By Alison Knopf
The five-year plan of the American Association for the Treatment of Opioid Dependence (AATOD) has a goal of increasing access to care in opioid treatment programs (OTPs). Treatment “wherever it is needed”—in the United States and in the world—with the aim of patient care, is a theme running throughout the document.
The first strategic five-year plan was approved in 2001, and updated in 2007 and 2012. The current plan is for 2017-2021.
Sustainability was a guiding principle, with initiatives aimed at expanding access to OTPs, increasing access to third party funding, and working with the World Federation for the Treatment of Opioid Dependence.
AATOD will work with its partners, including the Substance Abuse and Mental Health Services Administration (SAMHSA), to accomplish the following goals:
- Identify existing treatment resources for opioid dependent individuals
- Identify where treatment is needed in underserved areas of the country
- Identify what financial resources are needed
- Work with the criminal justice, behavioral, and primary medical care systems to ensure patients receive comprehensive and coordinated care
AATOD will strive to increase care in drug courts and correctional facilities, as well as in the rest of the criminal justice system, working with the Legal Action Center and other policy partners. This year AATOD will release a criminal justice fact sheet on OTPs.
Below are other key areas highlighted by the five-year plan.
Integrated Service Delivery
The three policy papers developed by AATOD for SAMHSA last year will be the foundation for better integration of care with OTPs and other health care settings. Key to this is reimbursement from third-party payers.
- Medicaid: There are still 16 states that do not allow use of Medicaid funds for OTPs. AATOD will provide guidance to help increase such reimbursement.
- Medicare: Last year, the Centers for Medicare and Medicaid Services (CMS) determined that it does not have the authority to allow Medicare to pay for OTP services. The plan is for AATOD to work with the White House Office of National Drug Control Policy (ONDCP), Medicare, and Congress to make it possible for Medicare to pay for OTP treatment. Again, the leadership of the current administration will be crucial to determining the outcome of these efforts.
- Commercial insurance companies: AATOD will work with commercial insurance companies on model contracts that would allow reimbursement to OTPs. There would also be cross-training opportunities so that insurance companies could better understand what OTPs do.
Working With Partners
- Educating Congress: AATOD developed an educational initiative aimed at Members of Congress, some of whom don’t understand how OTPs function or what services are provided, and the misunderstanding of medications—especially methadone—needs to be rectified. This will require financial resources to coordinate how OTP administrations and patient advocates can meet with Congressional representatives both in district offices and in Washington, D.C.
- Federal Agencies: AATOD will also work with federal agencies, building upon relationships with the ONDCP, SAMHSA, the Drug Enforcement Administration (DEA), the Food and Drug Administration, the National Institute on Drug Abuse, and other federal agencies. With SAMHSA, a key focus will be on cross-training initiatives, enabling OTPs to work with the states. With the DEA and SAMHSA, AATOD will focus on the Narcotic Treatment Program Guidelines, expected out during 2017.
- AATOD will continue to promote all medications approved to treat opioid use disorders through OTPs. This is important if OTPs are to be the “essential hub treatment sites” for opioid use disorders.
- Conferences, Webinars, Communications: AATOD conferences, which began in 1984, are a way to showcase leading initiatives and training to OTP staff. Conferences promote evidence-based practices and patient-centered care. Webinar-based training resources will continue to be used to advocate for AATOD’s goals. The AATOD website itself promotes new training opportunities and helps ensure wide dissemination of policy documents. There will be a mobile version of the website for access on phones and other devices.
- International Work: AATOD will continue to work with the World Federation for the Treatment of Opioid Dependence and EUROPAD in increasing access to treatment. The United Nations Office on Drugs and Crime is also helping to increase resources for developing programs. Vietnam and African nations have been using PEPFAR funds to increase access to care. (PEPFAR—the President’s Emergency Plan for AIDS Relief—was created in 2003 to help certain hard-hit countries combat HIV/AIDS, TB, and malaria in hard-hit countries.) AATOD will continue to work with international and United States government organizations to promulgate evidence-based treatment.
- Prescription Drug Use: AATOD will continue working with the Denver Health and Hospital Authority’s RADARS System on patterns of prescription opioid use and heroin use, and with NDRI, AATOD’s research partner, to understand how OTPs can respond to changes in drug use patterns in different parts of the country. Prescription drug monitoring programs (PDMPs) are also important to OTPs. Patient care improves when OTPs access PDMP databases. Finding out what other medications their patients are taking provides increased opportunities for counseling as well.
One of the biggest challenges OTPs have faced—and still face—is opening new facilities. This is part of the challenge AATOD is taking up: how to educate “a wary American public” to overcome the stigma of using medications to treat opioid use disorders.
“Our focus has always been to improve access to care, and when such access is available to be certain that the quality of care is evidence driven and patient centered,” the five-year plan document concludes. “It is anticipated that the next several years will continue to represent major challenges to our system. It is critically important to educate Members of Congress, state legislatures and the American public about the value of treating opioid addiction with medications based on evidence.”
The full version of the plan can be accessed at: http://www.aatod.org/2017-2021/
An executive summary of the plan can be accessed at: http://www.aatod.org/aatod-five-year-plan-executive-summary/