By Alison Knopf
The annual board meeting last December of the American Association for the Treatment of Opioid Dependence (AATOD) was more than just a meeting. Eight board members conducted a number of visits to Capitol Hill, educating Congressional representatives and staff. A key focus of these visits was getting reimbursement for Opioid Treatment Programs (OTPs) from Medicare Part B (which covers nonhospital treatment), said AATOD president Mark Parrino, MPA. “This will be a slow and labor-intensive process, but I believe that at the end, we will be successful,” Mr. Parrino told AT Forum.
The board also met with Richard Baum, MA, MPA, acting director of the Office of National Drug Control Policy (ONDCP); Demetra Ashley, MA, deputy assistant administrator for the Drug Enforcement Administration (DEA); Danielle Johnson Byrd, MPH, director of the Division of Pharmacologic Therapies at the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration; and Ms. Byrd’s staff. “They all led extremely productive discussions among AATOD board members,” said Mr. Parrino.
The ONDCP is expected to release the National Drug Control Strategy in March.
Speaking with the AATOD board, Mr. Baum, a longtime ONDCP official, continued to support the utilization of medication assisted treatment (MAT) for opioid use disorder (OUD), said Mr. Parrino. In addition to the use of medications, Mr. Baum stressed the need for offering comprehensive care services. “He expressed concern that treatment for opioid use disorder needs to reflect the best standards of care, so that we can be certain that patients are being properly treated when medications are selected by various treatment practitioners in the United States,” said Mr. Parrino. “ONDCP and its leadership continue to be supportive of the work of our Association and its members.”
Drug Enforcement Administration
The DEA officials who met with the AATOD board in December focused on three areas: mobile vans, telemedicine, and the new Narcotic Treatment Program Guidelines (NTP is the term the DEA uses).
Finalizing the mobile van policy development would certainly increase the use of mobile vans connected to the bricks-and-mortar OTPs, said Mr. Parrino. “We know that there are several states that want to purchase such vans so that they can expand the reach of OTPs in their areas.” For example, the Evergreen Treatment Services system in Seattle, Washington, is working in this area. In addition, the New York State Office of Alcoholism and Substance Abuse Services has indicated a strong interest in implementing mobile vans, especially in rural and upstate areas.
So, what is holding up the mobile vans issue? The DEA is interested in promulgating the rule, but is “running into some roadblocks regarding how fast they can introduce a new regulatory approach, at a time when deregulation seems to be the primary focus,” said Mr. Parrino. There will be more information at the conference in March when DEA leadership meets with the board of directors.
The release and implementation of the DEA’s new NTP guideline is being held back. The guideline discusses how mobile vans would be used, so it can’t be released until the mobile van policy is resolved.
AATOD is working with the American Academy of Addiction Psychiatry to develop telemedicine guidelines for OTPs. This matter will be discussed during the policy section of the March conference.
Danielle Johnson-Byrd and three of her associates led the discussion on how CSAT is targeting policies affecting OTPs in the United States. “We talked about the importance of proper OTP siting, especially as more treatment programs will be approved by CSAT to operate in the United States,” said Mr. Parrino.
There was also an in-depth discussion of the quality of care services offered through OTPs. CSAT reminded all board members that the agency will continue to promulgate effective oversight to be certain that OTPs follow existing standards, especially during a period of such rapid expansion.
The board also expressed concerns that states clearly demonstrate what they have done in using the grants from the State Targeted Response (STR) to the Opioid Crisis, issued by SAMHSA, for 2017. Are states using this money for MAT for OUDs? This is a matter of accountability, as states work to increase access to treatment; 80% of the STR grants had to be used for direct treatment for OUDs. But the board expressed concern that some states may be marginalizing the use of medications, such as methadone, or marginalizing OTPs themselves. For example, Wyoming decided not to use any STR grant funds for methadone maintenance treatment, and not to site any OTPs, Mr. Parrino noted.
“There are more encouraging reports from other states with regard to STR grant use, and it is expected that this will be reported on during the March conference in New York,” said Mr. Parrino. “There will be a number of policy discussions led by SAMHSA and CSAT representatives and it is certain this topic will come to surface.”