Officials at CODA, one of the three opioid treatment programs (OTPS) to win the 2012 Science and Service Awards sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), firmly believe the program’s commitment to research not only led to the prestigious award, but also is essential to improving outcomes for their patients.
About 10 years ago CODA started partnering with the National Institute on Drug Abuse (NIDA) to do clinical research, and in 2007 the Portland, Oregon program started its own research department with five people on staff. Grants come from NIDA, from other institutes of the National Institutes of Health, and from various other sources.
“What is so fantastic about having a research department that is integral to an agency is it creates a tone that carries through to the clinical staff,” said Alison Noice, director of medication-assisted treatment. “It’s not about lip service to evidence-based practices.”
The research department is financially independent, and is not used as a revenue generator for CODA. “We only get the money to pay for our materials” from grants, said Ms. Noice. “We get money for a nurse, for part of a physician, but it isn’t a funding stream,” she said. Having a research department is a “huge boost” to the clinical staff. “It’s something that my staff and my patients can be proud of.”
CODA was the first OTP in Oregon, starting in 1969, and is the only non-profit OTP in the state. “We feel fantastic” about the SAMHSA award, said Ms. Noice. “We’re cutting edge,” because of the research program.
That cutting edge quality owes a lot to the belief that “there is no such thing as a typical opioid-dependent patient,” said Ms. Noice. “CODA is committed to meeting the needs of that wide spectrum.”
Matching Patients to Groups
“The research we do around methadone is primarily on who are the better candidates for what kind of treatment,” said Katarina Weiss, research director. “For example, we were one of the first places to identify that we needed to have groups for younger women.” There has been an increase in young women in OTPs who are prescription opioid abusers, and this group of women “tends to do more sex in exchange for goods and services,” she said. CODA has also added a women’s sexuality group. CODA’s census of 657 is now half female.
Older males tend to drop out of treatment unless they are engaged quickly, said Ms. Weiss. More than 50 percent drop out in the first 90 days. “We’re working on identifying those patients who might be at higher risk of dropping out,” she said. “Why are we losing these people?” The people who are most likely to succeed in treatment are older, less likely to have polydrug abuse, less likely to use benzodiazepines, and ready for treatment, said Ms. Noice. “If we can target them well in the beginning, they will do very well,” she said. “But if we don’t focus on them, they will get lost in this crowd, which is younger and high need.”
Another innovation is massage. Many patients in medication-assisted treatment (MAT) have chronic pain. CODA is using massage therapy to see if that can help. Under a grant from the Massage Therapy Foundation, CODA is conducting research into non-pharmacologic supplementation for people who are in MAT with methadone and who have chronic pain. It’s a randomized controlled trial, with one group receiving treatment as usual, and one receiving treatment and massage.
Rapid HIV Testing
For a project funded by the Mutinomah County health department, CODA is looking at a problem that is plaguing many OTPs—how to get more patients tested for HIV. By implementing rapid HIV testing, more patients are being tested, and the county, which pays for the tests, will save money. Rapid tests, which don’t involve a blood draw, are much less expensive than lab tests.
“The CDC recommends that everyone be tested, but getting patients to go have the test is difficult,” said Ms. Noice, noting that nationally only 24 percent of OTP patients have been tested for HIV. “We found that by offering rapid HIV testing instead of the blood test, which takes two weeks to get results, we have a 95 percent rate of testing.” The sensitivity and specificity of the test is 99.7 percent, she said. “We can do a wonderful intervention and counseling right then,” she added. And that is the appeal—patients are more willing to get the test if they know they can get results and counseling immediately.
While other OTPs might not have wanted to do the work involved in applying for the SAMHSA grant, CODA’s research department is used to writing applications—another benefit of having a research department.
About the Awards
The purpose of the SAMHSA awards is to “promote excellence in the treatment of opioid addiction by recognizing OTPs who use pharmacotherapy as part of their treatment protocol and who have demonstrated implementation of exemplary innovative services, practices, and/or strategies, resulting in improved patient outcomes,” according to SAMHSA’s press release announcing the awards. Programs were judged based on the following criteria:
- Treatment population(s)/ subpopulation(s) served,
- Evidence-based practices and treatment,
- Improved patient outcomes,
- Innovativeness, and
- Management and staff capabilities.
The two other winners were the Addiction Institute of New York at St. Luke’s and Roosevelt Hospitals in New York City, and Connecticut Counseling Centers, Inc. of Norwalk, Connecticut.
The awardees were honored at the awards banquet at the national conference of the American Association for the Treatment of Opioid Addiction held in Las Vegas in April.