By Alison Knopf
Of the $1 billion in federal grants going out to states in 2017 and 2018 to respond to the opioid epidemic, 80% must go to treatment. The grant money comes from the 21st Century Cures Act, signed by President Obama last December. Checks for the first year of the State Targeted Response to the Opioid Crisis grants (STR), administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), went out in late April.
Increasing Treatment Access
At that time, Tom Price, MD, secretary of the Department of Health and Human Services (HHS), SAMHSA’s parent agency, made it clear that he wanted a report on how the money was being spent—quite likely before the first year was even finished. “Opioids were responsible for over 33,000 deaths in 2015; this alarming statistic is unacceptable to me,” said Dr. Price, just before distributing the checks.
“These grants aim to increase access to treatment, reduce unmet need and reduce overdose-related deaths. I understand the urgency of this funding; however, I also want to ensure the resources and policies are properly aligned with and remain responsive to this evolving epidemic.
“Therefore, while I am releasing the funding for the first year immediately, my intention for the second year is to develop funding allocations and policies that are the most clinically sound, effective and efficient. To that end, in the coming weeks and months, I will seek your assistance to identify best practices, lessons learned, and key strategies that produce measurable results.”
States’ Plans Differ
States, in their applications for the grants, differ in their plans for using the money. Some, like California, have a strong opioid treatment program (OTP) component. Since medication-assisted treatment (MAT) is the most effective treatment for opioid use disorders, that makes sense, said Jason Kletter, PhD, president of the California Opioid Maintenance Providers and BayMark Health Services. “I don’t understand why every state isn’t using their money for MAT.”
That said, OTPs are supportive of the Department’s interest in evaluating how STR grants have been used, said Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). “Doctor Price is right to ensure that funds are being well spent to provide a comprehensive treatment response to combat the nation’s public health crisis of opioid addiction,” said Mr. Parrino, who is very interested in learning what states are doing with their funding in regard to OTPs.
“Additionally, it is important to understand how states are managing service integration as these STR grants are utilized,” he said. “Illustratively, once an individual is saved through the use of a naloxone overdose kit, does the individual get transported to an emergency room and does the ER have someone that is professionally trained to properly assess the needs of the individual, with regard to further treatment? Does the ER have the capability of referring the individual to treatment at an OTP, DATA 2000 practice, residential unit or other treatment intervention?
“We also know that a number of states are increasing the number of OTPs, including Indiana, Ohio and Mississippi,” said Mr. Parrino, adding, “A number of providers and states are also using the STR grants to expand access to mobile van units, which are connected to the OTP.”
The Evaluation Component
But SAMHSA built in broad flexibility to the grants, allowing states to move funding elsewhere. “I understand that some states are using the funding for initiatives that aren’t likely to have an immediate impact mitigating the opioid epidemic,” said Dr. Kletter. “What’s really important is that we have SAMHSA and HHS look closely at how states are spending that money,” he said. “The whole purpose is a rapid response. I support Dr. Price’s intent to review this closely.”
Dr. Kletter also thinks states should have some data by the midway point—the end of year one—of the grants. “We have already convened our first implementation meetings,” said Dr. Kletter of California, which is using the money to expand the hub-and-spoke model using OTPs. If states can’t demonstrate they are using the money for evidence-based treatment interventions to reduce overdose deaths, “then the money should be reallocated to other states that can,” he said.
Categories: Addiction, Heroin, Medication-Assisted Treatment (MAT), Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids, Overdose
Tags: Heroin, Opioid Treatment Programs, Overdose, Prescription Opioids, SAMHSA, Substance Abuse Treatment
By Alison Knopf
It has become clear that many people with opioid use disorders (OUDs) end up in jails and prisons. Immediately cut off from their source, they go into opioid withdrawal. Some of these inmates become severely dehydrated. Some who do will die if their dehydration is left untreated.
Opioid treatment programs (OTPs)—programs that offer methadone or buprenorphine—are the ideal liaisons for people with OUDs. These programs not only provide treatment for the inmates; they also educate about the important role of medication-assisted treatment (MAT) in keeping people with OUDs out of jails and prisons in the first place.
Community Medical Services (CMS) in Arizona is working with Maricopa County and the state on several key initiatives for getting medications to patients in the area’s corrections systems. The first initiative is drug courts, because they can help keep offenders from incarceration, if the offenders agree to take part in a treatment program.
Unfortunately, for too long, many drug courts have been opposed to agonist treatment. But that started to change in 2015, with an announcement by the federal government that drug courts would not receive federal funding if they categorically refused to use MAT.
After the announcement, the drug court in Maricopa County, one of the oldest in the country, started working on a plan to incorporate MAT into its system.
Still in its infantile stages—it started in December— the drug court program is already successful. “At first, the drug court was skeptical,” Nick Stavros, CEO of CMS, told AT Forum. “They wanted to see the results of starting a small number of people on methadone or buprenorphine. Within weeks they came to us and said, ‘We’re seeing patients who have never tested negative for illicit opiates actually starting to test negative for the first time.’ They were sold right away.”
Currently, CMS is treating 50 to 60 patients with MAT in the Maricopa County drug court. “We have a drug court liaison who attends drug court staffing every day to help identify MAT candidates and helps navigate them to the closest treatment program,” Mr. Stavros said.
This is a particularly sweet success story for the OTP. Until 2014, the drug court was abstinence-based, and would work only with abstinence-based providers. “But then they came to us and said OUD members’ recidivism rates were too high and showing little progress in the abstinence-based curriculums.”
The drug court changes happened at about the same time that a key court decision was handed down in the county. The decision stipulated that any medical care available in the community should also be available inside local jails.
One of the strongest supporters of OTPs and methadone treatment in Maricopa county is Jeffrey Alvarez, MD. Dr. Alvarez, who has been medical director for Maricopa Correctional Health Services for more than five years, is also on the Board of Directors for the National Commission on Correctional Health Care.
“Dr. Alvarez wanted to start his own OTPs within Maricopa County jails,” said Mike White, director of community relations, and the liaison to correctional health for CMS. “Maricopa County Jails now have four internal OTPs, and are about to have a fifth.”
The Four Phases of the County Program
Phase 1 of the OTP collaboration within the Maricopa County corrections system was just for pregnant women; that program started 4 years ago. The MAT operations were completely operated by CMS while offenders were provided counseling services through the Correctional Health Services Counselors.
“Our chief medical officer provided the script; we provided counseling,” said Mr. White. “You can’t bill for this in jails, so we did it without charge.” Phase 1 was carried out only for current OTP-enrolled patients who became incarcerated. Phase 2 applied to new patients: women who were pregnant, addicted to opioids, and in jail. Phase 3 covered current maintenance patients, transferred to drug court: CMS would keep them on maintenance treatment.
The current project—Phase 4—involves the OTP as soon as anyone arrested in Phoenix is in withdrawal. “Correctional Health Staff conducts a COWS Assessment upon intake and determines if the person may be appropriate for MAT, and they are then inducted on methadone inside a Maricopa County jail,” said Mr. White. (A COWS Score—an 11-item Clinical Opiate Withdrawal Scale—is used to rate and monitor common symptoms and signs of opiate withdrawal.)
When Dr. Alvarez opened his own OTPs within the jail system, CMS hand-held the operation and trained the providers on how to prescribe medications.
No More Withdrawing in Jail
In addition to getting support from Dr. Alvarez, CMS has gained the backing of the corrections staff. “They support this because it makes their lives easier,” explained Mr. White. For inmates being sent to prison, the OTP has an agreement to provide a 30-day withdrawal management program for those diagnosed with OUD.
“Kellsie Green is a story that comes to mind.” Mr. White recalls the 24-year old who died last year in Anchorage, Alaska, six days after entering jail. She was detoxing from heroin. “When instances like this occur, corrections staff end up being our biggest advocates,” said Mr. White.
When inmates in withdrawal are given tapered doses of methadone or buprenorphine, it helps mitigate the sickness, and the guards don’t spend their time “cleaning up vomit and feces. It’s easier on them. On the front end they don’t see that, but once you have a program, everyone recognizes that it’s a big improvement.”
Pre-Release to Residential Care
CMS also supports release centers for people who are offered residential services through the AZ Department of Corrections. The offenders are given the option of methadone or Vivitrol during these stabilization periods, or pre-release, or can be offered an intake upon release for buprenorphine or methadone treatment.
A parole officer sometimes gives a newly released inmate who is struggling a “time-out” in a stabilization unit or re-entry center. The person may spend anywhere from one to 90 days there. During that time, CMS can get a referral from the corrections department, and start that person in treatment in one of its clinics.
These re-entry centers are a key second chance for people who otherwise might be re-incarcerated. “Let’s say they were on parole, and started using again upon their release. They have to go in to meet with their parole officer,” explained Mr. White. “It’s voluntary to go back into custody for treatment, but if you don’t, they incarcerate you. It’s not the same as jail, it’s very much trying to be a therapeutic community. So we go into this facility and provide the MAT services.”
Typically, Vivitrol has been the medication favored by criminal justice systems, where there is a longstanding bias against agonists. “In some ways, we are going down that road, too, where there is a plan to provide Vivitrol to 100 people,” said Mr. White.
“Alkermes lobbyists and sales reps are very active in Arizona,” noted Mr. Stavros. Gov. Doug Ducey, in his state-of-the-state message, called Vivitrol a “miracle drug” and announced that inmates would be offered a Vivitrol injection before their release from prison. To accommodate this order, the state asked CMS to be the Vivitrol provider.
However, the governor’s office acknowledged that the Vivitrol program hadn’t always been successful in other states. After completion of the 6-month antagonist treatment, over 90% of those treated ended up relapsing, said Mr. Stavros. “So our target is now 18 months of injections, with the first injection given before release.” Within 72 hours of release, the patient must report to CMS for comprehensive OTP services.
Eighteen months of injections, at $1,100 an injection—who is paying for this?
“Most of the integrations we’re building are either pro bono or are grant funded; CMS was awarded a 2016 MAT-PDOA grant to expand its jail in-reach program,” said Mr. Stavros. Methadone treatment itself is not expensive—about $55 to $60 a week in Arizona. But the cost of Vivitrol may not be something many jurisdictions are prepared for. “You see that in other states,” he added. “You start people on Vivitrol using a free sample that was given by Alkermes, and then when it’s time for the second shot, they start asking, ‘Who’s paying for this?’”
Mr. Stavros said the science is behind agonist treatment. “You have lay people, like correctional health employees and politicians, who prefer Vivitrol, but they pay attention to marketing and lobbying, not to research. Methadone is tried and true, but there’s little lobbying going on, and zero marketing,” he said. “Maybe some people think it’s not necessary, because methadone has the research behind it.”
Meanwhile, with the support of Dr. Alvarez and others, CMS has shown that an OTP can partner successfully with corrections systems, and that it can do so by using methadone.
Categories: Addiction, Buprenorphine, Drug Courts & Criminal Justice, Heroin, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids, Prescription Drugs
Tags: Buprenorphine, Criminal Justice, Drug Courts, Methadone Treatment, Opioid Treatment Programs, Prescription Opioids, Substance Abuse Treatment
By Barbara Goodheart, ELS
Prescription opioids are still getting much of the blame for the current opioid overdose crisis, yet heroin and synthetic opioids—fentanyl, carfentanil, and tramadol—have become the leading causes of opioid overdose deaths. The death rate from heroin and synthetic opioids other than methadone rose by more than 72% from 2014 to 2015, while overdose deaths linked to prescription opioids have leveled off or declined since 2011.
What would be a better way to deal with the opioid crisis? Three groups offer suggestions.
The Research-Oriented Approach
An article by Drs. Nora Volkow and Francis Collins in the New England Journal of Medicine urges stepping up research in three areas: overdose reversal: additional interventions and better formulations of naloxone; addiction treatment: new medications and technologies aiming at novel molecular targets; and pain management: safe, effective, nonaddictive treatments for chronic pain.
A Less-Conservative Approach: Legalizing Marijuana
Most states and Washington, D.C. have legalized marijuana use for medical purposes. But lacking substantial data to support medical marijuana’s effectiveness and safety, the broader medical community is calling for well-designed studies before lending its support.
In the Middle: The Drug Policy Alliance
The Drug Policy Alliance (DPA), a national nonprofit organization, describes itself as supporting drug reform and seeking to promote drug strategies “grounded in science, compassion, health and human rights.”
The focus of this AT Forum article is a policy paper the DPA released in April. Only 12 pages long, the paper includes dozens of recommendations, presented as suggestions for consideration.
The authors begin their policy paper by emphasizing patients’ legitimate need for access to pain medications, pointing out that “over 87 percent of people who used prescription opioid pain relievers in the past year did not misuse them.” They caution that “we must not widen the net and criminalize legitimate medical use of opioids, overstate the potential dangers of prescription opioid use and reduce access to needed pain medications, or stigmatize the people who use them.”
Some believe that the DPA overly favors marijuana, heroin, and harm-reduction interventions. As for marijuana and heroin, the DPA policy paper calls for safe drug consumption services, specifying “a pilot program” to clarify the heroin issue, and “additional research” to help resolve the marijuana question. It takes a stronger position on harm reduction.
(In harm reduction, individuals who have a substance use disorder but are not ready for rehab find ways to minimize the risks they incur.)
The DPA policy paper recommends setting up safe injection facilities (SIFs) and safe drug consumption services through local health departments or community organizations. While the paper was being written, proposals or legislation to establish such sites had already been introduced in California; Maryland; Ithaca, New York; and King County in Washington State.
The policy paper points out that studies in other countries have shown that SIFs reduce overdose deaths; provide an entry to treatment, even abstinence; reduce risky injection practices and disease transmission; reduce public injection practices; are cost effective; and do not increase the incidence of local crime, or encourage additional drug use.
Bottom line: some health care providers consider harm-reduction programs extreme; others believe they have potential benefits, and favor learning more about them, with well-designed clinical studies a necessary first step.
The DPA covers medication-assisted treatment (MAT) at length, and includes many recommendations opioid treatment programs (OTPs) will favor. Among them: increasing access to MAT by such means as providing office-based treatment.
Establish an Expert Panel on Treatment Needs. A panel in each state would address treatment needs and opportunities, while considering the following tasks:
- Evaluate existing barriers to treatment
- Identify ways to address gaps in treatment
- Make recommendations to the state legislature
- Set evidence-based standards of care
- Identify treatment components and recovery services to include
The paper notes that access to MAT is limited in U.S. treatment facilities.
Increase Insurance Coverage for MAT. Plans in some states do not cover methadone or buprenorphine,
and only about a quarter of patients treated for opioid use disorders at Veterans Health Administration (VHA) facilities are treated with methadone or buprenorphine.
Provide Office-Based Opioid Treatment for Methadone. Several states have limited the availability of methadone by establishing moratoriums on new OTPs. Office-based methadone would help make treatment broadly available, and could help reduce the stigma still associated with MAT.
Offer MAT in Hospitals, Jails, and Prisons. About 25% of incarcerated people are opioid-dependent. They are up to 130 times more likely to die of an overdose soon after release from incarceration than are opioid-dependent people in the general population. For the newly incarcerated, continuation of MAT should be mandated, the DPA believes; and for those who lack MAT, but need it, MAT should begin before their release from confinement.
Other Options: Helping Those Refractory to Treatment
The DPA suggests considering two options:
▬ A heroin-assisted pilot
▬ A program evaluating marijuana as an opioid substitute, or as an adjunct, in patients with chronic pain
The document provides good coverage of naloxone. It notes that great progress has already been made to increase access to this opioid overdose antidote—although access and protections vary widely among the states.
Criminalization, Syringe Sales, Diversion Programs, Decriminalization
The publication also recommends ending criminalization of syringe possession; lowering barriers to over-the-counter syringe sales; and allowing direct prescriptions for syringes (some states have already taken such steps); establishing an expert panel on prescribing practices, by states; mandating specific educational courses for degree-granting institutions; and developing an evidence-based curriculum for schools.
Two additional key recommendations found in the report: establish programs to help individuals with substance use disorders meet their basic needs; and decriminalize drug possession—that is, remove criminal penalties for possession of small amounts of controlled substances for personal use.
Although its approach is not as conservative as some would like, the paper offers many timely recommendations concerning MAT and naloxone. It also emphasizes a key requirement, sometimes overlooked—the need for policymakers to evaluate the benefits of “potential harm reduction, effective treatment, and prevention interventions—all backed by rigorous science—and to shift the focus of their efforts to implementing policies that actually have the power to save and improve lives [emphasis added].”
# # #
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths— United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. doi: http://dx.doi.org/10.15585/mmwr.mm655051e1.
Centers for Disease Control and Prevention. Opioid Overdose Data. Opioid Data Analysis. Categories of Opioids. https://www.cdc.gov/drugoverdose/data/analysis.html#contentArea. Accessed August 10, 2017.
Volkow N, Collins F. The role of science in addressing the opioid crisis. N Engl J Med. 2017; [Epub ahead of print]. May 31, 2017. doi: 10.1056/
The Drug Policy Alliance. A Public Health and Safety Approach to Problematic Opioid Use and Overdose. April 18, 2017. http://www.drugpolicy.org/resource/public-health-and-safety-approach-problematic-opioid-use-and-overdose. Accessed August 10, 2017.
Categories: Addiction, Buprenorphine, Drug Courts & Criminal Justice, Heroin, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids, Overdose, Prescription Drugs
Tags: Addiction, Buprenorphine, Health Insurance, Heroin, marijuana, Methadone Treatment, Opioid Treatment Programs, Overdose, Prescription Opioids, Substance Abuse Treatment
By Alison Knopf
Imagine opioid treatment program (OTP) patients being able to get counseling and prescriptions from their own smartphone, while sitting in the comfort of their home. This is now reality for two OTPs operated by California-based Aegis Treatment Centers.
“We’ve been practicing telemedicine for three years in our Fresno and Delano clinics,” said Alex Dodd, Aegis CEO and president. These are all private-pay patients, either through insurance or by self-pay. And the program may expand to other clinics, thanks to funding from the Cures Act, Mr. Dodd told AT Forum.
The software used for telemedicine must be compliant with the Health Insurance Portability and Accountability Act (HIPAA), said Mr. Dodd. You can’t use Skype or Facebook, for example. Many psychotherapists already have such software, he added.
Admission and Buprenorphine Induction
Admitting patients for buprenorphine induction takes longer than admitting them for methadone induction, because more observation time is needed to make sure the patient’s condition is stable, said Mr. Dodd. So the first part of the admission process occurs face-to-face with the physician, who explains to the patient that some degree of withdrawal must occur before induction can begin. The next day, if the patient can’t come to the doctor, or if the doctor isn’t in the clinic, induction can be done by telehealth.
The physician begins the telehealth induction by calling the patient and conducting an interview about any symptoms the patient may be having. Via the screen, the physician can observe the patient for withdrawal symptoms. “This is one of those situations where experience really matters,” said Mr. Dodd. “If you are an experienced doctor who has seen hundreds if not thousands of patients, you can do this.”
Coming Soon: More Counseling by Telehealth
Currently, patients go to OTPs in Fresno or Delano for counseling. As California rolls out its hub-and-spoke Cures money, more counseling will take place by telehealth, said Mr. Dodd, who added, “I’m sure that in the next year or two we’ll be using telehealth for both admissions and counseling.”
The Fresno and Delano sites were chosen because the Aegis doctor most familiar with buprenorphine works with patients at those clinics.
But the most important part of treatment is not induction, said Mr. Dodd. “It’s the communication between the patient and the counselor.” He went on to quote Marc Lasher, MD, medical director of Aegis: “Medication is good, counseling is good, but medication and counseling together is the best.”
Regardless of which medication the patient is taking—methadone or buprenorphine—the patient is in a “stable, non-drug-seeking state,” said Mr. Dodd, “and is open and amenable to a dialogue.”
Bright Heart Health has received some of the Cures money to provide telemedicine to California patients with opioid use disorders, according to Mr. Dodd. “They will use telehealth extensively, doing everything others would do with bricks and mortar. They want to admit patients over telehealth, dispense medication through telehealth, and do counseling through telehealth.”
Categories: Addiction, Buprenorphine, Medication-Assisted Treatment (MAT), Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids
Tags: Buprenorphine, Counseling, Methadone Treatment, Substance Abuse Treatment
By Alison Knopf
Opioid treatment programs (OTPs) still use methadone as their main medication, especially in states where there is no reimbursement for the far more costly buprenorphine. New York was the first state to set up reimbursement for buprenorphine in OTPs, but California is now well on its way.
Federal Medicaid Waiver Payments
Jason Kletter, PhD, president of California Opioid Maintenance Providers (COMP), told AT Forum that some counties are now paying for buprenorphine dispensed in OTPs. “We’re doing it under a federal Medicaid waiver that allows counties to opt in and pay for it under the organized delivery system,” Dr. Kletter said.
In California, each of the 58 counties is responsible for delivering Medicaid-paid substance use disorder treatment under the Drug Medi-Cal Organized Delivery System (DMC-ODS). “In counties that opt in, buprenorphine must be paid for,” said Dr. Kletter. “Unfortunately, only a few counties have been able to get up and running under this waiver. It’s voluntary and creates lots of new requirements for both counties and providers. We expected more counties to opt in, but so far, only a handful of counties have,” he said. “It may take some time.”
Cures Act Grants
But there’s another way buprenorphine can be paid for in OTPs—through the State Targeted Response to the Opioid Crisis (STR) grants, administered through the Substance Abuse and Mental Health Services Administration, under the Cures Act. California is using its Cures allocation to create a hub-and spoke system (http://atforum.com/2017/04/california-cures-act-80-million-expand-treatment-hub-spoke-system/).
In OTPs, Treatment in MAT is Key
“I’m proud of our state using the money to pay for medication-assisted treatment (MAT),” said Dr. Kletter, who is also president of BayMark Health Services and Bay Area Addiction Research and Treatment (BAART). “That term—MAT—has been hijacked to mean prescribing buprenorphine in doctors’ office, often without any additional services,” he said, adding that the “treatment” part of MAT is a key part of what OTPs do.
Office-based buprenorphine is a key piece of hub-and-spoke, in which the hub is an OTP where all patients are assessed and all patients treated with methadone (and some with buprenorphine) are served, and the spoke is the office-based practice where all patients are treated with buprenorphine and get additional services as needed.
“Still, we can’t use buprenorphine everywhere in the state,” said said Dr. Kletter. “There is some uncertainty because of the “repeal and replace” discussions in Washington, DC and because of the county share of the costs.” He cited the 90/10 federal/county split in cost-sharing under the Affordable Care Act. “So if they opt in and have to provide all these new medications, plus residential, they’re on the hook for 10 percent.”
In fact, there has not been a significant demand for buprenorphine in California OTPs yet, probably because patients know it isn’t covered, said Dr. Kletter. The organized delivery system is only for Medicaid, which is the main payer for OTPs in California.
People with private insurance are more likely to go to a primary care provider for buprenorphine, he said. And commercial insurance companies are likely to have coverage for buprenorphine; few have coverage for OTPs.
Categories: Buprenorphine, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioids
Tags: Addiction, Buprenorphine, Health Insurance, Medicaid, Opioid Treatment Programs
By Alison Knopf
The Drug Enforcement Administration (DEA) is not yet ready to talk about mobile vans. The agency is likely to release new licensing regulations, which will open the door to more mobile vans to provide medication-assisted treatment for opioid use disorders—most likely in conjunction with brick-and-mortar opioid treatment programs (OTPs)—sometime this fall.
Demetra Ashley, associate deputy assistant administrator of the Office of Diversion Control of the DEA, told the board of the American Association for the Treatment of Opioid Dependence (AATOD) that the project was underway last year. However, it was last fall that she said that, and the situation hasn’t changed yet.
New Mobile Vans Need New Regulations
Existing mobile vans can still operate, but new ones need new regulations.
This affects many programs. For example, Washington State, as part of its CURES State Targeted Response to the Opioid Crisis (STR) grant, wants mobile vans. Evergreen Services in Seattle would buy two vans. “They have the CURES money, they have a designated provider, now they’re just waiting for the vans,” said Mark Parrino, MPA, AATOD president, in an interview. “But they can’t buy the vans until the DEA releases its new licensure standards. They’re ready to go, but they can’t.”
About four years ago the DEA decided not to license any new vans, but they did not de-license any existing vans. Once the new regulations are released, more mobile vans are expected to provide more treatment to more patients.
States Linked to OTPs via Mobile Methadone Vans
The following states have mobile methadone vans connected to OTPs (all data as of 2014):
- California (3 vans/206 patients)
- Massachusetts (3 vans, 2 being used on an active basis/150 patients)
- Maryland (2 vans)
- New Jersey (5 vans/1,000 patients)
- Puerto Rico (2 vans)
- Washington (1 van/175 patients)
Importantly, federal authorities need to be ready with a team of consultants who can help state authorities and providers comply with the new regulations.
Mr. Parrino doubts that the DEA would allow methadone to be dispensed from mobile vans that are not associated with brick-and-mortar OTPs. The reason is the storage rules for the medication.
The DEA’s proposal needs to be vetted through its main agency, the Department of Justice. In addition, every regulation must go through the Office of Management and Budget.
Categories: Addiction, Heroin, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids, Prescription Drugs
Tags: Addiction, DEA, Methadone Treatment, Opioid Treatment Programs
By Alison Knopf
At its July 17 “America Honors Recovery” gala, Faces & Voices of Recovery awarded Mary Jeanne Kreek, MD, and Mark Parrino, MPA, two top honors. Dr. Kreek, head of the Laboratory of the Biology of Addictive Diseases at The Rockefeller University in New York City, was presented with the William L. White Distinguished Lifetime Achievement Award, and Mr. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), received the Lisa Mojer-Torres Award.
The gala, held this year at the Hyatt Regency on Capitol Hill, salutes the legacy of prominent trailblazers in the methadone maintenance recovery arena. Ms. Mojer-Torres, JD, a longtime patient advocate for methadone maintenance patients, was a founding member and first chairperson of the Faces & Voices of Recovery. William L. White is an author and a recovery historian whose important contributions to recovery literature span more than four decades. Mr. White collaborated with Ms. Mojer-Torres, who died in 2011, on a major publication, “Recovery-Oriented Methadone Maintenance.” http://atforum.com/documents/Recovery.pdf.
Dr. Kreek worked with Vincent Dole, MD, and Marie Nyswander, MD, in developing methadone as a treatment for opioid addiction. Her work showing that addiction is a brain disease has helped change the view of addiction in America.
For decades, Mr. Parrino has been in the forefront of advocacy for the treatment of opioid use disorders.
National Conference on Correctional Health Care
November 4-8, 2017
REFORM: International Drug Policy Reform
November 11-14, 2017
American College of Psychiatrists (ACP) Annual Meeting
February 21-25, 2018
(AATOD) American Association for the Treatment of Opioid Dependence, Inc. 2018 Conference
March 10-14, 2018
New York City at the Marriott Marquis