treatment of Opioid Dependence (AATOD).
Vickie L. Walters, LCSW-C, opened the standing-room-only plenary session in Baltimore on October 31. Executive director of the REACH Health Services substance abuse treatment program at the Institutes for Behavior Resources, she chaired the five days of workshops, plenaries, exhibits, and networking that took place at the Baltimore Marriott Waterfront.
At the opening plenary, Ms. Walters introduced Lt. Gov. Boyd K. Rutherford of Maryland, who talked about the six regional summits the opioid task force held last year. “There was a time when heroin addiction happened somewhere else, in someone else’s neighborhood, but that’s not the case anymore,” said Mr. Rutherford, who chairs the task force. He discussed the importance of education and prevention. “Every third-grader can tell you cigarettes are bad for you, but none of them can tell you the damaging effects of taking someone else’s prescription medication,” he said.
Barbara J. Bazron, PhD, executive director of the state’s Behavioral Health Administration, said there have been more than 1,000 overdose deaths in the state this year, as of the end of September. Lack of access to treatment is part of the problem, as is the wider availability of heroin and fentanyl.
Naloxone is an important part of the state’s initiative, especially in Baltimore, where the health commissioner, Leana Wen, MD, has, in effect, written a prescription for naloxone for every resident of the city. She has issued a blanket prescription—a “standing order”—for everyone in the city.
In the state, naloxone is available to everyone with a $1 to $3 copay, depending on insurance. In terms of treatment, Dr. Bazron is hoping to move to a “one-stop-shopping” model that encourages people to get treatment “at the earliest opportunity and the most convenient location.”
But there simply aren’t enough slots for treatment. Some people with opioid use disorders lie to Dr. Wen at the emergency department, saying that they are suicidal, because they know that will earn them a treatment bed, she said. Dr. Wen, speaking at the November 1 plenary, cited the difficulty the city has siting a “stabilization center” that would be near the hospital, so that patients who have been rescued by naloxone from overdoses could go there and start treatment.
The problem? It’s NIMBY.
And that leads to Mr. Parrino’s own plenary talk—anti-methadone stigma. The states are erecting barrier after barrier to treatment. “Maine has a governor who wants all OTPs closed because he doesn’t like the medication,” he said. “This is not a rational policy, but he’s not a rational person.”
West Virginia, which has had a moratorium on new OTPs since 2007, has “no plans” to re-evaluate that situation, even though the state is the epicenter of the opioid epidemic. Mississippi has only one OTP, requiring patient transport across state lines. In many cases, reasons for this involve zoning boards, not state policy. But the bottom line is this: “American citizens cannot claim that we need to treat their sons and daughters and spouses, and simultaneously prevent OTPs from opening in their communities,” he said, to applause.
Mr. Parrino also noted that OTPs provide comprehensive services, and DATA 2000 providers need to be accountable as well. Some provide prescriptions only for buprenorphine.
Vivek Murthy, MD, Surgeon General, talked about problems he faced in communities where people did not know about methadone, and where even physicians did not trust it. Gilberto Gerra, MD, Chief of the Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), based in Vienna, Austria, focused on lack of press attention to substance use disorders, when they were discussed at the UN last spring. Dr. Gerra also noted that the UN says it’s time to stop using the phrase “enforced” treatment—rather, treatment must be based on the consent of the patient.
At the closing plenary on November 2, Michael Botticelli, director of the Office of National Drug Control Policy (ONDCP), discussed White House policies, the need for expanded access to treatment with medications, and the need for naloxone to reverse overdoses. Mr. Botticelli, who has spearheaded the White House effort to get more funding for treatment, and to treat opioid use disorders like the health conditions they are—not a crime or a moral failing—has provided a wealth of support for medication-assisted treatment over the years.
The next AATOD conference will be held March 10-14, 2018, in New York City.