By Barbara Goodheart, ELS
With opioid overdoses now killing more people than traffic accidents or HIV infection—more than 45,000 lives were lost to overdoses in 2017—you’d think that most people with opioid use disorder (OUD) could easily access treatment. But that’s not the case. Only a minority receive any substance use treatment, such as counseling or inpatient treatment; even fewer receive medication treatment (MT).
With an eye to better understanding MT dynamics, and in hopes of helping policy makers “identify and close critical gaps in the opioid treatment infrastructure,” a team headed by Ramin Mojtabai, MD, MPH, PhD, at Baltimore’s Johns Hopkins Bloomberg School of Public Health, examined data from the National Survey of Substance Abuse Treatment Services. Study results covered 2007 through 2016, and were published in the January issue of Health Affairs.
Buprenorphine and XR Naltrexone Use Is Up; Methadone Lags
The percentage of facilities offering any MT increased from 20% in 2007 to about 36% in 2016; in the latter year only 256 facilities (6.1%) carried all three medications; almost two-thirds provided none.
As the Table below shows, driving the increase in treatment availability were buprenorphine and extended-release (XR) naltrexone. Virtually left behind: methadone—up less than one percentage point over the nine-year period. Yet methadone is “the only medication requiring a federally certified opioid treatment program,” the authors noted; and “methadone may be more effective in retaining patients in treatment and may be especially beneficial for patients with prior treatment failure.”
Medication Availability at OUD Facilities, 2007-2016
|Increase in % of facilities offering each medication type||14.9 to 25.4||9.6 to 20.7||9.4 to 10.3|
|Facilities offering each medication type among 4,218 offering any of these medications in 2016 (%)||2,968 (70.4)||2,429 (57.6)||1,208 (28.7)|
Factors Influencing Patient Access
Limits on Availability of Medication
In 2016, only 256 facilities (6.1%) offered all three MT medications; almost two-thirds provided none. Because each medication has pros and cons, the authors view the limited availability of all three at one facility as a “barrier to the optimal use of MT.”
Some likely benefits of full availability: some patients do better with the “structured treatment and accountability offered by methadone maintenance programs, while others may perceive treatment at a methadone clinic as stigmatizing or find the required daily travel overly burdensome.” As for naltrexone, some patients aren’t able or willing to complete naltrexone’s mandatory induction period.
States most likely to offer MT in their facilities were New York and Vermont; least likely were Hawaii, Arkansas, and Idaho. Offering MT was more common in:
- Department of Veterans Affairs facilities, compared to private for-profit facilities
- Facilities located in or operated by a hospital
- Facilities with residential and inpatient services, compared to those without these services
- Large facilities
- Facilities accepting health insurance, especially those accepting Medicaid in states that had expanded Medicaid eligibility
- Facilities in states that accepted Medicare, private insurance, and self-payment or cash
- Facilities in states with higher opioid death rates
- Facilities in states whose Medicaid plans offered more comprehensive coverage of MT
These findings, noted the authors, “highlight the persistent unmet need for MT nationally and the role of expansion of health insurance in the dissemination of these treatments.”
Type of Funding
Medicaid expansion has made MT available to more people, such as those treated in facilities that accept Medicaid. This is especially true in expansion states, where coverage under Medicaid is broader. Still, as the authors point out, many people don’t have easy access to facilities accepting Medicaid.
The Bottom Line
Financing has shifted from state and local general revenues to Medicaid and private insurance—thus, more money has gone into treatment in general medical settings, with prescription medications. This has dimmed the outlook for methadone, given the federal requirement for treatment programs.
Noting the typically slow pace of “changes in policy, financing of care, and insurance coverage,” the authors expressed concern that these changes “might not be extensive enough to meet the present urgent need for the expansion of MT.” They suggest governments may be able “to leverage block grants and other local funding mechanisms to promote more expeditious implementation of MT in substance use treatment facilities.”
Addiction Treatment Forum contacted Tami L. Mark, PhD, MBA, senior director, Behavioral Health Financing, at RTI International. Dr. Mark, an internationally known expert on behavioral health care financing and delivery, agreed with Dr. Mojtabai and colleagues about the need for better access.
“Dr. Mojtabai and his colleagues should be commended for providing data on access to MAT [medication-assisted treatment] in specialty addiction treatment programs,” she said. “The trend is moving in the right direction but we still have a ways to go to improve access to these life-saving medications. A critical next step is to give consumers easy to access and understand information on which providers offer MAT and other aspects of high quality addiction treatment, such as use of effective behavioral therapies for substance use disorders for which there are no medication-based treatments.”
In reply to Dr. Mark’s comments, Dr. Mojtabai agreed that provision of such information to consumers is a critical step, adding that it “should be accompanied by provisions at the federal and local level to increase availability of these treatments, improving patient access through expansion of public insurance and greater integration of these treatments in general health and specialty mental health services.”
(A grant from the National Institute on Drug Abuse supported the authors in this work.)
Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M. Medication treatment for opioid use disorders in substance use treatment facilities. Health Affairs. 2019;38(1):14-23. doi:10.1377/hlthaff.2018.05162.
For Additional Reading
Mark TL, Yee T, Levit KR, Camacho-Cook J, Cutler E, Carroll CD. Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014. Health Affairs. 2016;35(6):958-965. doi:10.1377/hlthaff.2016.0002.
“Where Multiple Modes Of Medication-Assisted Treatment Are Available.” Health Affairs Blog, January 9, 2018. doi:10.1377/hblog20180104.835958.
Categories: Addiction, Buprenorphine, Medication-Assisted Treatment (MAT), Medication-Assisted Treatment (MAT), Methadone, naltrexone, Newsletter, Opioid Abuse/Addiction
Tags: Buprenorphine, naltrexone, opioids
By Alison Knopf
There have been significant changes at Acadia Healthcare Company, which operates many opioid treatment programs (OTPs) among its 600 facilities. Last December, amid reports that the Nashville, Tennessee-based publicly traded company was possibly for sale, Joey Jacobs was fired as CEO and chairman of the board, replaced by Debbie Osteen, formerly with Universal Health Services. This is all very high-level wheeling and dealing, so what does it have to do with treatment in Acadia facilities?
To what extent do such high-level moves affect patients? For an answer to this question, we went to Jerry Rhodes, who was CEO of CRC Health Group when Acadia acquired it in 2014, and is no stranger to such changes.
The basic answer is: patients should not be affected at all. “To a large degree, patients are identifying with the facility at which they’re receiving treatment,” Mr. Rhodes told AT Forum. “A leadership change shouldn’t have any impact on a patient at all.”
Continuity of treatment is assured by the “quality of the program and the clinical abilities of the team,” said Mr. Rhodes. “Those traits are only indirectly attributable to the leadership changes of a company.”
There is a “ripple effect” on patients and staff, when headlines appear–which generally focus on the geographic area in which corporate is headquartered (in Acadia’s case, Nashville, Tennessee). But outside of Nashville there are few programs throughout the United States that have the Acadia brand. “From my perspective–and I’ve gone through this many, many times–if it’s a good quality program, which delivers good care and is well-managed, the impact at the facility will be negligible,” said Mr. Rhodes.
Transparency Is Key
There is one circumstance that worries patients and staff, and rightly so. It’s if a program is not performing and rumors abound that it may be shut down. “You have to be very direct and transparent about the intentions of a company,” said Mr. Rhodes. Otherwise, fear alone could adversely affect care. It’s up to corporate to be transparent with facilities, and up to facilities to be transparent with patients and staff.
In fact, Acadia issued a press release about the changes, when they took place (http://www.acadiahealthcare.com/investors), with the main audience being investors.
Importantly, in the OTP world, the main growth has been in the proprietary sector. This means a lot of mergers and acquisitions, and people are used to it. “Whether it’s being bought as a company or as a facility, this has been a facet of the business for a long time,” said Mr. Rhodes.
And it’s doesn’t really matter whether the investor is private equity, venture capital, or a hedge fund, he said. “The expectations are pretty much the same.”
Finally, Mr. Rhodes did express frustration that OTPs are not seeing more growth and acceptance in the past few years, with the stress on opioids front and center in the health care world. “This is because of the lingering stigmas associated with methadone,” he told AT Forum. “Over the years, it’s delivered the best results and most demonstrable, and yet, the industry does a terrible job of promoting itself and in public relations.” This is why the addiction field is gravitating toward integration with general health care. In the meantime, however, OTPs–including those with the Acadia brand–continue to move forward. Most recently, Acadia announced plans to open a new OTP in Vermont. Stay tuned.
By Alison Knopf
Not only is cannabis—marijuana—legalized for recreational use in many states; it’s also legal for medical use in even more states, and some states are even suggesting it can be used to treat opioid use disorders (despite the lack of scientific evidence supporting this as an indication). What’s an opioid treatment program (OTP) to do?
We talked with one OTP facility in Colorado, the first state to legalize recreational use, and with a representative of the American Society of Addiction Medicine (ASAM).
“I can really only share our experience in Colorado,” said Tina Beckley, MA, CACIII regional director in Colorado for Behavioral Health Group (BHG). Ms. Beckley was the go-to source recommended by the American Association for the Treatment of Opioid Dependence (AATOD), as her experience early on will be helpful.
State Testing Requirement
For example, initially, BHG didn’t test for tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, Ms. Beckley, whose home office is based in Dallas (she is based and lives in Colorado), told AT Forum. As a result, many patients were using marijuana regularly, she said. However, once THC testing was implemented (Colorado required it in OTPs, starting in 2006), many patients began losing their take-home doses, one phase at a time. “Some of them decided to give [marijuana] up, and others decided that they would continue losing [take-home] phases and come into the clinic more often,” she said. “There were others who left treatment altogether.”
Cannabis was first legalized in Colorado, for medical use before recreational use, as is the typical trajectory. Legalization for medical use presented an “immediate challenge” to OTPs in the state, said Ms. Beckley. “Patients who had been using THC for years thought that if they were able to get a medical marijuana card, they would be able to earn take-home medication if all other requirements were met,” she said. But only very few patients were able to continue to receive take-homes while using medical marijuana, she explained: those with no history of illicit marijuana use, who also had a medical condition that was identified as being treatable with marijuana, and whose primary care providers agreed to the use of medical marijuana. Only “a couple” of patients met those criteria, she said.
But once recreational marijuana was legalized, the situation become more complicated, said Ms. Beckley. “Many patients felt because it was legal, they could continue to use it. It has been a real challenge for the programs to explain that OTPs follow federal rules, so if a urine drug screen is positive for THC, it is considered a positive urine,” she said. “Many patients also believe that it is the clinic’s rule, and that it can be changed,” she added, citing the feedback locations get every year on patient satisfaction surveys.
And she pointed to a definite problem for OTPs in legalization states. “Initially, there were quite a few patients who moved here because of the marijuana industry,” she said. “They were quite discouraged that they could not earn take-home medication if they used marijuana.” And patients who transferred from states where OTPs did not test for marijuana also become discouraged when they found out they would be tested for it, and lose their take-homes.
One anecdotal note from Ms. Beckley: some of the patients who did stop using marijuana so they could keep their take-homes reported feeling “clearer” than they had in a long time.
Mood-Changing and Mind-Altering
“Our treatment staff feel that THC is mood-changing and mind-altering, with addictive properties, and is not conducive to sobriety, so it is a clinical and therapeutic struggle,” she said.
However, programs would like to see state regulations revised, said Ms. Beckley. “One of our programs recommended that THC be removed from the drugs tested for, and to leave it at the discretion of the OTP to treat clinically,” she said. Another option would be to allow patients who use recreational marijuana and meet all other requirements for take-home medication, to be allowed one take home a week (in addition to Sunday). That second option would significantly decrease the number of patients who must dose on Saturday, she said.
“We feel that it is unfortunate that cannabis is still considered a Schedule I drug,” said Ms. Beckley, noting that a number of states allow for recreational marijuana, and that even more states allow for medical marijuana. “Many of our patients, again anecdotally, report that THC helps with the opioid withdrawal symptoms, but without the ability to facilitate medical marijuana research, the positive claims cannot be substantiated,” she said.
While ASAM is opposed to asking patients to leave treatment because they use marijuana, there is a concern that other substances, whether cannabis, alcohol, cocaine, or any other drug, could adversely affect the OTP patients, said Yngvild Olsen, MD, medical director of the Institutes for Behavior Resources Inc/REACH Health Services in Baltimore City, and an ASAM Board Member. Use of cannabis or other substances “needs to be identified and treated as a health condition,” she told AT Forum.
What if the OTP patient—or, for that matter, an OBOT patient on buprenorphine—has a prescription for cannabis? “ASAM policy says that in those states where medical cannabis is permitted under state law, the same kind of clinical and health-related approaches should be used as for other medications, such as benzodiazepines and opioids,” said Dr. Olsen. “Even if it’s recommended or prescribed, it still may have negative consequences” for patients on methadone or buprenorphine, she said.
And while the Substance Abuse and Mental Health Services Administration and the Joint Commission do not require OTPs to test for marijuana, except upon admission, some states, such as Maryland and Colorado, do, said Dr. Olsen. “There are a number of OTP medical directors and other clinicians who wonder about the value and benefit of testing for marijuana,” she said. “But it’s similar to why we do breathalyzers for alcohol and test for other substances—it’s not to discharge patients, but it’s a marker for people who are at risk for other health conditions.”
Meanwhile, states continue to look at the idea of marijuana as a treatment for opioid use disorders, possibly replacing methadone and buprenorphine, despite the lack of evidence. “It’s frustrating,” said Dr. Olsen.
By Alison Knopf
The world of addiction has a deeply embedded image of the oft-cited elephant in the room: substance use disorder in a family member, a fellow employee, a loved one; bigger than life, but not mentioned. The elephant in the room.
For opioid treatment programs (OTPs), the elephant is often alcohol, which, when combined with opioids (including therapeutic methadone or buprenorphine) can be dangerous, and even deadly. AT Forum talked about this problem with Lorenzo Leggio, MD, PhD, Chief of the Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, a joint NIAAA (National Institute on Alcohol Abuse and Alcoholism) and NIDA (National Institute on Drug Abuse) laboratory.
Alcohol kills 89,000 people a year in the United States—double the rate of opioid overdoses, Dr. Leggio noted.
The problem isn’t only that the combination of alcohol and methadone or buprenorphine is a bad one—it’s the high comorbidity rate of alcohol use disorder and opioid use disorder, Dr. Leggio said. “Roughly 30 to 40 percent of patients who are on agonist maintenance also drink an excessive amount of alcohol—maybe even 50 percent.” And this may be a low estimate—the actual percentage may be much higher. This is based on epidemiological data from the United States and Europe. “It’s a remarkable number, unfortunately,” he said.
From a clinical perspective, the numbers are concerning. First, alcohol has an effect on the way the body metabolizes many drugs. Here’s how it works: the alcohol prevents the methadone from being metabolized, so the levels of methadone in the blood rise.
There is also the problem of sedation. In the case of methadone, alcohol would potentiate the effect of the medication—and in turn, the methadone would potentiate the effect of the alcohol. “Think about someone who is on methadone and is also drinking and is driving,” he said. “There’s the risk of sedation,” even if the methadone alone is not sedating (and it isn’t, for stable patients in OTPs). Alcohol, on its own, has a risk of sedation, of course. “By mixing methadone and alcohol, you can have an amplification of this effect,” said Dr. Leggio.
Sedation is a known side effect of methadone. Central nervous system (CNS) depression is also a side effect, and combining methadone with alcohol could be lethal because the person stops breathing—just as they do after an opioid overdose.
“The best way to explain alcohol to patients is to make it clear: this is not trivial,” said Dr. Leggio. “We are talking about the effect of these drugs in your body that may lead to respiratory depression—your brain is not able to handle this, and you can die.”
Be clear to the patient who is taking methadone or buprenorphine that they are increasing their risk of death by drinking alcohol, he said.
On the bright side, methadone and buprenorphine patients, by definition, have been bought into treatment. “They are already committed to try to improve their health,” said Dr. Leggio.
So what can an OTP do? According to Dr. Leggio:
- Screening. First, the assessment must be clinically oriented and comprehensive, including alcohol screening. “You can use CAGE, you can use AUDIT, but you need to use some well-validated tool.”
- Patient education. “Patients may not recognize that alcohol is problem for them.” Lorenzo Leggio,
- Treatment. Depending on the level of care needed, providing brief intervention, motivational interviewing, or contingency management may be effective. Cognitive behavioral therapy is more complex and requires more time, but is also effective. “Try to do the treatment as part of a comprehensive approach,” said Dr. Leggio. For example, if the patient is coming into the OTP for methadone dosing, perform the alcohol counseling at the same time. And remember, it could be as simple as a brief intervention; if patients learn about the dangers, they may stop drinking, or at least reduce their drinking.
- Medications. This can be a complex issue, said Dr. Leggio, moving on to discuss three medications indicated for alcohol use disorder: naltrexone, acamprosate, and disulfiram. Patients on buprenorphine or methadone can’t take naltrexone, a medication that is only for patients who are opioid-free, but does reduce alcohol cravings. However, the patient may want to taper off methadone and buprenorphine (this is unlikely, but just in case a patient is interested in doing that, the naltrexone would be a good solution to prevent opioid use and reduce or prevent alcohol use). However, it’s important to remember that naltrexone reduces alcohol cravings in only 30% of patients—and nobody knows ahead of time which 30%.
There are no studies in which acamprosate, indicated for alcohol use disorders, has been studied in the context of methadone, said Dr. Leggio, but it would also be a possible treatment. He flatly ruled out disulfiram (which causes the patient to become very ill temporarily when combined with alcohol). “I would be concerned about the disulfiram syndrome in the context of opioid use disorder,” he said.
Finally, Dr. Leggio pointed to the fact that so few people get treatment for substance use disorder. “If we provided treatment to only 10 percent of people with breast cancer, it would not be accepted, but with addiction, it is accepted,” he said. “At the end of the day, we tend to put our head under the sand, until we are hit personally” by addiction. “It doesn’t help that we are so far beyond other medical fields, like cancer and infectious disease; it doesn’t help that there is so much we don’t understand.”
And criticism is more pointed in addiction than in the rest of the field. A Nobel Prize in Physiology or Medicine was awarded for cancer immunotherapy, a treatment that helps one-third of patients—the same success rate as naltrexone for alcohol, noted Dr. Leggio. However, for the cancer treatment, a molecular analysis can be done to predict whether a patient will respond or not. “For naltrexone, we don’t have that knowledge yet,” he said.
NIAAA is currently funding clinical trials looking at ondansetron and topiramate for alcohol use disorder. “But a trial is very expensive, with multiple sites needed,” said Dr. Leggio. Of course, physicians are free to use approved medications off-label.
If the most an OTP can do is get a patient to reduce his or her drinking, that would be a “clinical success,” said Dr. Leggio. “If a patient were to drop from five drinks a day to one, would that be a success?” we asked. “That would be a wonderful success, I would sign off on that,” he said. “You have to be practical and compromise, and sometimes do baby steps. Abstinence should be the real goal, but reduction is an important goal.”
By Alison Knopf
Canadian Addiction Treatment Centres (CATC), based in Toronto, has over 14,000 patients, 80% of whom are taking methadone. Unlike in the United States, patients in Canada do not have to receive their medication within the treatment center — they can, if they choose, go to an outside (community) pharmacy with a prescription. But in the CATC model, which is probably unique compared to typical pharmacy practice in Canada, the pharmacies are part of the care continuum, linked to the clinic through daily communication about the patient’s care and a shared Electronic Medical Record (EMR).
“We have pharmacies that are in-house and co-located with the clinic,” explained Christine Folia, RPh, BScPhm, PharmD, pharmacy director of operations for CATC. In some CATC clinics there is a “delegation” pharmacy model, in which the methadone or buprenorphine is delivered to the clinic by the pharmacy, and the physician’s delegate witnesses the dosing formulation. When the patient comes to the clinic, he or she can receive their medication, including take-home doses, from the in-house pharmacy or clinic nurse. (Methadone is liquid only, mixed with juice in 100-milliliter bottles; buprenorphine is the combination product—Suboxone tablets only; only the film is available in the U.S.)
Patients do have a choice, said Ms. Folia. “Not all patients will dose with us,” she said. But after one year, 60% of the patients who use the in-house pharmacy services are still in treatment, compared to only 12% of the patients who get their medication from a non-affiliated pharmacy in the community.
“The opportunity to have a therapeutic relationship is much stronger when you have the connected circle of care,” said Ms. Folia, explaining one reason why the retention is so much higher for patients who pick up their dose at the in-house pharmacy. “You get to know your patients very well. You have that close network of care. Keep them close and make sure they’re on track.” But in the absence of a deliberate coordinated care approach, there is a greater opportunity for breakdown of communication between clinic, pharmacy, and patient.
A community pharmacy may not have the same knowledge of the patient, or, for that matter, a knowledge base about addiction/Opioid Use Disorder, said Ms. Folia. Pharmacists who work as part of a multidisciplinary team that focuses on treatment of addiction, have the opportunity to develop specialized skills and expert knowledge, which ultimately supports better patient care/outcomes.
Gauthier G, Eibl JK, Marsh DC, Improved treatment-retention for patients receiving methadone dosing within the clinic providing physician and other health services (onsite) versus dosing at community (offsite) pharmacies, Drug and Alcohol Dependence (2018), https://doi.org/10.1016/j.drugalcdep.2018.04.029
By Alison Knopf
James Thomas Payte, MD, died January 22 at the age of 87. A pioneer in the treatment of opioid use disorder with methadone, Dr. Payte was one of the very few individuals who were never in medication-assisted recovery themselves, yet inducted as an “honorary patient” by NAMA Recovery, recalled Zachary Talbott, CADCII, CACII, MATS, ICADC, treatment center director with MedMark. Dr. Payte received this honor “because his commitment to patient issues rivaled advocates who were (or are) patients themselves,” Mr. Talbott told AT Forum.
“I vividly remember the last time I was with Dr. Payte in person; it was at the AATOD 2015 Conference in Atlanta, when we set together at the Policy Makers Luncheon,” said Mr. Talbott. He added that Dr. Payte, at one time the medical director of Colonial Management Group (CMG), was also at the hot topic roundtable at that same conference, along with Bettye Harrison (then account manager for the OTP accreditation program at CARF). The topic was the problem of ongoing “dose-capping” in opioid treatment programs (OTPs)—despite the fact that dose-capping was contrary to best practices, as well as a violation of federal accreditation guidelines (see http://atforum.com/2015/06/methadone-dose-capping-still-continues-in-practice-if-not-in-policy/).
“Tom Payte left a legacy of great patient care,” said Mark W. Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). “He made tremendous contributions to our field, and devoted his professional career to improving the lives of patients.”
Mr. Parrino asked Dr. Payte to help organize the medical chapters for the first Treatment Improvement Protocol (TIP) from the Substance Abuse and Mental Health Services Administration, “State Methadone Treatment Guidelines,” published in 1993. Dr. Payte was chairman of the treatment committee of the American Society of Addiction Medicine at the time.
Dr. Payte also developed the curriculum for AATOD’s original training course for clinicians, in conjunction with Drs. Susan Neshin, Andrea Barthwell, and Peter DeMaria. “The course continues to this day as another example of Tom’s creativity,” said Mr. Parrino.
Dr. Payte wrote influential articles throughout his career; one of his seminal publications was coauthored by Dr. Joan Zweben—”Methadone Maintenance in the Treatment of Opioid Dependence. A Current Perspective.”
“What has always impressed me about Dr. Payte, and what will live on in my memories of him, was his undying devotion to patients, above all else,” said Mr. Talbott. “I continue to use his memo to all CMG staff from the early 2000’s titled, ‘Bad Patients? Or Bad Treatment?’ with all of my staff, especially new hires,” he said. “Dr. Payte reminds us that too often poor treatment outcomes are not the fault of the patient, but the fault of the provider—for not giving them all the tools they need to combat their illness.”
In terms of clinical advice, Dr. Payte’s teachings on peak-and-trough blood testing and on induction have been resources for many physicians, said Mr. Talbott. “Along with Dr. Bob Newman, the loss of Dr. Payte is one of the greatest losses to MAT patient advocacy since Dr. Dole’s passing in 1996.”
Remembering the “honorary patient” designation, Joycelyn Woods, director of NAMA Recovery, said Drs. Vincent Dole and Marie Nyswander coined the term when they were asked by news reporters how they could understand addiction and methadone. “Their response was that they were ‘honorary patients,’” Ms. Woods told AT Forum. Dr. Herman Joseph is also an honorary patient, she said.
“I also recall a story from the late John Finger [formerly the head of Texas NAMA] from his first few months in treatment,” said Ms. Woods. Mr. Finger thought Dr. Payte was a patient, because he was frequently sitting in the waiting room talking with patients, she said. “It reminds me of Dr. Dole, who did the same thing.”
MARS core training uses Dr. Payte’s Power Point slides, which are timeless, said Ms. Woods.
Mr. Parrino described Dr. Payte as “an extremely elegant gentleman, and a lovely human being”—and anyone who met him would attest to that. But, as Mr. Parrino said, he liked to describe himself as a “simple country doctor.”And here’s an anecdote that privacy devotees from today will cherish. When Dr. Payte began working for CMG, the company had purchased several programs, all of which Dr. Payte visited. “Some had cameras in the bathroom, and when he saw them, he asked for pliers to cut them out,” said Ms. Woods. “He told me that was one of the most satisfying things he had done in a while.”
ASAM Annual Conference
April 4-7, 2019
New York ASAP Prevention Conference
April 8-9, 2019
Albany, New York
National Rx Drug Abuse and Heroin Summit
April 22-25, 2019
National Association of Addiction Treatment Providers (NAATP) 41th Annual Conference
May 5-7, 2019
College of Problems on Drug Dependence Annual Meeting
June 15-19, 2019
San Antonio, Texas