Medication Assisted Treatment: A Standard of Care. An interview with Elinore McCance-Katz, MD, PhD, Chief Medical Officer, SAMHSA

Edit-Dr.M-KNote: This interview was issued by SAMHSA’s HRSA Center for Integrated Health Solutions in their February 2014 eSolutions newsletter.

“We have a huge need in our country to treat mental health and substance use concerns, and we have a chronic shortage of specialty care programs with enough capacity to treat everyone with a substance use concern. It is our responsibility to expand access to this care in a way that allows greater choice of where individuals can receive treatment.

With the Affordable Care Act, the treatment of substance use disorders is now an essential benefit. Individuals with multiple complex healthcare needs, including mental health and substance use concerns, can be seen in integrated care settings and health homes.

We are going to see more and more integrated care. All healthcare providers, whether in primary care, mental health, or substance use treatment, will need to learn how to provide treatment for disorders they may not have historically treated. Providers who are not used to treating patients with certain types of problems may not feel confident about providing care. When that happens, the individual is less likely to get the care they need. Primary care providers especially will need to be ready to assess and provide treatment for clients who present with mental health and substance use concerns.

The Need for Medication Assisted Treatment

Medication assisted treatment (MAT) is a standard of care. There are a variety of medications that have been shown to be effective in treating substance use disorders and that can be used safely. Specifically, there are a number of FDA-approved medications for tobacco, alcohol and opioid abuse treatments.

MAT is an effective form of care, when medication is taken as prescribed, used properly, and the individual is engaged with other supports and services. With opioid use disorders, studies show that clients who get medical detoxification only have a greater than 90% relapse rate.

We have to think about how effective the treatment is, what the alternative is if not treated, and where an individual is in their recovery. Individuals with chronic relapsing diseases should have access to MAT. It’s just the standard of care. We cannot diminish the importance of that.

Substance use disorders are not simply treated by taking a medication. In fact, taking medications can be part of the problem. Just giving someone medication is not enough. Psychosocial interventions, counseling, and other services are absolutely necessary and will always be very important.

Integrated care providers are going to have to learn about how to use these medications. Many medications can be used within primary care. We’re going to see a spectrum of severity with clients in primary care. Some may need referral to specialty care and others can be treated at the primary care organization.”

The interview can be accessed at: http://www.atforum.com/addiction-resources/documents/SAMHSA-MAT-A-Standard-of-Care-Feb-2014.pdf

Source: The Substance Abuse Mental Health Services Administration – February 2014

SAMHSA’s New Report Tracks the Behavioral Health of America

 

samhsa“A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends – many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.

SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key indicators of behavioral health problems including rates of serious mental illness, suicidal thoughts, substance abuse, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.

The Barometer indicates that the behavioral health of our nation is improving in some areas. For example, the rate of prescription pain reliever abuse has fallen for both children ages 12-17 and adults ages 18-25 from 2007 to 2011 (9.2 percent to 8.7 percent and 12.0 percent to 9.8 percent respectively).

In the United States, only 14.8% of persons aged 12 or older with illicit drug dependence or abuse (an estimated 1.1 million individuals) in 2012 received treatment for their illicit drug use within the year prior to being surveyed.

The Barometer also shows more people are getting the help they need in some crucial areas. A case in point is that the number of people getting buprenorphine treatment for a heroin addiction has jumped 400 percent from 2006 to 2010. In 2012 the number of people who received buprenorphine as part of their substance abuse treatment was 39, 223. The number of people who received methadone as part of their substance abuse treatment was 311,718 in 2012.

The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.

“The Barometer is a dynamic new tool providing important insight into the “real world’ implications of behavioral health issues in communities across our nation,” said SAMHSA’s Administrator, Pamela S. Hyde.”Unlike many behavioral health reports, its focus is not only on what is going wrong in terms of behavioral health, but what is improving and how communities might build on that progress.”

The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.”

To view and download copies of the national or any state Behavioral Health Barometer, please visit the SAMHSA web site at http://store.samhsa.gov/product/SMA13-4796?from=carousel&position=1&date=0130214

http://www.samhsa.gov/newsroom/advisories/1401301041.aspx

Source: – Substance Abuse and Mental Health Services Administration – 1/31/14

Winter 2014 Issue of SAMHSA News Now Available Online

Articles of interest on parity and the Affordable Care Act include:

  •  Final Parity Rule Issued – Learn what the final rule on the Federal Parity Law means for insurance coverage of behavioral health services.
  • Affordable Care Act Update – Q&As on the Health Insurance Marketplace and the latest on efforts to enroll consumers.

http://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_1/default.aspx

Source: Substance Abuse and Mental Health Services Administration – February 3, 2014

Quick Guide for Administrators, Based on TIP 52: Clinical Supervision and Professional Development of the Substance Abuse Treatment Counselor

Offers tips for program administrators on developing a best-practices program for clinical supervision in the substance abuse treatment field. Presents key issues to consider, including cultural competence, supervisor ethics and values, and more.

The Guide is available to order at: http://store.samhsa.gov/product/Quick-Guide-for-Administrators-Based-on-TIP-52/SMA13-4771

Source: The Substance Abuse Mental Health Services Administration – October 2013

Article from SAMHSA News: Emergency Response: SAMHSA’s Regional Administrators

coping“In January 2012, the Substance Abuse Mental Health Services Administration (SAMHSA) placed regional administrators (RAs) in each of the 10 Department of Health and Human Services’ (HHS) regional offices for the first time in its history. By spreading some of its staff across the country, SAMHSA helped to ensure that mental and substance use disorders are addressed in the regions along with all other health issues. The RAs provide information to communities; providers; state, territorial, and tribal representatives; and others in their regions. They facilitate SAMHSA’s collaboration with other HHS colleagues. They also help SAMHSA stay informed about behavioral health needs throughout the country.

“The RAs have been remarkably effective at making sure behavioral health has been at the table for discussion at the state level,” said Anne Herron, Director of the Division of Regional and National Policy Liaison at SAMHSA, who serves as the coordinator between the RAs and SAMHSA’s central office. “This wasn’t possible when everything was centralized in Rockville, MD.”

Two recent events—Hurricane Sandy and the Boston Marathon bombings—show that the RA system is especially well-suited to responding to disasters and terrorism.

When Hurricane Sandy slammed into New Jersey last October, the damage was unprecedented. From ripped-up boardwalks on the Jersey shore to a flooded lower Manhattan, the impact would be felt for months to come. For SAMHSA’s Region II Administrator Dennis O. Romero, M.A., the disaster was a test of preparedness, communication, and effective response—in short, a test of SAMHSA’s regional administrator (RA) system itself.

While storms can be predicted hours or days before, what happened in Boston on April 15, 2013, came without warning. Two pressure cooker bombs exploded at the finish line of the Boston Marathon, and the city instantly took on a stark atmosphere of worry, concern, and fear.

RA Kathryn Power quickly mobilized to manage the crisis intervention and mental health support that would be needed in the weeks and months to come.”

To see how the RAs responded to these disasters, the article can be accessed at: http://www.samhsa.gov/samhsaNewsletter/Volume_21_Number_3/regional_administrators.aspx

Source: The Substance Abuse and Mental Health Services Administration SAMHSA News – Summer 2013

SAMHSA’s New Medical Director Will Focus on Medical Treatment of Addiction

Edit-Dr.M-KElinore McCance-Katz, MD, PhD, the first medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), shared with AT Forum her view of her new role in an interview in late June. She focused on opioid treatment programs (OTPs) in our discussion, but she is bringing to the agency a renewed concentration to medical treatment of serious mental illness and addiction in general. She was hired effective June 3.

My role at SAMHSA is one of providing input on medical and psychiatric issues related to the treatment of substance use and mental disorders,” Dr. McCance-Katz said. She has extensive experience working in large research programs based within OTPs, most recently with the development of buprenorphine treatment under SAMHSA, and with the National Institute on Drug Abuse, as the Drug Abuse Treatment Act of 2000 was implemented. And with health care reform on the near horizon, she sees OTPs providing treatment not only for substance use disorders (SUDs), but also for primary medical care on site, an important link for this population. “We’re going to have literally millions of people coming into the health care system,” she said.

We asked Dr. McCance-Katz, an ardent supporter of medication-assisted treatment (MAT), what SAMHSA’s role should be when states and insurance companies try to restrict access to medications like methadone and buprenorphine for treatment for opioid addiction. “I believe in individuals being offered all treatment options, and I believe methadone is an appropriate treatment for many individuals,” she said. “Having said that, that’s pretty much the extent of what I can do, from the perspective of a government agency.” However, she said that she thinks she will be able to advocate for MAT. If states asked for her opinion, she would say that methadone needs to be available and accessible to patients.

One of the main distinctions between physicians prescribing buprenorphine and OTPs dispensing methadone is the required ancillary services for OTPs, particularly counseling. Dr. McCance-Katz said SAMSHA already strongly advocates for counseling, whether the medication is buprenorphine or methadone. “Look at TIP 40,” she said, referring to the SAMHSA publication, Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. “It’s very clear that prescribing physicians are advised strongly” to refer patients to counseling. “In our buprenorphine trainings, and I can speak to this very well, there’s a huge focus on the counseling piece,” she said. “To get the waiver to prescribe, they have to say that they will evaluate and refer for ancillary services if they’re not going to provide them themselves—that’s been SAMHSA’s view from the start.”

She said that OTPs could provide counseling to buprenorphine patients, but was unclear about how they would be reimbursed for this. OTPs have expertise in counseling, and many physicians don’t know where to refer patients for counseling, she said. In addition, drug testing, which Dr. McCance-Katz called “the backbone of treatment,” could be done by the OTPs. “Somebody has to do the drug testing, either the physician prescribing the buprenorphine, or the OTP.”

In addition to advocating for MAT, Dr. McCance-Katz will be focusing on treatment for severe mental illness and other disorders related to behavioral health care. She has a background in general psychiatry, is board certified in addiction psychiatry, spent most of her career in addiction medicine, and most recently was medical director of California’s Department of Alcohol and Drug Programs (which ceased to exist on July 1). She was also on the faculty of the University of California, San Francisco.

SAMHSA Request for Comments on the Federal Guidelines for Opioid Treatment

SAMHSAOn May 16 the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a Dear Colleague letter seeking public comments on the revised 2007 SAMHSA Guidelines for the Accreditation of Opioid Treatment Programs. These guidelines elaborated upon the Federal opioid treatment standards set forth under 42 CFR Part 8.

The Federal Guidelines for Opioid Treatment are intended to inform accreditation organizations in revising their accreditation standards. In addition, the Guidelines provide useful elaborations on the regulatory standards set forth under 42 CFR Part 8. As such, the updated guidelines will assist both accreditation organizations and OTPs in complying with regulatory requirements.

Prepared initially in 1997, SAMHSA’s Guidelines for Opioid Treatment are being updated now to reflect new information and research in the field of opioid assisted treatment. The Center for Substance Treatment (CSAT) convened an expert panel to provide the draft guideline now being circulated for comment. CSAT is soliciting comments on the guideline from the public, and expects comments from OTPs, accreditation organizations, patients, the medical community, and other interested parties.

In order to publish a revised guideline, CSAT will consider all comments submitted by July 16, 2013.

The Dear Colleague letter is available at: http://www.dpt.samhsa.gov/pdf/dearColleague/DearColleagueAccredGuidelines5-16-13.pdf

The revised draft of the Guidelines is available at: http://www.dpt.samhsa.gov/pdf/FederalGuidelinesforOpioidTreatment5-6-2013revisiondraft_508.pdf

Source: SAMHSA.gov – May 16, 2013

SAMHSA Appoints Elinore F. McCance-Katz, M.D. to the New Position of Chief Medical Officer

“The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Administrator Pamela S. Hyde announced the appointment of Elinore F. McCance-Katz, M.D., Ph.D. as SAMHSA’s first chief medical officer. In this capacity she will provide medical-scientific expertise to SAMHSA’s major behavioral health efforts including those promoting the prevention of mental illnesses and substance use disorders, as well as the treatment and recovery of people from these conditions.

Dr. McCance-Katz will also work with leading scientists in the field of behavioral health to ensure that SAMHSA is advancing the most effective, state-of-the-art, evidence-based approaches to promoting the nation’s behavioral health services. She will also represent SAMHSA on key departmental groups requiring medical expertise and work with stakeholder groups on clinical issues.

In her post as chief medical officer, Dr. McCance-Katz will play a key role in providing a medical perspective to SAMHSA’s staff and advisory committee members on the wide range of behavioral health issue they address. She will also organize, direct, present and participate in other public meetings and symposia involving SAMHSA’s work and the field of behavioral health.”

http://www.samhsa.gov/newsroom/advisories/1305203306.aspx

Source: SAMHSA.gov - May 20, 2013

New Tip Manual from SAMHSA: Addressing Substance Use Disorders in Men

TIP 56: Addressing the Specific Behavioral Health Needs of Men presents the specific treatment needs of adult men with substance use disorders. TIP 56 reviews gender-specific research and best practices, such as common patterns of initiation of substance use among men and specific treatment issues and strategies.

The manual is available to download at: http://atforum.com/addiction-resources/documents/SMA13-4736.pdf

Source: The Substance Abuse Mental Health Services Administration – May 2013

Federal Rule Provides Flexibility in Dispensing Buprenorphine for Opioid Addiction Treatment in OTPs

The Substance Abuse Mental Health Services Administration (SAMHSA) issued a Federal rule to allow patients being treated through an opioid treatment program (OTP) to receive take-home supplies of buprenorphine from an OTP in a more flexible manner. Buprenorphine is a medication used in opioid addiction treatment. The regulation takes effect on January 7, 2013.

Under the rule change, OTPs will be permitted to dispense buprenorphine to eligible patients without having to adhere to previous length of time in treatment requirements. Currently, OTPs require a person to be in treatment a certain amount of time before being given a multiple days’ supply of medicine to take home.

The change in the rule will not affect requirements for dispensing methadone. SAMHSA based the change in the restrictions for dispensing buprenorphine on several factors. These include differences in the abuse potential between methadone and buprenorphine, as well as the actual abuse and mortality rates (buprenorphine is lower in each instance).

For more information on the rule, go to: http://www.ofr.gov/OFRUpload/OFRData/2012-29417_PI.pdf

The Federal Register notice can be accessed at: https://www.federalregister.gov/articles/2012/12/06/2012-29417/opioid-drugs-in-maintenance-and-detoxification-treatment-of-opiate-addiction-proposed-modification

Source: The Substance Abuse Mental Health Services Administration – December 6, 2012

New Issue of SAMHSA News Features Articles on Health Information Technology

The Winter/Spring 2012 issue of the Substance Abuse Mental Health Services Administration (SAMHSA) News feature articles on Health Information Technology: What It Means For You and SAMHSA Enhances Health Information Technology Efforts.

SAMHSA Administrator Pamela S. Hyde, J.D. notes “the full impact of a health system that opens the door to rapid, efficient, innovative care can only be realized when behavioral health providers are able to access and embrace health information technology (HIT) and electronic health record (HER) systems to coordinate care with primary care providers.”

http://www.samhsa.gov/samhsaNewsletter/Volume_20_Number_1/Winter2012-volume-20-number-1.pdf

Source:  Substance Abuse Mental Health Services Administration – May 2012    

Why Xanax is the Most Popular Anti-Anxiety Drug in America


So reliably relaxing are the effects of benzodiazepines that ­SAMHSA’s director of substance-abuse treatment, H. Westley Clark, says they’ve gained a reputation as “alcohol in a pill.” And their consumption can be equally informal. Just as friends pour wine for friends in times of crisis, so too do doctors, moved by the angst of their patients, “have sympathy and prescribe more,” says Clark. There are a lot more benzos circulating these days, and a lot more sharing.

http://nymag.com/news/features/xanax-2012-3/

Source: New York Magazine – March 18, 2012

SAMHSA News Winter 2012 Now Available Online

The Winter edition of the Substance Abuse Mental Health Services Administration is now available online at: http://www.samhsa.gov/samhsaNewsletter/Volume_20_Number_1/Winter2012-volume-20-number-1.pdf

Articles in this issue include:

¨       Health Information Technology—What It Means for You

¨       SAMHSA Enhances Health IT Efforts

¨       Behavioral Health IT Resources

¨       View From the Administrator: Embracing Health Information Technology

¨       Using Social Media To Save Lives

¨       Study Finds One in Five American Adults With Mental Illness

¨       National Survey on Drug Use and Health shows 45.9 million adults across the United States experienced mental illness in the past year.

¨       SAMHSA’s Budget Affirms Commitment to Behavioral Health

¨       Celebrating 20 Years of Behavioral Health Advances

¨       SAMHSA Releases Two New Resources

Source: Substance Abuse Mental Health Services Administration – March 29, 2012

SAMHSA Announces Working Definition and Guiding Principles of Recovery

A new working definition of recovery from mental disorders and substance use disorders was announced Dec 22 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.

The new working definition of Recovery for Mental Disorders and Substance Use Disorders is as follows:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
  • Home: a stable and safe place to live;
  • Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
  • Community: relationships and social networks that provide support, friendship, love, and hope.

The press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

For more on the Guiding Principles of Recovery go to: http://blog.samhsa.gov/2011/12/22/samhsa%E2%80%99s-definition-and-guiding-principles-of-recovery-%E2%80%93-answering-the-call-for-feedback/

Source: The Substance Abuse and Mental Health Services Administration – December 22, 2011

New Report: Illicit Drug-Related Emergency Department Visits in Metropolitan Areas of the United States: 2009

hospital signMajor metropolitan areas show significant variation in the rates of emergency department (ED) visits involving illicit drugs. In terms of overall illicit drug-related emergency room visits, Boston has the highest rate (571 per 100,000 population), followed by New York City (555 per 100,000 population), Chicago (507 per 100,000 population), and Detroit (462 per 100,000 population). By comparison the national average was 317 per 100,000 population.

This new report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) was drawn from the agency’s Drug Abuse Warning Network (DAWN), a public health surveillance system that monitors drug-related emergency department visits throughout the nation. This information was collected from eleven metropolitan areas including Boston, Chicago, Denver, Detroit, Miami (Dade County and Fort Lauderdale Division), Minneapolis, New York (Five Boroughs Division), Phoenix, San Francisco, and Seattle.

“When friends, family members and health professionals miss the signs and symptoms of substance abuse the results can be devastating,” said SAMHSA Administrator Pamela S. Hyde. “One consequence is the costly and inefficient use of emergency rooms as a first step to treatment. Substance abuse prevention and early intervention can keep people off drugs in the first place and clear the path to healthier lifestyles.”

The emergency department findings were similar to the overall trend regarding visits related specifically to heroin use. Again Boston had the highest rate (251 per 100,000 population, followed by Chicago (216 per 100,000 population), New York City (153 per 100,000 population), Detroit (150 per 100,000 population) and Seattle (118 per 100,000 population). The national average was 69 per 100,000.

The report can be accessed at: http://www.samhsa.gov/data/2k11/WEB_DAWN_023/DAWN_023_IllicitDrugEDVisits_plain.pdf

Source: Substance Abuse and Mental Health Services Administration – December 15, 2011

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