Stigma – Addiction Treatment Forum

AATOD Issues Five-Year Plan: Bottom Line Focus Is Still on Stigma

April 13, 2017

By Alison Knopf

The five-year plan of the American Association for the Treatment of Opioid Dependence (AATOD) has a goal of increasing access to care in opioid treatment programs (OTPs). Treatment “wherever it is needed”—in the United States and in the world—with the aim of patient care, is a theme running throughout the document.

The first strategic five-year plan was approved in 2001, and updated in 2007 and 2012. The current plan is for 2017-2021.

Sustainability was a guiding principle, with initiatives aimed at expanding access to OTPs, increasing access to third party funding, and working with the World Federation for the Treatment of Opioid Dependence.

Increasing OTPs

AATOD will work with its partners, including the Substance Abuse and Mental Health Services Administration (SAMHSA), to accomplish the following goals:

Identify existing treatment resources for opioid dependent individuals

Identify where treatment is needed in underserved areas of the country

Identify what financial resources are needed

Work with the criminal justice, behavioral, and primary medical care systems to ensure patients receive comprehensive and coordinated care

AATOD will strive to increase care in drug courts and correctional facilities, as well as in the rest of the criminal justice system, working with the Legal Action Center and other policy partners. This year AATOD will release a criminal justice fact sheet on OTPs.

Below are other key areas highlighted by the five-year plan.

Integrated Service Delivery

The three policy papers developed by AATOD for SAMHSA last year will be the foundation for better integration of care with OTPs and other health care settings. Key to this is reimbursement from third-party payers.

Medicaid: There are still 16 states that do not allow use of Medicaid funds for OTPs. AATOD will provide guidance to help increase such reimbursement.

Medicare: Last year, the Centers for Medicare and Medicaid Services (CMS) determined that it does not have the authority to allow Medicare to pay for OTP services. The plan is for AATOD to work with the White House Office of National Drug Control Policy (ONDCP), Medicare, and Congress to make it possible for Medicare to pay for OTP treatment. Again, the leadership of the current administration will be crucial to determining the outcome of these efforts.

Commercial insurance companies: AATOD will work with commercial insurance companies on model contracts that would allow reimbursement to OTPs. There would also be cross-training opportunities so that insurance companies could better understand what OTPs do.

Working With Partners

Educating Congress: AATOD developed an educational initiative aimed at Members of Congress, some of whom don’t understand how OTPs function or what services are provided, and the misunderstanding of medications—especially methadone—needs to be rectified. This will require financial resources to coordinate how OTP administrations and patient advocates can meet with Congressional representatives both in district offices and in Washington, D.C.

Federal Agencies: AATOD will also work with federal agencies, building upon relationships with the ONDCP, SAMHSA, the Drug Enforcement Administration (DEA), the Food and Drug Administration, the National Institute on Drug Abuse, and other federal agencies. With SAMHSA, a key focus will be on cross-training initiatives, enabling OTPs to work with the states. With the DEA and SAMHSA, AATOD will focus on the Narcotic Treatment Program Guidelines, expected out during 2017.

Other Issues

AATOD will continue to promote all medications approved to treat opioid use disorders through OTPs. This is important if OTPs are to be the “essential hub treatment sites” for opioid use disorders.

Conferences, Webinars, Communications: AATOD conferences, which began in 1984, are a way to showcase leading initiatives and training to OTP staff. Conferences promote evidence-based practices and patient-centered care. Webinar-based training resources will continue to be used to advocate for AATOD’s goals. The AATOD website itself promotes new training opportunities and helps ensure wide dissemination of policy documents. There will be a mobile version of the website for access on phones and other devices.

International Work: AATOD will continue to work with the World Federation for the Treatment of Opioid Dependence and EUROPAD in increasing access to treatment. The United Nations Office on Drugs and Crime is also helping to increase resources for developing programs. Vietnam and African nations have been using PEPFAR funds to increase access to care. (PEPFAR—the President’s Emergency Plan for AIDS Relief—was created in 2003 to help certain hard-hit countries combat HIV/AIDS, TB, and malaria in hard-hit countries.) AATOD will continue to work with international and United States government organizations to promulgate evidence-based treatment.

Prescription Drug Use: AATOD will continue working with the Denver Health and Hospital Authority’s RADARS System on patterns of prescription opioid use and heroin use, and with NDRI, AATOD’s research partner, to understand how OTPs can respond to changes in drug use patterns in different parts of the country. Prescription drug monitoring programs (PDMPs) are also important to OTPs. Patient care improves when OTPs access PDMP databases. Finding out what other medications their patients are taking provides increased opportunities for counseling as well.

One of the biggest challenges OTPs have faced—and still face—is opening new facilities. This is part of the challenge AATOD is taking up: how to educate “a wary American public” to overcome the stigma of using medications to treat opioid use disorders.

“Our focus has always been to improve access to care, and when such access is available to be certain that the quality of care is evidence driven and patient centered,” the five-year plan document concludes. “It is anticipated that the next several years will continue to represent major challenges to our system. It is critically important to educate Members of Congress, state legislatures and the American public about the value of treating opioid addiction with medications based on evidence.”

The full version of the plan can be accessed at: http://www.aatod.org/2017-2021/

An executive summary of the plan can be accessed at: http://www.aatod.org/aatod-five-year-plan-executive-summary/

Research Results: Opioid Agonist Treatment Versus Detoxification in Lowering the Costs of Crime

February 13, 2017

By Barbara Goodheart, ELS

A recent study compared opioid agonist treatment (OAT) and detoxification in patients with opioid use disorders. The goal was to see which treatment approach is associated with costs of crime.

A team of six investigators, supported by a grant from the National Institute on Drug Abuse (NIDA), led the study. They published their findings last December in the online version of Addiction.

Study Group

Included were more than 31,650 patients. Treatment took place in publicly funded facilities in California from the beginning of 2006 to the end of 2010. The median treatment time was 130 days; median observation time was 2.3 years.

Patients’ Characteristics:

Median age at treatment admission: 32 years
Men: 64.2% of the population
Substances used (%): prescription opioids, 37.1; marijuana, 15.1; opiates that have not been prescribed, such as fentanyl,14.9; heroin, 6.6; alcohol, 4.7; stimulants, 2.0
Some involvement with the criminal justice system: 43.2%

Costs of Crime: Justice System and Victimization

Justice system costs included policing, court, and corrections. Costs related to victimization included crime-specific medical expenses, cash losses, property theft or damage, and earnings lost due to injury, etc. The team was especially interested in the difference in crime costs during and after OAT, a time-unlimited (maintenance) treatment.

Costs were compiled in 2014 US dollars; see the full report for details.

Analysis

Medications. Treatment in publicly funded programs “predominantly entailed” offering patients methadone, rather than buprenorphine, buprenorphine/ naloxone, or naltrexone.

Costs. Average daily costs of crime per person, over an assumed 1-year period—including treatment and post-treatment categories—were $113.

When investigators compared the costs of crime per patient during treatment, they found daily costs were $126 lower than after treatment for the group receiving OAT, and $144 lower than after treatment for those undergoing detoxification.

But the picture changed when they included length of treatment time—161 days for the OAT group, much longer than the 19 days for the detoxification group.

The bottom line: When totaling the costs of publicly funded treatment in California over a postulated 6-month time frame, the cost savings of crime per patient became clear: “enrolling an individual in OAT as opposed to detoxification would save $17,550.”

The table below shows how that figure was calculated.

Resources

Birnbaum HG, White AG. Schiller M, Waldman T, Cleveland JM, Roland CL. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. [Epub March 10, 2011]. Pain Med. 2011; Apr;12(4):657-667. PMID:21392250. doi: 10.1111/j.1526-4637.2011.01075.x.

Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; Oct;54(10):901-906. PMID: 27623005. doi: 10.1097/MLR.0000000000000625.

Krebs E, Urada D, Evans E, Huang D, Hser Y, Nosyk B. The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California. [Epub ahead of print December 15, 2016.] Addiction. doi: 10.1111/add.13729.

New Document: How the Words We Use Can Support People on The Path to Recovery

January 25, 2017

“The White House Office of National Drug Control Policy prepared a document for Federal agencies about terminology related to substance use and substance use disorders. The document was developed in consultation with external research, policy, provider, and consumer stakeholders and in collaboration with Federal government agencies. It addresses the role stigma plays, identifies scientific and medical literature demonstrating how certain terminology adversely affects the quality of health care and treatment outcomes, and promotes the use of person-first language and terminology that aligns with the current edition of The Diagnostic and Statistical Manual of Mental Disorders (5th ed., American Psychiatric Association, 2013).

Because stigma and shame may deter help-seeking behavior among individuals with substance use disorders and their families, the document draws attention to terminology that may cause confusion or perpetuate stigma.”

The document can be accessed at: https://s3.amazonaws.com/core-products-s3/e81e0e06-a767-415c-a8bc-ad5f64295b95?response-content-type=application%2Fpdf&response-content-disposition=inline%3B%20filename%3D%22Memo%2520-%2520Changing%2520Federal%2520Terminology%2520Regrading%2520Substance%2520Use%2520and
%2520Substance%2520Use%2520Disorders.pdf%22%3B%20filename%2A%3DUTF-8%27%27Memo%2520-%2520Changing%2520Federal%2520Terminology%2520Regrading%2520Substance%2520Use%2520
and%2520Substance%2520Use%2520Disorders.pdf&X-Amz-Content-Sha256=e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAJEJX3SFQYQNRCXMQ%2F20170125%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20170125T155430Z&X-Amz-SignedHeaders=Host&X-Amz-Expires=604800&X-Amz-Signature=0acf5c71be584de8791e1f30117adbd00a70cc193ba6c1ab13b53baec67277f2

Source: Office of National Drug Control Policy – January 9, 2017

Fifty Years After Landmark Methadone Discovery, Stigmas and Misunderstandings Persist

December 13, 2016

“Methadone, the first pharmacological treatment for heroin addiction, was pioneered 50 years ago by Rockefeller University’s Mary Jeanne Kreek and her colleagues. Since then the drug, which is widely used in treatment programs across the globe, has saved countless lives and allowed millions of heroin users to transition into normal lives.

Yet in the United States, where medical treatment of addiction is controversial, the drug’s use has remained limited even as deaths due to heroin-related overdoses have surged to expose a towering public health problem. Kreek’s career, spanning more than six decades, has not only led to medical treatments for various diseases of addiction, but has taught us much about the molecular and genetic underpinnings of drug cravings. In addition, she has been championing the implementation of drug treatment programs worldwide.

“Addictions are diseases, they are diseases of the brain,” says Kreek. “They are not criminal behaviors, and they are not weaknesses. They however do respond to treatments—and it’s unfortunate that we have tools available to treat opiate addiction, but we’re not using them.”

Source: Rockefeller.edu – December 9, 2016

Election: OTPs Should Be Vigilant, But Optimistic

December 6, 2016

By Alison Knopf

How will the election of Donald Trump as president of the United States, with far-ranging changes in administration officials and policy, affect opioid treatment programs (OTPs)? There are many questions about the future, with Mr. Trump having said little in terms of concrete plans.

Drug policy reform may take a turn away from the “we can’t arrest our way out of the problem,” with a return to punishment instead of treatment for drug offenders. If Sen. Jeff Sessions (R-Alabama) becomes the new Attorney General, this may be the direction taken.

Increased access to medication-assisted treatment for opioid use disorders (OUDs) may be in the future, and there are indications that a Trump administration would favor the pharmaceutical industry. And Vivitrol may be getting more of a boost, especially as treatment in the criminal justice system takes a bigger role.

The fact that OTPs are highly regulated could be a plus in the eyes of a Trump administration.

What’s Next for Medicaid Expansion, the ACA, and OTPs?

But the biggest question in many people’s minds is what will happen with health insurance. Medicaid expansion, which made it possible for many more patients to get treatment, is now up in the air due to questions about the future of the Affordable Care Act (ACA). What Congress will do, now that the House of Representatives, the Senate, and the White House are Republican-controlled, is a question.

“To a large degree, we are all in the dark,” said Jerry Rhodes, former CEO of CRC Health Group, and now chairman of BayMark Health Services. “There has been scant discussion or indication of policy on behavioral health and addiction issues from President-elect Trump.

“Mr. Trump did attend an opioid abuse summit in New Hampshire, where he was confronted with the extent of the problem.” And the involvement of Rudolph Giuliani as a close advisor to Mr. Trump “certainly gives pause to folks who have been in the field a long time, as they remember that as Mayor, Mr. Giuliani proposed shutting down the OTP clinics in New York City.”

Still, drug abuse is a nonpartisan issue, and there has been broad agreement among Republicans and Democrats that the opioid crisis needs to be addressed.

Field groups were already aligned to work with either administration, and are working as usual to make sure treatment is accessible.

Mr. Rhodes is concerned about the ACA. “Everyone is clearly aware of the promise to repeal and replace the ACA,” he told AT Forum. There are several Republican plans floating around, he added, noting that a consistent theme of these plans has been to limit further Medicaid expansion, or to outright eliminate expanded Medicaid populations. Other plans include “bare bones plans” and developing high-risk pools, he said.

While OTPs have benefited from Medicaid expansion, this has been on a state-by-state basis, noted Mr. Rhodes. “There have been significant variances among states on the Medicaid commitment, including some states not offering any Medicaid reimbursement for OTPs.”

Factors to Keep in Mind

When thinking about the future of OTPs, Mr. Rhodes recommends weighing several factors:

Fundamental demand. “We are in the midst of a pandemic of opioid abuse,” he told AT Forum. “This has devastated communities in the Midwest, the Northeast, and New England, and now is a plague across all the country.”

Despite Mr. Trump’s lack of policy specifics, drug abuse was an important topic in the elections. “The new administration cannot ignore the issue,” said Mr. Rhodes. “I think that the facts supporting OTPs, their proven efficacy, and the cost and the outcomes are compelling. These facts hopefully will continue to weigh strongly in favorable policy.”

Mental Health Parity and Addiction Equity Act (MHPAEA). This Act had strong bipartisan support in Congress, and has helped OTPs in policy and regulation, said Mr. Rhodes. “Despite the imposition of mandates, I don’t think there is any appetite to repeal or modify MHPAEA.”
Comprehensive Addiction and Recovery Act (CARA). This legislation is supportive of evidence-based and cost-effective treatment options—all options favoring OTPs, noted Mr. Rhodes. CARA also has strong bipartisan support in Congress.
Block grants. “Some of Mr.Trump’s inclinations on policy favor the use of federal block grants for entitlements and other funding and allowing the states significant latitude to disseminate funding as they see fit outside of federal mandates,” said Mr. Rhodes. Whatever happens here, “there would continue to be variability among the states, with some that continue commitments to OTPs, and some that don’t,” he said.
Fortunately, stigma is diminishing as a factor in policy and regulation, Mr. Rhodes commented. “Many in law enforcement now favor treatment, not incarceration, as the critical intervention.”

“Everyone involved with OTPs should have heightened vigilance,” he added. “However, given the factors above, I think there is some cause for optimism that we will continue to see support for expanded OTP services.”

As AT Forum went to press, Congress was considering adding $1 billion over two years to treat the opioid epidemic.

Top Honors at AATOD Award Ceremony Go to Michael Botticelli, Others in Field

December 6, 2016

By Alison Knopf

A centerpiece of the American Association for the Treatment of Opioid Dependence (AATOD) is the award banquet, honoring leaders for their work in the field.

dd_botticelli_headshot It was no surprise that Michael Botticelli, director of the White House Office of National Drug Control Policy (ONDCP), received the Friend of the Field award at the Baltimore Marriott Waterfront on November 1. Mr. Botticelli, in long-term recovery from alcoholism, has been a steadfast supporter of treatment, including medication-assisted treatment, during his tenure at ONDCP. He has also championed the use of naloxone to reverse opioid overdoses, and has worked to improve recovery support for people with opioid use disorders (OUDs).

The Nyswander/Dole “Marie” awards were established in honor of the two researchers who, along with Mary Jeanne Kreek, MD, pioneered the use of methadone in the maintenance treatment of OUDs. Dr. Kreek was also at the conference. Jerome H. Jaffe, MD, presented these awards to:

Ray Caesar, LPC: The State Opioid Treatment Authority (SOTA) of Oklahoma, Mr. Caesar helped change regulations in the state to make it possible for more opioid treatment programs (OTPs) to open, played a key role in stigma reduction, and now works on Medicaid reimbursement.
Spencer Clark, MSW: Under the leadership of Mr. Clark, North Carolina’s SOTA and Mental Health, Developmental Disabilities, and Substance Abuse Services Division have worked together to provide recovery support services and treatment to people in the state with OUDs.
Alice Gleghorn, PhD: During her 20 years at the San Francisco Department of Public Health, Dr. Gleghorn worked to ensure access to MAT in several locations, including jails.
Robert Kent: As general counsel for the New York State Office of Alcoholism and Substance Abuse Services (OASAS), Mr. Kent has provided support to OTPs during the state’s transition to Medicaid managed care, establishing OTPs as essential providers, and creating regulatory relief where necessary.
Robert Lambert, MA: President and executive director of Connecticut Counseling Centers, Mr. Lambert helped create innovative intensive outpatient programs within OTPs; he also developed “Bridge to Recovery,” a peer-mentoring program.
Richard Moldenhauer, MS: The Minnesota SOTA for the past 15 years, Mr. Moldenhauer is not afraid to take political risks, successfully advocating for OTP patients.
Einat Peles, PhD: Research director at the Adelson Clinic for Drug Abuse Treatment & Research in Tel Aviv, Dr. Peles studies retention and hepatitis C in her clinic in Israel and at a “twin” clinic in Las Vegas.
Kenneth Stoller, MD: Dr. Stoller’s Broadway Center for Addiction in Baltimore includes wraparound services that cover housing, primary health care, and other areas, making it a center of excellence. In addition, his research has advocated the cost-effectiveness of treatment in an OTP.
Trusandra Taylor, MD: Dr. Taylor has worked in addiction medicine for more than three decades. In Philadelphia, where she served as a clinician and an expert in managed care, she took part in many workgroups and consensus panels at the federal level.
Hoang Van Ke, MD: In Vietnam, which historically has treated SUDs as a moral problem, Dr. Van Ke has pioneered the work in MAT for OUDs, showing in 2008 that a methadone clinic pilot could be effective. Under his efforts, the number of clinics in Vietnam has grown from six in 2008 to 250, now serving more than 45,000 patients.

Brenda Davis, MS, received the Patient Advocacy Award, named for Richard Lane and Robert Holden, both recovering heroin users. Ms. Davis has been employed as a patient advocate for 20 years by NAMA Recovery, and she helped establish the MARS Project at the Mount Sinai/Beth Israel methadone program in New York City.

The awards banquet is supported through a grant from Mallinckrodt Pharmaceuticals.

NIMBY: Even in an Opioid Epidemic, OTPs and Patients Fight an Uphill Battle

October 11, 2016

By Alison Knopf

Opioid treatment programs (OTPs) across the country have been engaged in battles to locate, in the case of new facilities, and to expand, in the case of already existing ones. The problem isn’t with federal regulators, who are mainly supportive of OTPs. Rather, the barriers come from the very communities where treatment is needed. This article will sum up some of the ongoing struggles, as well as some victories.

Maine

In Maine, where Gov. Paul LePage has been an outspoken opponent of OTPs—and methadone and buprenorphine—the opioid epidemic is among the worst in the country. Yet even the bullying behavior by the governor is not as significant as local opposition. Colonial Management Group (CMG), based in Orlando, Florida, has been trying to expand its patient capacity in Bangor. The company operates 64 OTPs, with two in Maine—the Penobscot County Metro Treatment Center in Bangor, and another in Rockland.

The Bangor City Council denied the application to treat more patients, and the company, no stranger to legal zoning battles, is considering whether to sue.

Penobscot Metro was seeking to expand the patient capacity from 300 to 500; CMG had recently spent $600,000 preparing for more patients, the Bangor Daily News reported. The state had already approved the expansion. Bangor has three OTPs, with a total 1,500 patients served.

The root of the problem is, as is so often the case, an ordinance. Local approval is required for expansion. The city council of Bangor decided there wasn’t a need for increasing the capacity. Instead, CMG should have opened new facilities elsewhere in Maine, so patients wouldn’t have to travel so far, according to the city council. (Another oddity of the addiction world is that politicians think they know how to treat it—unlike cancer or tooth decay.)

At the root of a possible legal defense, also usually true, is that the ordinance is discriminatory because it singles out patients with addiction, in violation of the Americans with Disabilities Act.

The case is reminiscent of what happened in Warren, Maine, where CRC Health Group (now Acadia) was trying to locate an OTP, and the town enacted an ordinance that restricted the location of OTPs and would have made it impossible for CRC’s site to open. CRC did sue, and the court ruled easily that the ordinance was a violation of the ADA. Warren agreed to settle the case by paying CRC $495,000. The OTP never opened.

Colorado

This year, following a long legal battle, CMG was paid $350,000 by Monument, Colorado, part of a $900,000 settlement (the remainder to be paid by the town’s insurance agency), according to the Colorado Springs Gazette. The tiny town of Monument used all of its funds to pay the settlement, under which CMG would close its facility and never open again in Monument.

The residents opposing the facility claimed it would attract drug users. Last year, the town denied CMG a business license, and CMG sued. It settled, and is leaving. The victims: patients.

Louisville, Kentucky

There is also the unsavory scenario of another treatment program contributing to the demise of an OTP. This happened in Louisville, Kentucky, where Baymark was edged out of a building complex by a competing treatment program that not only is not an OTP, but believes that medication should be tapered, not given on a maintenance basis.

BayMark had proposed opening the OTP, but the building owners, Brain Chase and Walter Crutcher, said instead that they would not allow BayMark to rent there. The main opponent of the OTP was Seven Counties Services, which rents 40,000 square feet in the two-story building, the Courier-Journal reported August 19. BayMark would have occupied 7,500 square feet.

This would have been BayMark’s first OTP in Kentucky. In Louisville, there is one OTP, run by the Metro Health Department (1,300 patients), and another, by the proprietary Center for Behavioral Health (300 patients).

Alabama, Tennessee, and More

This summer the Opelika, Alabama city went on record as opposing an OTP there, with the Mayor telling the Opelika-Auburn News, “We don’t want a methadone clinic in Opelika or Auburn, or Lee County.” CMG had filed a certificate of need. A lawyer has now been signed up to represent the city.

In general, Tennessee is not a bright spot in the OTP world. But there is good news. After years of struggling, an OTP in Johnson City is finally near reality. Local citizens had tried to prevent the program from opening.

In West Virginia, there has been a moratorium on new OTPs for years. There is now a moratorium in OTP-friendly Georgia as well, although only for a year. There is only one OTP in Mississippi, where about 100,000 patients cross the border to access care in Louisiana and Alabama. Maryland came close to passing a bill that would require any new OTP to site in an industrial park, away from residential areas.

Prejudice Against OTPs

An oft-repeated criticism of OTPs is that they are “only in it for the profit,” and some people say that OTPs should be allowed to operate only if they are not-for-profit or publicly funded—ironically, these critics are in states that do not have any public funding for OTPs. Even progressive Illinois will start having Medicaid cover OTPs in January 2017, for the first time.

What’s going on? Many OTPs—and patients, including prospective patients, want to know the answer. Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), told AT Forum that NIMBY (Not In My Back Yard) is the major impediment to OTPs. “It has nothing to do with DATA 2000 (buprenorphine office-based practices) or any federal issues,” he said. “It’s the resistance to increase access to treatment for anyone who needs it.”

dd_botticelli_headshot Mr. Parrino spoke with Michael Botticelli, director of the Office of National Drug Control Policy (ONDCP) about this—and other issues—recently. Mr. Botticelli’s idea was to conduct a state-by-state inventory identifying all the existing resources used to treat people with opioid use disorders, so that gaps in treatment can be identified.

Mr. Botticelli believes that OTPs are needed in those areas. But how will the OTPs be funded? The data will have to go to proprietary systems that will use them to target the areas of greatest need. On the other hand, there could be broader funding, as Vermont did, with public money to expand treatment.

The adversaries to OTPs, however, can’t be reduced to dollars—not when cities are willing to almost bankrupt themselves to pay to keep an OTP out. The main barriers are stigma and zoning restrictions, and unfounded fear.

And in terms of bordering states, there is the wish that patients would just go elsewhere if they need treatment, with little regard for how many hours patients have to drive.

There is also Stop Stigma Now (http://www.stopstigmanow.org/), which is urging patients and family members to be proud of their recovery, and plans to confront unfounded, erroneous information whenever it appears in print. Unfortunately, the confrontation will have to take place in many city council meetings before it will help OTPs open.

Patient Advocate Calls On Federal Government to Fight NIMBY

October 11, 2016

By Alison Knopf

Jocelyn Woods, MA, executive director of the National Alliance for Medication Assisted Recovery (NAMA-R), has a lot to say about NIMBY-ism. As the lead advocate for OTP patients, she shared her thoughts with AT Forum.

“Research was conducted decades ago showing that methadone reduces crime and public health problems,” she said. “Even more importantly, for the majority of methadone patients, if they were homeless, they find a place to live. They find work and begin to pay taxes, take care of their children, repair relationships with their family, and begin to live pretty normal boring lives.”

This transformation usually occurs within the first year of treatment, something Ms. Woods finds “pretty remarkable, considering that many have no work history, and legal entanglements that are often barriers.” They do it anyway. The reason, said Ms. Woods, is that most patients enter methadone treatment because they are “tired of the lifestyle, waking up sick in the morning and having to find a way to purchase drugs.” After a few months in treatment, they become stable on their medication, and see opportunities before them that they never had before.

They are not “loafers.” The struggle these new patients have before them is enormous. They will face discrimination in health care, education, employment, life insurance, family welfare and the court system, and criminal justice. “To succeed, you have to have a ‘never-give-up attitude,” said Ms. Woods. “There are a lot of very smart people being held back just because of the medication they are taking.”

It’s clear that society thinks it knows everything about opioid addiction and how to treat it, and that’s the problem, said Ms. Woods. “They don’t realize that they don’t know the answer.”

Ms. Woods would like the federal government, which itself does not espouse NIMBY, to “step up and create a massive public relations program to educate the public about opioid addiction and the effective treatments for it,” she said. “Only the federal government can do it right. But they’ve tried only campaigns that were ineffective and a waste of money.”

States also have a responsibility to make sure that adequate treatment is available for everyone who needs it, she said. “Both methadone and buprenorphine treatment is so inexpensive in comparison to the alternatives.”

In addition, the federal government’s aggressive campaign to discourage physicians from prescribing opioids for pain has had a very negative effect, said Ms. Woods. “We need to be smarter than that,” she said. “Limiting prescriptions to pain medication is not only imprudent, but self-defeating, because people will find a way to relieve their pain or they will commit suicide.”

She called the Drug Enforcement Administration “out of control” in its shutdown of pain treatment centers “without considering what could happen next.” What happened was that many valid pain patients attending the clinic were in crisis. It didn’t take long for heroin dealers to step in.

“You cannot stop an epidemic by limiting pain medication or illicit opioids,” she said. “The only way to get it under control is to provide pain medication for those that need it, and addiction treatment for those that need it. And to do this NIMBY cannot be tolerated.”

The MARS Project (http://marsproject.org/) and Stop Stigma Now (http://www.stopstigmanow.org/) are projects of NAMA-R.

News From Maine: Methadone Clinic Sues Bangor Over Expansion Denial

September 13, 2016

“A Bangor methadone treatment center has filed a lawsuit against the city two weeks after the facility’s bid to expand from 300 to 500 patients was rejected by the City Council.

“We are hopeful and optimistic that the federal court will rule in favor of our client, and will permit those awaiting treatment to begin to receive that treatment as soon as possible,” said John Doyle, an attorney with the law firm Preti Flaherty, which is representing the clinic.

The city’s attorney, Norm Heitmann, declined to comment Tuesday, saying the city won’t comment on pending litigation. The city likely will file a response in federal court within the next few weeks.

“Although [Penobscot Metro Treatment Center] has obtained the state licenses it needs to expand and meets the requirements of federal law, the city has denied it permission to expand, under an ordinance that illegally singles out methadone clinics for special discriminatory treatment,” the lawsuit, filed Tuesday in federal court, alleges.”

Source: BangorDailyNews.com – August 23, 2016

See related editorial – Our View: Maine doesn’t need more barriers to addiction treatment – 8/23/16 http://www.pressherald.com/2016/08/23/our-view-maine-doesnt-need-more-barriers-to-drug-treatment/

SAMHSA Blog: Words Matter

May 25, 2016

What’s in a word? Some words in our everyday lexicon hold a deeper, inexplicable meaning beyond their dictionary definition and become embedded in the way we think, feel, and act. “Stigma” is such a word that evokes a certain reaction when it is used. In general, it means a mark or a sign, usually of disapproval. In the context of mental illness or addiction, “stigma” can manifest itself in many ways.

Externally, those with mental or substance use disorders often experience stereotyping, negative attitudes, and discrimination from the people around them, including their communities, families, and friends. Internally, they may start to believe these stereotypes and negative attitudes about themselves, harming their self-esteem and their chance for recovery.

Source: Substance Abuse and Mental Health Services Administration – May 16, 2016