By Alison Knopf
Plenty of opioid treatment program executives are leaders in the field, but their names don’t get out nearly enough. This article is meant to change that. The list of leaders isn’t exhaustive, but it includes some of those at the helm of the nation’s opioid treatment programs (OTPs).
AT Forum asked the leaders what they consider their main achievements, what they see as the field’s biggest challenges, and what specific reasons they have—if any—for their deep interest in the opioid treatment field.
Their stories clearly reveal their love of the addiction treatment field. Surprisingly, when they entered the field, several had no intention of making it a long-term career commitment. But they started in it, for one reason or another, and simply “fell in love” with it.
We have profiled the following OTP leaders:
Their stories are below.
Ann Jamieson, MS, aged 46, is the Chief Operating Officer and Director of Professional Development for Maric Healthcare, a Tulsa, Oklahoma-based company operating OTPs across six states. Ms. Jamieson recently served as the Executive Director of Oklahoma Treatment Services, which runs seven OTPs in Oklahoma.
Ms. Jamieson received a BS in Psychology from Louisiana State University, and an MS in Counseling from Northeastern State University. She is licensed as a mental health and addictions counselor, and as a clinic supervisor.
When she was 25 years old, Ms. Jamieson started her career in opioid treatment—first, as a drug and alcohol counselor. Her passion for the field grew into a 21-year career, evolving from counselor to program director, then to many other leadership roles.
Under Ms. Jamieson’s leadership, the Oklahoma Association for the Treatment of Opioid Dependence (OKATOD) was established in 2010; she was elected its first president and AATOD delegate. Beginning in 2000, Ms. Jamieson was instrumental in expanding access to treatment, helping to open clinics in North Carolina, Oklahoma and Colorado. She continues to consult on CARF, regulatory compliance, and best practices for facilities within Maric Healthcare.
Ms. Jamieson has developed a series of trainings—approved by NAADAC—for CEU credits specific to substance use and unique to the needs of OTP providers and practitioners, and delivers training workshops across several states. As Director of Professional Development, she created an extensive set of initial and ongoing training programs for personnel at the OTPs managed by Maric Healthcare. These trainings have been vital to improving competencies of OTP personnel, and improving the quality of treatment and reputation of OTPs in many states.
Ms. Jamieson’s goals are to continue to improve the quality of treatment across Maric’s OTPs, and to engage in initiatives to improve opioid treatment throughout Oklahoma, working with OKATOD, and throughout the United States, working with AATOD.
“In the current climate of opioid treatment in the United States, it is essential that OTP leaders serve as gatekeepers and ensure that OTPs are providing no less than the highest quality of services to a population of patients that need this life-saving treatment,” concludes Ms. Jamieson. “In order to reach so many whose lives are at risk we have to battle a pervasive stigma that permeates our modality of treatment and serves as a strong accessibility barrier to treatment. This is what I strive for every single day.”
Jason Kletter, PhD, aged 47, is the President of BayMark Health Services, where he has worked for 25 years in operational, management, and executive roles. As his parents founded BAART (Bay Area Addiction Research and Treatment) in 1977, and added more programs, he grew up “hanging around” in the clinics, then working summers doing Medicaid billing through high school. His first clinic jobs in college included front-desk work, urine collection, then counseling and intakes. He assumed a leadership role in 1999 when BAART had 10 clinics in California.
He and his siblings grew BAART to 23 clinics in five states before partnering with Webster Capital, and then MedMark Treatment Centers. He then worked with the BayMark management team to grow the company to 167 locations in North America.
Dr. Kletter in 2010 led a successful campaign to block the effort by former Governor Schwarzenegger to eliminate Medicaid funding for addiction treatment services in California. He worked with the California Department of Health Care Services to adopt the hub-and-spoke model in the state, using the largest allocation of Opioid STR grant funding of any state to develop 19 hub-and-spoke systems.
Dr. Kletter earned his doctorate in organizational psychology in 2001. He serves as the President of the California Opioid Maintenance Providers (COMP), representing the state association with the largest group of opioid treatment programs in the country; and as a board member of the American Association for the Treatment of Opioid Dependence (AATOD). Dr. Kletter also Chairs the AATOD Legislative Affairs Committee.
The AATOD Nyswander-Dole awardee in 2015, Dr. Kletter works regularly with local, state, and federal government officials to advise on regulations, policy, funding, and health care trends. Dr. Kletter has served as advisor to the California State Department of Health Care Services on many committees, including the Narcotic Treatment Program Advisory Committee, The California Outcome Management System Workgroup, the Counselor Certification Advisory Committee, and the 1115 Waiver Advisory Group.
He has also participated in federal Substance Abuse and Mental Health Services Administration initiatives, advising on accreditation guidelines and evaluating training curricula for opioid treatment program physicians, as well as advising state legislators helping to craft sound policy into legislation. Dr. Kletter was appointed by California’s Governor Jerry Brown to the Lawyers Assistance Program Oversight Committee in 2013.
“The opioid epidemic in the U.S. and Canada has wreaked havoc on peoples’ lives, families, and communities,” said Dr. Kletter. “Like the HIV epidemic of the 1980s, the current opioid epidemic has created widespread awareness about opioid use disorder. With that awareness has come a tsunami of opinions about how to treat opioid use disorder, and more broadly about how to solve the epidemic.
“Many of those opinions are science-based and innovative, but some are philosophically based and potentially harmful. Our field must remain vigilant in educating our communities, and especially policy-makers, at all levels, as often as possible, about opioid use disorder and the effectiveness of medication-assisted treatment.”
On the bright side, the attention has brought significant new resources to treatment, added Dr. Kletter. And he urged the field to advocate for funding and policies that support a continuum of evidence-based services. “This means meeting with State Opioid Treatment Authorities and state and federal legislators to steer current and new funding toward increasing access to medication-assisted treatment and, critically, evaluating the effectiveness of all funding for opioid use disorder.”
On “medication-assisted treatment,” or MAT, Dr. Kletter said this can be delivered in various settings, all of which have merit. “We know from many years of research that MAT has the greatest chance of helping people recover from opioid use disorder,” he said. “But it’s critical that we not conflate terminology—MAT has always been defined as the use of medication in combination with robust psychosocial support services.
“More recently, there are efforts to undermine that science, suggesting that medication alone is sufficient to treat opioid use disorder. Our field must continue to ensure the provision of high-quality, evidence-based practices, despite calls by some for diluting the quality of care provided in the interest of prescribing more medications.”
Robert C. Lambert
Robert C. Lambert, MA, aged 54, president and executive director of Connecticut Counseling Centers, Inc., began as an entry level counselor in the center’s Methadone Maintenance Treatment Program (MMTP). He told AT Forum that he signed on immediately after graduating with a bachelor’s degree in psychology, “because it was the only decent position in the counseling field available at the time.”
Mr. Lambert admitted he didn’t know much about methadone back then. “I fully intended to work as a methadone counselor for a year or two, to gain some experience, then move on to a ‘real’ counseling position,” he said. His goal was to become a clinical psychologist; in fact, at the time he had no real interest in addiction treatment.
“However, during that first year, I fell in love with the population I was treating, and never left.”
Among his accomplishments, Mr. Lambert, now a Licensed Alcohol and Drug Counselor with 31 years of experience in the field, created the Connecticut Certified Alcohol and Drug Abuse Counselor Training Program; helped establish a Master’s Degree Certificate Program in Addictions Counseling at Albertus Magnus College; and created and implemented the nationally recognized innovative MMTP based peer-mentoring program, Bridge to Recovery.
In 2012 his Bridge to Recovery program received the prestigious Substance Abuse and Mental Health Services Administration “Science and Service” award. This was followed in 2016 by the Nyswander-Dole (Marie) Award, presented to Mr. Lambert by the American Association for the Treatment of Opioid Dependence (AATOD).
Mr. Lambert also had a role in significantly expanding access to medication-assisted treatment (MAT) in Connecticut, where he chairs the Methadone Treatment Provider Group. Mr. Lambert is currently a member of the AATOD Board of Directors and is the Chair of the 2019 AATOD Conference Workshop Committee.
But he’s not resting on his laurels. His goals include expanding access to all approved medications for opioid use disorders, regardless of insurance coverage. This applies to OTPs as well, for OTPs must now embrace all FDA-approved medications, he said. In addition, “collectively, we need to keep the pressure on to achieve parity.”
Another goal is to eliminate or at least greatly reduce stigma, which is responsible for so many barriers to care, he said. To that end, Mr. Lambert has facilitated numerous regional and national forums on stigma and misinformation regarding MAT. He has also authored research on MAT related attitudes in the behavioral healthcare field and the effect of stigma on counselor expectations and patient outcomes in MAT.
Finally, Mr. Lambert emphasizes that during this current period of MAT expansion, programs must make sure that quality of care is consistent, and high. “The world is watching,” he said.
Christine Martin, LMFT, CACII, aged 35, is director of clinical services for Center for Behavioral Health, North Charleston, South Carolina. She started working as an OTP counselor shortly after completing her Master’s degree program in marriage and family therapy.
“Initially, I didn’t envision staying in the field, but it wasn’t long before I found myself invested in the work and passionate about the population and the treatment modality,” she said. Eventually, she was given the chance to advance with Center for Behavioral Health, an organization with 22 OTPs across the country.
In 2016 Ms. Martin was elected president of the state OTP association, SCATOD (South Carolina Association for the Treatment of Opioid Dependence). With that role came representations of the state on the AATOD board. She is also the spokeswoman for the South Carolina OTPs with the state drug and alcohol authority.
“We secured contracts with our state authority during year one of the Opioid STR grant to cover methadone treatment for pregnant and postpartum women unable to pay,” she said. For year two, this will be expanded to cover services for all patients who are indigent or cannot pay. “Our year-two contracts will include funding for OTPs to implement, at their sites, Overdose Education and Naloxone Distribution (OEND) programs,” she added.
Ms. Martin’s primary, immediate goal is to get coverage for OTP services under SC Medicaid. South Carolina is one of a handful of states that does not cover methadone treatment and OTP services under Medicaid. “We are continuing to work with SC DHHS, and hope to see this accomplished within the next year,” said Ms. Martin. “I would also love to see better integration of medication-assisted treatment in our drug courts and incarcerated settings here in South Carolina.”
Ms. Martin believes that the most important thing for OTPs to do now, while funding is being increased because of the opioid epidemic, is to reach out and work with their State Single Authority (SSA)—the agency or person in charge of the Substance Abuse Prevention and Treatment Block Grant, and the STR grants. “I think it is essential that we give input into the use of these funds, and better coordinate and expand the capacity of our systems of care,” she said. “There are quite a few care coordination models emerging where OTPs are being utilized for their specialty expertise.”
Finally, Ms. Martin urges OTPs to embrace the peer recovery movement. She serves on the board of FAVOR Lowcountry, her local Recovery Community Organization. “I see great value in people being able to recover within a fellowship of peers and within their communities,” she said. “In a couple of the states where Center for Behavioral Health operates, we’ve been able to use STR funds to begin adding peer support to our service array.”
She would also like to see more patients who are in medication-assisted treatment getting certified or trained to become peer coaches or support specialists. “I think it is important to have medication-supported recovery represented in this movement.”
Stacey Pearce, aged 43, Chief Compliance Officer at Alliance Recovery Centers, in Georgia, started working in an OTP in 1995 as a part-time receptionist. “It was one of three jobs to pay my rent and bills,” she said. “I never had intentions of working in substance abuse treatment, and didn’t think I would make a career of it. But I really enjoyed watching the changes people were able to make in their lives after entering medication-assisted treatment.”
She decided that she wanted to work in the field, and changed her college classes to reflect that.
Mrs. Pearce has developed good relationships with many people in state offices to identify and meet the needs of patients and providers in the state. Among her other accomplishments, she opened an OTP in an underserved area in 2002 at the age of 27; has been a CARF surveyor; has been an active and involved AATOD board member for more than a decade; received the Nyswander-Dole (“Marie”) award; and helped organize Methadone Treatment Awareness Day at the state capitol.
Her top goal currently is to get a bundled rate from Medicaid, to cover take-home medication. She also wants OTPs and office-based providers to have better relationships, so patients “can receive more coordinated care that suits their needs and enhances their recovery,” she said. “Higher-need patients can be treated in OTPs, and once they become stable, and lower need, they can transition to OBOT.”
Pearce also wants to decrease stigma within the Department of Family and Children Services, and to be able to coordinate better with patients when there are open cases.
Finally, she wants to have medication-assisted treatment in the state’s correctional facilities.
Ms. Pearce urges more collaboration among OTPs. “I think one of the missing pieces within the leadership of many OTPs is a sense of commitment to the field as a whole and a willingness to do things for the greater good,” she said. “Many people are inwardly focused and involved in what is going on in their clinic or their small area of the world and are missing the broader conversation. By not being involved in the providers organization or group in your state, and not attending the national AATOD conference, you are missing opportunities for growth and learning. All levels of clinic personnel need to be involved in things and attend educational opportunities, or the facility will become stagnant and out of touch.”
Allegra Schorr, aged 56, is president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA). Ms. Schorr has over 25 years of experience in health care and substance use treatment services. An owner and vice president of West Midtown Medical Group, an OTP, Ms. Schorr also represents New York State as a board member of AATOD, and was chair of the 2018 national AATOD conference.
Through her efforts, West Midtown Medical Group became the first opioid treatment program to dispense buprenorphine in an OTP setting in New York State. Most recently Ms. Schorr was appointed to the New York State Pain Management Steering Committee, formed as part of the State’s 2018-2019 Budget.
Ms. Schorr is a graduate of Sarah Lawrence College and expects to complete her Master’s of Science degree in Healthcare Management at Rutgers University-School of Health Professionals at the end of 2018.
Ms. Schorr’s father and uncles began managing Methadone Maintenance Treatment Programs in 1973. “I grew up around MMTPs and learned at an early age how methadone could help patients,” said Ms. Schorr. “After college, I worked on developing an HIV treatment program that would provide outpatient medical care for patients with HIV who were enrolled in the MMTP.” She submitted a certificate-of-need application for the MMTP to become certified as West Midtown Medical Group, a NYS Article 28 Diagnostic and Treatment Center—a comprehensive primary care facility with OTP and outpatient treatment for substance use disorders. (The MMTPs were Article 33 facilities.) The application was approved, and “my sister, cousins, and I became the owners of West Midtown Medical Group, located on West 35th Street in Midtown Manhattan.
“OTP leaders need to be alert to and speak out against stigma regarding MAT—and especially methadone,” said Ms. Schorr. On the other hand, “we need to hear legitimate criticism regarding our programs, and take positive steps to respond and improve things,” she said. “OTPs truly are essential hub sites and can provide leadership for the entire treatment field. The framework for OUD treatment in an OTP has enormous potential to offer integrated and coordinated care. Our leaders should think about how to utilize this structure to respond to our patients and our communities, and to turn the tide on the opioid epidemic.”
Ms. Schorr is also president of the Coalition of Medication-Assisted Treatment Providers and Advocates.
Nick Stavros, age 39, CEO of Community Medical Services, presided over the recent sale of the OTP platform to the private equity firm, Clearview Capital. The sale relieved the inactive owners of their equity in the company, and left Mr. Stavros as the largest individual owner. With Clearview leaving him at the helm as CEO, no operations are expected to change within the Arizona-based
Even though the OTP system began as a family business, Mr. Stavros did not grow up in the industry. “Five years ago, I didn’t know what methadone treatment was,” he told AT Forum. Prior to joining the company, he spent eight years in the military, and then left his position as an Infantry Captain and attended UCLA, where he earned an MBA. His parents, who founded the company in 1983, called him soon after and asked him to join the business to help them prepare the company for a sale. “This was in 2012,” he said. He was on the job for nine months, and found out that he had a strong passion for treating
So he changed course. Instead of prepping the company to sell to a larger organization, he decided he’d rather stay with it and partner with a private equity firm to buy out the other owners—family members and non-family members. “With the intention of staying with the company, I spent four years building a platform to grow from, to attract investors.” He partnered with Clearview Capital after meeting with numerous interested investors, because “they have an outstanding reputation in this space,” he said. “They’re pretty hands off and their values aligned most with
“I love what I’m doing,” said Mr. Stavros, asked why he is staying involved. “From an entrepreneurial perspective, this is an opportunity to build an amazing business. We are very patient-focused; We live by our values; I do a mission, vision, values presentation with every new employee and a weekly online town-hall meeting with the whole company. We make decisions based on our values and we are all impassioned by the uphill battle of our cause and by the tenacity of our patients in their recovery. There aren’t a lot of companies out there that continue to grow while staying true to their
Under his tenure, Community Medical Services has grown from 6-14 clinics in 4 states and from one Medicaid contract to more than 15. “Our goal was to be cash-flow neutral every year, investing every penny back into the company,” he said. “By the end of 2018, we’re going to be at 21 organic clinics and the private equity funds will allow us to potentially add on an additional 10-20 acquisitions. The goal is to be treating 60,000 patients by the end of 2022.” Currently, the program treats more than 5,000
There is still a shortage of slots nationwide. “One of the problems is that there is mostly just a consolidation taking place,” he said. “The growth rate of new OTPs isn’t coming close to paralleling the growth rate of the
Finally, Mr. Stavros seconded other leaders who said it’s important for OTPs to get involved in their communities and to seek out STR funds and other new forms of funding. “We are the largest recipient in the state of Arizona for STR funds,” he said. With those funds, the program has started the country’s first 24/7 OTP, a number of Medication Units, and a vibrant peer support
As with many other advocates in this space, Mr. Stavros has a personal connection to this field. His sister died from a heroin overdose when she was 21.
Zachary C. Talbott (“Zac”), aged 35, a native of Tennessee, is administrator and program director of Counseling Solutions Treatment Centers, based in Georgia. When he was at the University of Tennessee Knoxville College of Social Work, pursuing his Master of Social Work (MSW) degree, his addiction to prescription opioids and heroin spun out of control, leading to an academic dismissal.
After several years of “spiraling into the darkest places opioid addiction can take an individual,” as he puts it, Mr. Talbott found evidence-based treatment at an opioid treatment program (OTP). When he achieved a stable dose of methadone and took part in individual counseling, the “old Zac” quickly re-emerged. He then became involved in recovery advocacy, joining a Tennessee/Northwest Georgia Chapter of the National Alliance for Medication Assisted Recovery (NAMA), and serving on the national Board of Directors of NAMA until March of 2017.
Since he started his long-term recovery, Mr. Talbott has re-enrolled in the MSW program his addiction robbed him of years ago, and has opened two opioid treatment programs under the name “Counseling Solutions Treatment Centers”: Chatsworth, Georgia, in February 2016; and Brasstown (Murphy), North Carolina, in March 2017.
Mr. Talbott serves as program sponsor of both OTPs, and as program director of the OTP in Chatsworth, Georgia. He also co-founded, along with Sharon Dembinski—at the time, director of quality and clinical services for MedMark Treatment Centers—the Methadone (and buprenorphine) Discussion Group on Facebook.
As a “closed group,” where only approved members can see posts or make comments, the Methadone Discussion group has grown into the largest online community for Medication-Assisted Treatment (MAT) support and information, boasting more than 8,000 members. Most members are methadone and buprenorphine patients, but some are MAT providers and family and friends of MAT patients. Mr. Talbott was committed to ensuring that those enrolled in or considering MAT would always have a safe place to go; where credible information could be provided, and shared experiences in recovery would be a source of strength.
Mr. Talbott is a Certified Alcohol and Drug Counselor, Level II (CADC II), through the Alcohol & Drug Abuse Certification Board of Georgia (ADACBGA); a Certified Addictions Counselor, Level II (CAC II), through the Georgia Addiction Counselors Association (GACA); a Medication-Assisted Treatment Specialist (MATS), through the ADACBGA; an Internationally-Certified Alcohol & Drug Counselor (ICADC), through IC&RC; a Registered Addiction Specialist (RAS), through the Breining Institute; and a Certified Medication-Assisted Treatment Advocate (CMA), through NAMA Recovery. He currently serves on the Credentialing Committee and Board of Directors of the Alcohol and Drug Abuse Certification Board of Georgia (ADACBGA), and the Georgia IC&RC affiliate and addiction counselor credentialing body, as well as on the Board of Directors of the Southeastern Institute on Chemical Dependency (SICD).
Mr. Talbott has been a Recovery Month Planning Partner with the Substance Abuse and Mental Health Services Administration (SAMHSA) for the last four years. Despite his ability to successfully engage in medically supervised withdrawal, slowly tapering the dosage of his medication in transition to a medication-free state of recovery, he acknowledges that “one size does not fit all.” He believes firmly that our response to the opioid crisis must include public education that acknowledges long-term or even indefinite maintenance with methadone or buprenorphine may be necessary for some people, as it is for any other medication for any other illness. He remains passionate about evidence-based treatment approaches, and will always be, first and foremost, a patient advocate.
Mr. Talbott feels it is important that clinicians and medical professionals not lose their place in the leadership of an ever-merging field. Always remembering and acknowledging that opioid treatment programs first and foremost provide medical treatment and clinical care to an overly stigmatized and vulnerable population is critical to turning around the current opioid addiction and overdose epidemic. While he acknowledges that OTPs have a business component that is important to ongoing sustainability, he believes it is critical to ensure that physicians with expertise in addiction medicine, and counselors or clinical social workers with training in substance use disorders, remain in the leadership positions of companies that operate opioid treatment programs and office-based medication-assisted treatment clinics.
Dr. Mary Jeanne Kreek, one of the three founders of methadone treatment, alongside Doctors Vincent Dole and Marie Nyswander, inspired Mr. Talbott so deeply that her words remain his daily mantra. Dr. Kreek told him at the 2013 AATOD Conference in Philadelphia: “The love and care of patients is what everything we do and every decision we make should ultimately be about.”