Addiction Treatment Forum

AT Forum Volume 29, #8 December 2018

	The Shocking Facts About Opioid Deaths in the Very Young
	The “Three-Day Rule” Needs To Be Extended to Allow Longer Treatment With Methadone or Buprenorphine
	How OTPs Can Help Pain Patients With OUDS: SAMHSA
	42 CFR Part 2 Still a Target for 2019
	In-House, On-Site Pharmacy Provides Convenience and Minimizes Stigma, Enhancing Retention
	Events

Categories: Medication-Assisted Treatment (MAT), Newsletter, TOC

The Shocking Facts About Opioid Deaths in the Very Young

By Barbara Goodheart, ELS

Yale researchers have uncovered startling data about the number of children and adolescents (younger than age 20) dying from opioid poisoning.

The general belief—until the Yale team delved into it—was that children and adolescents rarely die from ingesting illicit and prescription opioids.

But the researchers found that most studies had looked at deaths related to hospitalizations or emergency department visits—not deaths occurring outside hospitals.

Adding the deaths outside hospitals brought the average yearly death total to nearly 500—far more than had been expected; meaning that over the 18-year span of the study, ending in 2016, opioid deaths claimed the lives of almost 9,000 children and adolescents. Almost 8,000 of the deaths occurred among adolescents (aged 15 to 19), and just over 600 among children aged 0 to 4 years.

The findings were especially grim among children younger than age 5. Tragically, almost one death in four in this highly vulnerable group was due to homicide.

The study results were published in the December issue of JAMA Network Open.

Study Focus, Design, and Data Source

Led by Julie R. Gaither, PhD, MPH, the investigators looked at deaths in children per year from opioid poisonings. This was a retrospective analysis of data from the WONDER database, which compiles information from all death certificates from the National Center for Health Statistics. The team used the Multiple Causes of Death file to identify poisonings.

Summarized below are data gathered over the study period.

Study Focus, Design, and Data Source

Summarized below are data gathered over the study period.

Deaths Among All Children and Adolescents, No. (%)

Unintentional	Homicide	Suicide	Undetermined
7,263 (80.8)	219 (2.4)	445 (5.0)	1,061 (11.8)

In particular, the authors noted that the under-5 group was “highly vulnerable.” This group had “the second-highest mortality rates overall,” and “the second-largest increase in rates over time.”

Many deaths in this age group were due to homicide or to unintentional harm.

Deaths Among Children Younger Than 5 Years, No. (%)

Unintentional	Homicide	Undetermined
230 (38)	148 (24.5)	227 (37.5)

Additional findings:

Mortality rates rose by 252.6% in adolescents aged 15 to 19 years, and by almost as much—225.0%—in children aged 0-4 years
In infants, 34.5% of deaths were categorized as homicides—the highest percentage so categorized for any age group
In all age groups, 10.4% died in the inpatient setting, and 24.1% in the emergency department—but the largest proportion—38.0%—died at home

Again, the last finding—most deaths occurring outside a medical setting—helps to explain the original widely held, but incorrect, belief that the young rarely die from ingesting opioids.

The authors pointed to the need for further research “to determine what roles abuse, neglect, and parental substance abuse—specifically, opioid abuse—play in these deaths.”

Current Practices

Policies and practices in the opioid field have focused on adults, but the Yale team pointed out that this needs to change, and steps need to be taken to protect young children. For example, it’s easy to open the foil wrappers of Suboxone and Duragesic—products that are potentially lethal to a young child.

The Bottom Line

For the under-5 age group, the authors foresee a public health problem that is likely to grow “unless parents, legislators, public health officials, and clinicians—including physicians who prescribe opioids to adults—begin to take a wider view of what is a systemic crisis.” The authors call for something better than ”isolated solutions that fail to account for how entire families and communities are affected by adult opioid use.”

Reference

Gaither JR, Shaban ova V, Leventhal JM. US National trends in pediatric deaths from prescription and illicit opioids, 1999-2016. Original Investigation / Pediatrics. JAMA Network Open. 2018;1(8);e186558. doi:10.1001/jamanetworkopen.2018.6558.

Categories: Medication-Assisted Treatment (MAT), Newsletter, Opioid Abuse/Addiction, Opioids
Tags: Addiction, opioids

The “Three-Day Rule” Needs To Be Extended to Allow Longer Treatment With Methadone or Buprenorphine

By Alison Knopf

In 2017, Gail Groves Scott, MPH, manager of the Substance Use Disorders Institute at the University of the Sciences in Philadelphia, wrote a passionate piece in the Philadelphia Inquirer about the importance of expanding existing Drug Enforcement Administration (DEA) rules to expand and relax hospital regulations. Ms. Scott sought to remove the “three-day rule,” which limits treatment with methadone or buprenorphine for an opioid use disorder (OUD) to three days. A related rule requires hospitals to say whether the opioid addiction diagnosis is primary or secondary to other diseases for which the patient is being treated at the hospital, Ms. Scott wrote.

Under existing DEA regulations, hospitals are allowed to dispense methadone and buprenorphine for OUDs without an opioid treatment program (OTP) license, for three days. Ms. Scott wants to greatly extend that, because three days is not long enough to stabilize someone who has an OUD. Experts want hospitals to refer patients to OTPs— which would be better suited to stabilize them. But if a patient must be hospitalized, there should be provisions for that patient to receive agonist medication, notes Ms. Scott.

And that’s not all. The DEA should extend this waiver to nonhospital residential programs and correctional facilities, says Ms. Scott.

Specifics

In a policy brief written by Ms. Scott, a copy of which was obtained by AT Forum, Ms. Scott explains that:

Hospital clinicians must have a regulatory “waiver” if they dispense buprenorphine to treat acute withdrawal (beyond 3 days) or write a discharge prescription. These rules impede efforts to streamline care continuums and access to the most effective “medications for addiction treatment” (ie, MAT, with buprenorphine and methadone).
Hospitals, jails, nursing homes, and non-hospital residential facilities providing inpatient treatment, or “rehab,” must have a “waivered” physician, nurse practitioner, or physician assistant order buprenorphine pharmacotherapy; yet less than 5% have this credential. Plus, the facility must register as a licensed OTP to initiate or maintain OUD patients on methadone (outside of a confusing loophole for hospitals about “secondary” treatment). Or, they must contract with an OTP to deliver “take-home” methadone doses, although they don’t have an OTP nearby. Yet if the diagnosis is pain, not OUD, there are none of these costly barriers. OTP regulations were based on the outdated model separating behavioral health care from mainstream health care (rooted in stigma), yet integration of care is our goal today.

Specifically, Ms. Scott recommends that the “three-day rule” for dispensing buprenorphine in hospitals treating acute withdrawal—waiver or not—should be expanded to 7 to 14 days. This would allow acute provision of medication to bridge patients to outpatient appointments or inpatient admission, she said.

Primary and Secondary Diagnosis

In addition, Ms. Scott recommends removal of the requirement that the hospital waiver applies only to an OUD diagnosis, secondary to another treatment condition for unlimited dispensing, within a hospital or long-term treatment facility. “This confusing rule becomes a compliance liability that deters innovation in drug overdose prevention and OUD treatment in hospitals,” said Ms. Scott. “Enforcement has never been practical, in any case. (Should the DEA be auditing individual patient charts and assessing which diagnosis was ‘primary’?)”

Finally, the waiver for the hospital—as revised—should be extended to corrections facilities and licensed residential treatment programs, she said.

Ms. Scott has clear recommendations for changing regulations, including language, and she has widespread support in the field.

“Just to be clear, the three-day rules were obviously created by someone other than an addiction medicine physician,” said Jane Liebschutz, MD, MPH, visiting professor of medicine at the University of Pittsburgh. “I assume that whoever made those rules did not actually care for patients, because the rules don’t address the actual experience of patient care.”

Indeed, the DEA made the rule. According to the DEA, the “three day rule” allows a practitioner who is not separately registered as a narcotic treatment program to administer (but not prescribe) narcotic drugs to a patient, under certain conditions. Administration must be for the purpose of relieving acute withdrawal symptoms, while arranging for the patient’s referral for treatment, as follows:

Not more than one day’s medication may be administered or given to a patient at one time
This treatment may not be carried out for more than 72 hours
This 72-hour period cannot be renewed or extended

The DEA was not available for an interview on this topic, due to the government shutdown.

Ms. Scott continues to be involved in efforts to change regulations regarding methadone and buprenorphine. As she explains in her Philadelphia Inquirer story, she has held the hand of a loved one recovering from an overdose.

For more information, go to:

https://www.usciences.edu/about/substance-use-disorders-institute/index.html

and:

http://www.philly.com/philly/opinion/commentary/trump-emergency-opioids-treatment-regulation-change-20171106.html

Categories: Addiction, Buprenorphine, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioids
Tags: Buprenorphine, Medication-Assisted Treatment, Methadone Treatment, Opioid Treatment Programs, opioids

How OTPs Can Help Pain Patients With OUDS: SAMHSA

By Alison Knopf

Can opioid treatment programs (OTPs) help pain patients who no longer need opioids for pain? Absolutely, says Elinore F. McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at the Department of Health and Human Services (HHS). “For overuse and misuse of pain medications over time, which may have been initiated for a pain condition—I definitely think there’s a role for OTPs in this,” she told AT Forum.

One barrier is that the patients themselves don’t want to be considered “addicted,” and certainly don’t want to go to a treatment program that advertises itself as treating “addicts.” Another is that pain physicians themselves sometimes don’t want to be associated with addiction—and don’t even want to get the waiver to prescribe buprenorphine for their patients who develop opioid use disorders (OUDs).

Stigma of “Addict”

As assistant secretary at HHS, Dr. McCance-Katz is also responsible for managing and directing the Substance Abuse and Mental Health Services Administration (SAMHSA), and for leading SAMHSA policy and program development. So Dr. McCance-Katz understands the barriers facing patients, physicians, and OTPs. She cited an example. “I think there’s a certain stigma to using the word addiction with someone who believes they have a legitimate painful condition for which they received opioid therapy,” she said.

My own approach with those patients is not to use the word ‘addiction’ or ‘addict,’ but to discuss with them how these opioids have affected their life in a negative way,” she said. “It’s not just about dependence—it’s about overuse to the extent that it’s medically dangerous.” For example, overuse of opioids can result in periods of respiratory depression or aspiration pneumonia that could lead to death, she said. Another problem is that people on long-term opioids for pain “are not very active, and don’t exercise their lungs,” further exacerbating the respiratory issues, she said.

To help these patients accept treatment in an OTP for their OUD—because that’s what people who overuse and misuse opioid painkillers have—it’s best not to “label” them, but to “get them to tell you themselves about some of the negative ways opioids have affected their life,” said Dr. McCance-Katz.

Comprehensive Care

As for helping people who are coming off high-dose long-term opioids get their lives back together, that’s exactly what OTPs do in providing comprehensive care, she said. “They have all the resources that are necessary to help that person.” And treating the OUD may not necessarily be with methadone—increasingly, OTPs are offering all three medications, said Dr. McCance-Katz: methadone, buprenorphine, and naltrexone.

“In my own clinical experience, so many people start out on opioids with pain, and legitimate pain,” said Dr. McCance-Katz. They were vulnerable to developing an OUD—and they did. “I talk to them about the positives and negatives, and they start to talk about the positives and negatives.”

Tapering

It may be that the patient’s own pain management physician needs to taper a patient’s opioid medications before the patient can start taking methadone, because most OTPs are not allowed to induce patients at doses above 20 or 30 milligrams. “Pain management may need to taper them to a point where they can safely transfer over to methadone or to buprenorphine,” said Dr. McCance-Katz. “There are protocols for doing that (specifically, for buprenorphine, she noted, although she added that it is easier to go from buprenorphine to methadone than from methadone to buprenorphine).

Unlike methadone given for OUDs, methadone for pain is given in multiple daily doses. “I don’t think we have all of the science” to understand why we give methadone once a day for OUD but not for analgesia, she said. Both methadone and buprenorphine are long-acting drugs.

How does a clinician know if a patient on long-term opioids for pain has an opioid disorder? It’s based on DSM-5 and behavioral manifestations—not just tolerance and withdrawal, which are not necessarily pathological, noted Dr. McCance-Katz.

“One of the key questions, when you get people who are on these large doses of opioids, and who meet criteria for an OUD, is, what do you do with them?” she said. “What you don’t do is cut them off. Too often that’s happening. Will they go through withdrawal? You bet, and that is wrong—in my opinion, it’s inhumane. We have to have protocols in place, that is part of the individualized relationship between a clinician and their patient.”

The federal Centers for Disease Control and Prevention, in their guidelines for long-term opioid use, did not recommend cutting patients off immediately, noted Dr. McCance-Katz. Yet, many pain physicians are doing that. OTPs have the resources and the pharmacological know-how to induce methadone and buprenorphine.

But tapering? That’s hard for anyone to do, said Dr. McCance-Katz. “I don’t think this is an area that gets a lot of emphasis in training programs,” she said. “Often clinicians aren’t aware of what all the downstream effects are, of tapering, and especially of cutting patients off of their opioids,” she said. “We know how to taper opioids. We need to make these protocols available.”

In fact, the federal government is working to get clearance to release tapering protocols to the field, said Dr. McCance-Katz. “As a field, as prescribers, we cannot absolve ourselves of responsibility when we are the ones who started these medications, usually without good evidence of their effectiveness.”

Emergency Departments

Some emergency physicians have suggested that if patients come in in withdrawal from opioids, all they need to give them is some opioid—any opioid—to stop the symptoms. “The problem with that approach is that within a few hours they’re going to be right back where they started from,” said Dr. McCance-Katz of these patients, noting the problem will be particularly bad if patients are giving short-term opioids, like Dilaudid.

“In fairness to emergency medicine colleagues, they are under intense time constraints, and this is not the kind of work that should be assigned to them,” she told AT Forum. “Increasingly, EDs are looking to do this kind of work, but it’s really very difficult to give the person the proper assessment, to determine if they’re a candidate for any opioid,” she said. The patient also needs to be able to move on to a clinic quickly where they can continue treatment. “If you just give them a dose of opioids, you’ve done nothing except put off the problem for a few hours or a few days.”

Categories: Addiction, Newsletter, Opioid Abuse/Addiction, Opioids, Pain
Tags: Buprenorphine, Methadone Treatment, Pain, Stigma

42 CFR Part 2 Still a Target for 2019

By Alison Knopf

Perhaps the best example of what can happen to loss of confidentiality is the story of the Boston Medical Center nurse, who, doing exactly what the Surgeon General of the United States recommended, got a prescription for naloxone in case she needed to rescue anyone from an opioid overdose. She was denied life insurance, because the insurance company thought she herself was at risk of overdosing (https://www.npr.org/sections/health-shots/2018/12/13/674586548/nurse-denied-life-insurance-because-she-carries-naloxone).

In fact, life insurance is one thing that is not protected under the Americans with Disabilities Act—you can be denied it if you have a history of addiction, just as you can be denied (or charged higher rates) if you have a dangerous occupation or hobby. But there was only one thing operating here: stigma.

Stigma

“In this case, it was the stigma that was driving the discrimination,” said H. Westley Clark, MD, JD, in an interview with AT Forum. “She did not have a substance use disorder problem.”

“All you have to do is map out the logic,” said Dr. Clark, who is Dean’s Executive Professor at Santa Clara University, and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA). Information about prescriptions is in medical records, easy to get, and everyone, from banks to employers to credit card companies, wants to get it.

“We know that when we open that door, as the message starts to disseminate, people will become reluctant to engage in treatment,” said Dr. Clark. “We no longer have the ‘what ifs.’”

Bill Stauffer, CADC, CCS, LSW, executive director of the Pennsylvania Recovery Organizations—Alliance, and a co-Chair of the public policy committee of Faces & Voices of Recovery, agreed.

One of the strangest parts of the story is the people and organizations who want to get rid of the regulation: the American Society of Addiction Medicine, the National Association for Behavioral Health (which counts many large OTPs as members), and the National Association of Addiction Treatment Providers, to name a few. These are the groups that treat people with substance use disorders (SUDs)—one would think they would want their patients to be able to trust them. “I don’t think they fully understand the impact” taking away confidentiality would have on their business, said Mr. Stauffer.

“Someone goes to Hazelden Betty Ford, and gets their rights violated, the patient will end up on the treatment facility doorstep to figure out who violated their rights,” he said.

In fact, it’s that fear—of being sued when a job is lost or custody of a child is lost due to SUD treatment records—that made NAADAC, the Association for Addiction Professionals (NAADAC)—drop out of the coalition to amend 42 CFR Part 2.

“It won’t take long before people start realizing these are adversarial relationships,” said Dr. Clark, referring to patients and treatment providers. One reason providers won’t do Screening and Brief Intervention and Referral to Treatment (SBIRT) is that they are worried about liability, said Dr. Clark—and this is primary care providers, who aren’t even subject to 42 CFR Part 2 (it applies only to treatment providers who put themselves forward as treating SUDs and who accept federal funding, including Medicaid or Medicare).

There is only one small piece left, really, of 42 CFR Part 2—it’s the piece that requires the patient to give consent about who gets his or her patient information. All the patient is saying is, “Let me participate in that decision,” said Dr. Clark.

Data Mining

But electronic health records (EHRs) have become currency. Because of 42 CFR Part 2, they don’t include treatment for SUDs. This annoys the entire system of hospitals and insurance companies. “Think of the value that would have for an employer who didn’t want to hire people who were at high risk for having a SUD,” said Mr. Stauffer, who is in recovery and frequently cites the first question he asked his doctor upon seeking help: “Will this be confidential?”

When SAMHSA changed the regulation a year ago to allow release of information for the purpose of the vaguely phrased “health care operations,” a chink in the door was opened. “This information is lucrative,” said Mr. Stauffer. “How would we ever know what the healthcare operations vendors do with the information? What keeps them from selling information that can eventually be re-associated with the patient?”

There is also the personal concern about getting pain medication—difficult enough for people without an addiction history these days. “Medical discrimination against people with SUDs is common,” he added. “My doctor knows I’m in recovery. I had a dental problem one time, I needed antibiotics and a painkiller at 2:00 in the morning. I got the medication I needed, so that I could stabilize it and see a dentist, I was able to make that judgment. But if my record has addict written on the front of it, they’re going to say, ‘No you’re drug seeking,’ and I’m going to be in agony.”

Congress

What’s happening in Congress? Well, the House Energy and Commerce Committee, which held many hearings focused on getting rid of 42 CFR Part 2 under Republican leadership, is now headed by Rep. Frank Pallone (D-New Jersey), whose questions in past hearings clearly showed he is on the side of protecting the regulation. “In the previous Congress, he was a champion for patient confidentiality rights as Minority Leader of the Energy and Commerce Committee,” noted Deborah A. Reid, senior health policy attorney with the Legal Action Center. “This supported the advocacy efforts of other key stakeholders, such as Faces & Voices of Recovery and the AMA,” she told AT Forum, adding that “the Legal Action Center remains committed to working closely with advocates to educate the new Congress about the importance of maintaining strong confidentiality protections for SUD patients.”

However, Mr. Stauffer, who watches these things closely (he told us around Christmas that he would not rest until 11:59 December 31 when the lame-duck Congress would have to give up its plot to get rid of 42 CFR Part 2) said that the starting point for this new session will likely be where the last session left off. “They were looking to create a huge new loophole which would allow the release of information for all kinds of reasons—civil, administrative—that to me is the same as losing consent.”

“We have to have a larger discussion about privacy in America,” said Mr. Stauffer.

The nail in the coffin of last year’s attempt to gut the regulation was the American Medical Association (AMA), which, in a dramatic last-minute letter to Congressional leadership, warned that such an action would deter patients from seeking treatment. The AMA told us that they had someone at the table during the last weeks of December as efforts were made to get rid of 42 CFR Part 2, and they’re continuing to watch the situation.

Perhaps the bigger target now is the Affordable Care Act (ACA), because, certainly in the Senate, this is still under fire. “We need to hold the fort, because the ACA is very fragile,” said Dr. Clark. The decision last year from a Texas judge—which has been challenged by most state attorneys general, and will head to the Supreme Court—that the ACA is not constitutional, has caused great concerns among the treatment field.

AATOD

Meanwhile, the stalwart defender of 42 CFR Part 2 is the American Association for the Treatment of Opioid Dependence (AATOD). President Mark Parrino, MPA, told AT Forum that ultimately, he and Mark Covall, who heads the National Association for Behavioral Health, “had to agree to disagree.”

However, Mr. Parrino did also talk with the CEOs of the large OTP systems, some of whom belong to Mr. Covall’s group, as well as with AATOD, and they do not support converting 42 CFR Part 2 to a much weaker regulation, HIPAA. “In effect, they are members of AATOD and NABH, but do not necessarily agree with a HIPAA conversion,” Mr. Parrino told AT Forum. “They may stay silent on the topic, but I have not read of a public disagreement with AATOD’s position.”

And AATOD’s position has been consistent. “I understand the financial and record-keeping reasons why groups support the conversion to HIPAA,” said Mr. Parrino, ever the diplomat. “In my judgment, they are not aware of the impact that this will have on patients,” he said. “This also explains why Faces and Voices of Recovery and NAMA Recovery are so worried.”

Some policy-making groups are of the judgment that 42 CFR Part 2 is burdensome and an impediment to service integration and more rapid claims processing—something that insurance companies and EHRs may believe. But it’s not easy to understand that from a clinical viewpoint when helping patients with SUDs.

“The AMA’s support has been critically important in this policy debate, but I do not think this matter is resolved,” said Mr. Parrino. “I am acutely aware of how patients feel about preserving their right to confidential treatment, having spent 18 years of my professional life working in an OTP in New York.”

During the process of being admitted to treatment, patients are not focused on the value of confidentiality, because they are in a time of crisis, said Mr. Parrino. But the confidentiality protections took on greater importance for them when they became stabilized, got jobs, and had children. “At that point, preserving confidentiality was critical,” said Mr. Parrino. “There were a number of patients who could not get health insurance, disability insurance, or life insurance, once it became known that they were in treatment. I do not think that has changed.”

Finally, patients are also attuned to “how others would engage them in and out of health care once they revealed that they were in a methadone treatment program,” said Mr. Parrino. “It is of great interest to me that these views seem to be in the minority at the present time against the backdrop of the opioid epidemic.”

For more articles, see:

http://atforum.com/2018/11/42-cfr-part-2-its-still-under-threat-misunderstood-but-otp-patients-need-it/

http://atforum.com/2018/09/42-cfr-part-2-faces-tough-going-congress/

http://atforum.com/2017/02/final-rule-42-cfr-part-2-retains-core-confidentiality-protections/

http://atforum.com/2016/06/longtime-confidentiality-rule-sud-consent-provisions-up-for-change/

Categories: Medication-Assisted Treatment (MAT), Newsletter

In-House, On-Site Pharmacy Provides Convenience and Minimizes Stigma, Enhancing Retention

By Alison Knopf

In opioid treatment programs (OTPs) in the United States, all pharmacy is “in-house,” meaning that patients are dispensed medication by nurses in the facility. There is no need to go to an outside community pharmacy—and for methadone, it’s not even legal for pharmacies to dispense for treatment of opioid use disorder (OUD).

In Canada, however, methadone patients can—and do—go to community pharmacies for their methadone, which is dispensed by the pharmacist, often on a daily basis. But it’s better if they stay in their facility to get the medication—in Canada, the treatment facility can have its own on-site pharmacy—because they are more likely to stay in treatment.

David K. White, PhD, president and CEO of BayMark Health Services, which has OTPs in both the United States and Canada, discussed the importance of pharmacy with AT Forum, focusing on the benefits that result from an in-house pharmacy that ultimately improves retention.

“The main benefits are convenience and lack of stigma,” Dr. White told AT Forum. This applies to the pharmacy in the United States, as well as to the proprietary pharmacy offered in Baymark’s Canada programs. “Our pharmacists deal every day with people who need methadone, buprenorphine and naltrexone,” said Dr. White. “They have the specific answers our patients need at their fingertips.”

Study Links In-House Pharmacies With Better Retention

A study published last year in Drug and Alcohol Dependence found that patients who receive medication at in-house pharmacies are more likely to stay in treatment. When Canadian patients choose to use an outside pharmacy, the percentage remaining in treatment one year later drops to 12%, compared to 56% of patients who receive their medication at the in-house specialty pharmacies (the study was conducted at Baymark treatment programs in Ontario).

While there are no significant cost implications for the patient or the payer in terms of medication delivery, the costs related to poor treatment retention are huge, said Dr. White. “If we retain more patients in treatment, it’s helpful to the patient and it saves money,” he said. He noted that studies in the United States show that for every dollar spent on treatment, 7 to 10 dollars are saved in costs related to criminal justice, medical problems, and work-related problems.

Most Baymark patients get methadone, but about 10 years ago some started receiving buprenorphine. Currently, about 6% of Baymark patients take buprenorphine.

Reassuring Patients

“The costs of methadone are low, and the setup of the pharmacy system isn’t that complicated,” said Dr. White. “The retention rates for the collocated pharmacy are huge.”

It is also reassuring to patients to get their medication with other methadone and buprenorphine patients, “as opposed to walking into a pharmacy and feeling stigmatized,” said Dr. White. “It’s important to have a sensitive group of staff who understand the addiction issue, particularly given all of the misinformation out there, and the unfortunate stigma of medication- assisted treatment, both within and outside of the industry,” he said. “It’s better not to have patients exposed to that, to have them walk in and be accepted.”

Reference

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 Alcohol Depend. 2018; Oct 1;191:1-5. Epub 2018 May 31. doi:10.1016/j.drugalcdep.2018.04.029.

Categories: Medication-Assisted Treatment (MAT), Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction
Tags: Medication-Assisted Treatment, Methadone Treatment