Medication-Assisted Treatment (MAT) – Page 2

Dr. Jana Burson Blog: Guest Dosing at Opioid Treatment Programs

March 26, 2018

“Guest dose unto others as you would have others guest dose unto you.”

I think all opioid treatment program physicians should follow this twist on the Golden Rule.

That is to say, when OTP physicians are contemplating the appropriateness of approving one of our patients to be guest dosed at another OTP, we need to consider whether we would want to be on the receiving end of a similar patient.

What happens if the patient needs to go out of town before they are eligible for these take homes?

There are three options: leave treatment, the worst option, because of the increased risk of death for patients who leave treatment; special take home doses, often risky if the patient isn’t able to take them as prescribed; and guest dosing.

Guest dosing means a patient of one treatment program can be dosed at another program if that patient travels to another area. All opioid treatment programs send their patients for guest dosing and allow guest dosing for patients of other facilities. It should be a smooth and simple process, under ideal circumstances.

But sometimes circumstances get complicated.”

Source: Dr. Jana Burson – March 26, 2018

See Dr. Jana Burson’s blog Physicians’ Decisions to Start Buprenorphine: The Key Factors available at: https://janaburson.wordpress.com/2018/03/11/physicians-decisions-to-start-buprenorphine-the-key-factors/

Opioid Overdoses Treated in Emergency Departments: CDC Vital Signs New Report

March 10, 2018

“Emergency department (ED) visits for opioid overdoses rose 30% in all parts of the US from July 2016 through September 2017. People who have had an overdose are more likely to have another, so being seen in the ED is an opportunity for action. Repeat overdoses may be prevented with medication-assisted treatment (MAT) for opioid use disorder (OUD), which is defined as a problematic pattern of opioid use. EDs can provide naloxone, link patients to treatment and referral services, and provide health departments with critical data on overdoses.

Key points:

30% Opioid overdoses went up 30% from July 2016 through September 2017 in 52 areas in 45 states.
70% The Midwestern region witnessed opioid overdoses increase 70% from July 2016 through September 2017.
54% Opioid overdoses in large cities increased by 54% in 16 states.

Read more and download the fact sheet at: https://www.cdc.gov/vitalsigns/opioid-overdoses/

Source: Centers For Disease Control and Prevention – March 7, 2018

The States Taking the Opioid Epidemic Seriously (And Not), In One Map

March 10, 2018

“There’s a simple way to understand how the opioid epidemic got so bad in America: In the US, it is much easier to get high than it is to get help for addiction.

How this applies at the state level, though, can differ — some states have made an effort to build serious infrastructure around opioid addiction treatment, while others have not. This map from the health research firm Avalere Health, shows how states are doing in providing a key frontline treatment for opioid addiction (certified buprenorphine providers), compared to the amount of opioid overdose deaths they have.”

Source: Vox.com – February 22, 2018

New Opioid Treatment Model Increases Efficiency

March 10, 2018

“Drug overdose is the leading cause of accidental death in the U.S., according to the American Society of Addiction Medicine. The open-access treatment model, developed and implemented by a team of Yale researchers, has the potential to become a key component of treatment for people addicted to opioids.

Led by School of Medicine professor Lynn Madden, the research team recorded the behavior of patients with opioid abuse disorder at the APT Foundation, a substance abuse rehabilitation center in New Haven. Madden, also the CEO of APT, worked with five other professors from the School of Medicine. The study was conducted over 10 years; one year prior to the open-access model’s implementation and nine years after its initiation at the facility. The study was published online on Feb. 17 and will soon be printed in the journal Addiction.

The open-access model is defined in the paper as a framework “where prospective patients are enrolled rapidly in methadone maintenance treatment, irrespective of their ability to pay, and provided with real-time access to manifold group and individual treatment options from which they are free to choose.”

Source: YaleDailyNews.com – February 27, 2018

SAMHSA Publishes Guidance on Clinical Best Practices Using Medication-Assisted Treatment to Combat the Opioid Epidemic

February 21, 2018

“The Substance Abuse and Mental Health Services Administration (SAMHSA) is publishing guidance today to help broaden healthcare professionals’ understanding of medications that can be used to treat Americans with opioid use disorder (OUD).

“We know that people can and do recover from opioid use disorders when they receive appropriate treatment, and medication-assisted treatment’s success in treating opioid use disorders is well documented,” said Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use. “TIP 63 emphasizes that increasing access to medications to treat opioid use disorder will help more people recover, enabling them to improve their health, living full and productive lives.”

The Treatment Improvement Protocol (TIP) 63, “Medications for Opioid Use Disorder,” reviews the use of the three Food and Drug Administration-approved medications to treat opioid use disorders: methadone, naltrexone, and buprenorphine. Mandated by Section 303 of the Comprehensive Addiction and Recovery Act (P.L. 114-198), this TIP provides guidance for healthcare professionals and addiction treatment providers on appropriate prescribing practices for these medications and effective strategies for supporting the patients utilizing medication for the treatment of OUD. TIP 63 also educates patients, families, and the general public about how OUD medications work and the benefits they offer.”

The tip is available at: https://store.samhsa.gov/product/SMA18-5063FULLDOC

Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) – February 15, 2018

Which Opioid Addiction Treatments Work? White House OKs Study to Find Answers

February 21, 2018

“The White House has approved a new, national research effort headed by the Centers for Disease Control and Prevention to determine the most effective treatments for people battling opioid addiction.

The CDC, which received approval Monday from the executive branch, said it hopes that the study’s results will help inform policymakers, communities and providers on when drug-assisted therapies may or may not be appropriate.

“Few studies are available to help patients and providers make informed decisions about the risks and benefits associated with the different medication-assisted treatments,” the agency said in a notice.”

Source: ModernHealthcare.com – February 13, 2018

Why Do So Few Docs Have Buprenorphine Waivers?

February 21, 2018

“The barriers to obtaining a buprenorphine (Suboxone) waiver in the U.S. are small, but loom large in many physicians’ minds.

Only 46,500 — about 5% of the nation’s doctors — have waivers to prescribe buprenorphine, a medication used to treat opioid addiction. While that number has grown in recent years, it includes psychiatrists and addiction specialists, many of whom don’t practice in rural areas.

But even including those specialties, it’s not enough. “The current number of waivered physicians is not sufficient to ensure access to buprenorphine treatment for all individuals with opioid use disorder, even if every physician were prescribing at the maximum of their waivers,” said Hannah Knudsen, PhD, of the University of Kentucky College of Medicine in Lexington. Knudsen has studied the relationship between the supply of buprenorphine-waivered physicians and prescription opioid mortality.”

Source: MedPageToday.com – February 14, 2018

How Trump’s Medicaid Work Requirements Prevent Opioid Treatment

February 21, 2018

“Requirements to vet Medicaid patients to make sure they are working could prevent patients with opioid addiction from getting treatment, more than 160 groups told the Trump administration last week.

Highlighting the opioid crisis is the latest line of attack by health groups and patient advocates hoping to get the Trump administration to withdraw guidance on work requirements.

“Medicaid work requirements policy is directly at odds with bipartisan efforts to curb the opioid crisis,” the 160 national, state and local groups including the American Foundation for Suicide Prevention, the NAACP, Mental Health America and the American Psychological Association said in a letter Friday to U.S. Secretary of Health and Human Services Alex Azar.”

Source: Forbes.com – February 18, 2018

See related article from the Legal Action Center: Organizations Join to Oppose Medicaid Work Requirements – 2/15/18

Methadone Improves Inmate Outcomes

February 11, 2018

“Jail inmates who continue to receive methadone treatment for opioid use disorder have better outcomes both during and after incarceration, according to a new Yale study conducted in conjunction with several state agencies.

People receiving methadone treatment are often forced to withdraw from treatment when they go to jail, which can induce severe withdrawal symptoms and hamper their abilities to successfully reenter society after incarceration. To evaluate the impacts of forced withdrawal, the researchers investigated the effects of providing methadone in the New Haven Correctional Center. Published on Jan. 16 in the Journal of Addiction Medicine, the study was conducted in partnership with the APT Foundation and the Connecticut Department of Mental Health and Addiction Services.

“What this study has shown, from a policy perspective, is that if you maintain people on an evidence-based, FDA-approved medication for the disease of substance use disorder, then you can improve people’s lives when they leave [prison],” said Kathleen Maurer, director of Health and Addiction Services for Connecticut’s correctional system, who led the methadone program.”

Source: YaleDailyNews.com – February 2, 2018

AATOD Board Meeting Features Visits With Lawmakers, ONDCP, DEA, and SAMHSA

February 11, 2018

By Alison Knopf

The annual board meeting last December of the American Association for the Treatment of Opioid Dependence (AATOD) was more than just a meeting. Eight board members conducted a number of visits to Capitol Hill, educating Congressional representatives and staff. A key focus of these visits was getting reimbursement for Opioid Treatment Programs (OTPs) from Medicare Part B (which covers nonhospital treatment), said AATOD president Mark Parrino, MPA. “This will be a slow and labor-intensive process, but I believe that at the end, we will be successful,” Mr. Parrino told AT Forum.

The board also met with Richard Baum, MA, MPA, acting director of the Office of National Drug Control Policy (ONDCP); Demetra Ashley, MA, deputy assistant administrator for the Drug Enforcement Administration (DEA); Danielle Johnson Byrd, MPH, director of the Division of Pharmacologic Therapies at the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration; and Ms. Byrd’s staff. “They all led extremely productive discussions among AATOD board members,” said Mr. Parrino.

ONDCP

The ONDCP is expected to release the National Drug Control Strategy in March.

Speaking with the AATOD board, Mr. Baum, a longtime ONDCP official, continued to support the utilization of medication assisted treatment (MAT) for opioid use disorder (OUD), said Mr. Parrino. In addition to the use of medications, Mr. Baum stressed the need for offering comprehensive care services. “He expressed concern that treatment for opioid use disorder needs to reflect the best standards of care, so that we can be certain that patients are being properly treated when medications are selected by various treatment practitioners in the United States,” said Mr. Parrino. “ONDCP and its leadership continue to be supportive of the work of our Association and its members.”

Drug Enforcement Administration

The DEA officials who met with the AATOD board in December focused on three areas: mobile vans, telemedicine, and the new Narcotic Treatment Program Guidelines (NTP is the term the DEA uses).

Finalizing the mobile van policy development would certainly increase the use of mobile vans connected to the bricks-and-mortar OTPs, said Mr. Parrino. “We know that there are several states that want to purchase such vans so that they can expand the reach of OTPs in their areas.” For example, the Evergreen Treatment Services system in Seattle, Washington, is working in this area. In addition, the New York State Office of Alcoholism and Substance Abuse Services has indicated a strong interest in implementing mobile vans, especially in rural and upstate areas.

So, what is holding up the mobile vans issue? The DEA is interested in promulgating the rule, but is “running into some roadblocks regarding how fast they can introduce a new regulatory approach, at a time when deregulation seems to be the primary focus,” said Mr. Parrino. There will be more information at the conference in March when DEA leadership meets with the board of directors.

The release and implementation of the DEA’s new NTP guideline is being held back. The guideline discusses how mobile vans would be used, so it can’t be released until the mobile van policy is resolved.

AATOD is working with the American Academy of Addiction Psychiatry to develop telemedicine guidelines for OTPs. This matter will be discussed during the policy section of the March conference.

SAMHSA/CSAT

Danielle Johnson-Byrd and three of her associates led the discussion on how CSAT is targeting policies affecting OTPs in the United States. “We talked about the importance of proper OTP siting, especially as more treatment programs will be approved by CSAT to operate in the United States,” said Mr. Parrino.

There was also an in-depth discussion of the quality of care services offered through OTPs. CSAT reminded all board members that the agency will continue to promulgate effective oversight to be certain that OTPs follow existing standards, especially during a period of such rapid expansion.

The board also expressed concerns that states clearly demonstrate what they have done in using the grants from the State Targeted Response (STR) to the Opioid Crisis, issued by SAMHSA, for 2017. Are states using this money for MAT for OUDs? This is a matter of accountability, as states work to increase access to treatment; 80% of the STR grants had to be used for direct treatment for OUDs. But the board expressed concern that some states may be marginalizing the use of medications, such as methadone, or marginalizing OTPs themselves. For example, Wyoming decided not to use any STR grant funds for methadone maintenance treatment, and not to site any OTPs, Mr. Parrino noted.

“There are more encouraging reports from other states with regard to STR grant use, and it is expected that this will be reported on during the March conference in New York,” said Mr. Parrino. “There will be a number of policy discussions led by SAMHSA and CSAT representatives and it is certain this topic will come to surface.”

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