More than 1,350 people attended the American Association for the Treatment of Opioid Dependence (AATOD) meeting held in Las Vegas April 21-25 at the Venetian/Palazzo Hotel. Among the more than 60 attendees from other countries was a large delegation from Vietnam, reporting on that nation’s successful expansion of methadone treatment.
Under the theme “Recovery for Patients, Families, and Communities,” the conference was co-hosted by the Substance Abuse Prevention and Treatment Agency (SAPTA) of the Nevada Department of Health and Human Services/Division of Mental Health and Developmental Services.
The conference opened with Gov. Brian Sandoval endorsing the work of Nevada’s opioid treatment programs (OTPs). The governor remained to listen to Deborah A. McBride, MBA, SAPTA director, make her opening remarks. There are 11 OTPs in Nevada, and Ms. McBride expressed unwavering support for their valuable contribution in the wake of epidemic prescription-drug abuse in Nevada. AATOD president Mark Parrino, MPA, reported on AATOD’s national work. Gilberto Gerra, MD, director of the Drug Prevention and Health Branch of the United Nations Office on Drugs and Crime, Vienna, Austria, emphasized the international need for medication-assisted treatment (MAT).
The second plenary session, dedicated to Lisa Mojer-Torres, lawyer, methadone patient, and tireless advocate, who died last year, focused on methadone as a valid pathway to recovery. The session was led by Carol McDaid, co-founder and principal of Capitol Decisions, and William L. White, MA, senior research consultant, Chestnut Health Systems, both in recovery themselves.
“The whole issue of methadone as part of recovery is critical,” remarked Mr. Parrino, noting the negative attitude in many states among legislators and judges who simply don’t think methadone maintenance treatment constitutes recovery.
Timothy P. Condon, PhD, visiting research professor at the Center for Alcoholism, Substance Abuse, and Addictions at the University of New Mexico, did an excellent job of highlighting the science and policy aspects of MAT during the closing plenary. There was also a presentation on MAT as part of health care reform, provided by Paul Samuels of the Legal Action Center.
And during the closing plenary, Justice Michael Cherry, now Chief Justice of the Nevada Supreme Court, expressed strong support for methadone and buprenorphine in the courts and criminal justice system. It is rare to have the highest judge in the state participate throughout an entire AATOD conference, said Mr. Parrino.
Buprenorphine and Federal Register Notice
Nicholas Reuter, senior public health advisor with the division of pharmacologic therapies at the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), talked with AT Forum about hot topics at the conference, including the pending Federal Register notice allowing OTPs to dispense buprenorphine.
Mr. Reuter said the final rule is now in the Office of Management and Budget (OMB) regulatory review process, where it has been since March 8. The final rule will allow OTPs to prescribe buprenorphine under the same rules as DATA 2000-waived physicians, with some additional requirements. Now, OTPs can dispense buprenorphine only with the same take-home and treatment rules that apply to methadone in 42 CFR Part 8.
This final rule has taken years to reach this point. The approval may be slowed by the interagency review, speculated Mr. Parrino, with one or two agencies expressing concern about diversion. Ironically, when the proposed rule was first published three years ago, comments expressed concern about OTPs causing buprenorphine diversion. Diversion of buprenorphine is now a major issue, without the final rule. Many OTPs feel that is due to the lack of counseling and other services in the office-based system.
Hepatitis C—A SAMHSA Priority
Robert Lubran, director of the division of pharmacologic therapies at CSAT, talked about the public health implications of hepatitis C virus (HCV) in the U.S., noting that SAMHSA will shift emphasis to screening and treatment for HCV. (See related article in this issue.)
Mr. Reuter added that CSAT has had a focus on HCV at many AATOD conferences: “We emphasize screening and treatment. This is the same situation we had with HIV,” he said. Programs are concerned that if widespread testing is undertaken, funds for treatment must be available. Most states cover the medical treatment for HCV, but stigma against opioid dependence and OTP patients makes it harder for them to access care. Mr. Parrino added that AATOD has trained over 700 clinical staff in hepatitis C testing and counseling, but few programs offer on-site treatment.
Methadone Mortality Form Becomes Optional
Surprising AATOD, CSAT announced the suspension of their methadone mortality form, introduced only about three years ago. CSAT will do a “more formal information collection and analysis,” Mr. Lubran told the AATOD Board. “Instead of a voluntary form, we thought we would work with our colleagues in the Center for Behavioral Health Statistics and Quality to do something more official,” he said. “Right now we’re trying to come up with the best analytic procedure, and pursue a pilot. The idea is to do this in a way that is consistent.” A Dear Colleague letter to the field about the change is dated April 3, but Mr. Parrino wasn’t given it until April 30. (For a copy of the letter, go to https://www.atforum.com/documents/DearCollegueMethMortalitySuspension-04-2012.pdf).
Benzodiazepine Use in OTP Patients
The use of benzodiazepines in OTP patients was again a hot topic. Ron Jackson, MSW, LICSW, conducted an excellent, well-attended roundtable discussion about how to handle benzodiazepine use in OTP patients. The long-awaited benzodiazepine guidelines are expected to be part of a set of guidelines that cover the use of many different psychoactive substances in an OTP, instead of just benzodiazepines, Mr. Reuter said after the meeting. “We decided to broaden it, to talk about psychoactive medications in general,” confirmed Mr. Parrino. “But it’s really about benzodiazepines.” (See related article in this issue.)
Beny J. Primm, MD, executive director, Addiction Research and Treatment Corporation, presented the Nyswander/Dole “Marie” Awards to nine recipients.
Joseph V. Brady, PhD, Maryland
Otto C. Feliu, MS, New York
Hilary Jacobs, MSW, Massachusetts
Edward J. Johnson, MA, South Carolina
Barbara Schlichting, LCSW, New Jersey
Stacy Seikel, MD, Florida
Steve Tapscott, MA, Texas
Stephan Walcher, MD, Germany
William C. Wilson, California
Banquet honorees also included William L. White, MA, who received the prestigious Friend of the Field Award, and Roxanne Baker, CMA, recipient of the Richard Lane/Robert Holden Patient Advocacy Award for her work on behalf of methadone and recovery.
The next AATOD National Conference will convene in November 2013 in Philadelphia.