Double the number of opioid treatment programs—from 1,400 to 2,800—in the United States over the next three years: that was the main message from Mark Parrino, MPA, President of the American Association for the Treatment of Opioid Dependence (AATOD), and from the organization’s conference in Baltimore this fall. There were almost 1,800 attendees at the meeting, which held its customary open board meeting on the evening of October 29.
Open Board Meeting
Great News: Mobile Vans Slated to Return
There was some really good news for the field at that meeting. The 30 board members and 175 attendees heard from Demetra Ashley, associate deputy assistant administrator of the Office of Diversion Control of the United States Drug Enforcement Administration (DEA). She told the group that the DEA is working to re-open the licensing of mobile vans next year.
Mobile methadone vans are connected to brick and mortar opioid treatment programs (OTPs), and their return would be great news for patients who have to travel far, or who lack transportation. According to Mr. Parrino, the DEA has gone through a “tectonic shift” over the past 18 months in several ways, including in their thinking about mobile vans.
But Support Seen as Lacking for Methadone and OTPs
Another issue at the open board meeting was the federal government’s observed lack of support for methadone and OTPs. “Don’t forget that OTPs exist,” board members told Kimberly A. Johnson, PhD, director of the Center for Substance Abuse Treatment (CSAT), the agency of the Substance Abuse and Mental Health Services Administration (SAMHSA) that, along with the DEA, regulates OTPs.
Ms. Johnson and Mitra Ahadpour, MD, DABAM, director of SAMHSA’s Division of Pharmacologic Therapies, were told that they were more focused on buprenorphine and Vivitrol than on methadone. They were also told that when they talk about “medication-assisted treatment,” nobody thinks they are talking about OTPs.
“If you really want to help us, then tell a state that they have to put block grant money into OTPs,” was the sentiment of some board members. Some state governors—such as Maine’s—are opposed to methadone, it was noted. What can SAMHSA do? Dr. Johnson said that SAMHSA can provide technical assistance (federalese for advice, assistance, and training) if a state is resistant. “What about local zoning boards?” she was asked. Dr. Johnson’s response: SAMHSA can’t get involved in local problems.
All of SAMHSA’s literature reflects advice that the three medications should be used, said Dr. Ahadpour. But OTPs have no challenges to the SAMSHA literature—“the problem is what’s on the ground,” said one. States can look at the SAMHSA literature, read about the three medications, and pick one—buprenorphine or Vivitrol—leaving out methadone and OTPs, but thinking they are still going along with SAMHSA. “AATOD Board members were saying that the literature is intact, but the action plan doesn’t follow,” as Mr. Parrino put it.
Perhaps one of the for-profit OTPs put it best: “If you want to see a targeted expansion capacity, you’re going to have to target funds.” However, it’s unlikely that public funds will be used to expand treatment in a private setting.
There was a distinct presence of office-based opioid treatment—the buprenorphine-prescribing physicians—at AATOD, “driven by the conference content, which transcends a unique interest in OTPs,” said Mr. Parrino. And AATOD itself does have some members who are DATA 2000 physicians, he said.
The basic concept of an OTP is not just treating many patients at a single site—there are buprenorphine clinics that do that. “What services do you provide—that’s what distinguishes you as an OTP,” said Mr. Parrino.
To get from 1,400 to 2,800 OTPs in three years will “compel federal authorities to focus on the impediments to opening new clinics,” he said. “You need to educate communities. You need to reverse the thinking that a treatment program in a community is a negative. We’re going to help your community save lives, we are going to help your families and your neighbors.”
This, in fact, was a central theme throughout the conference. People are dying from opioid overdoses, and America is clamoring for help, but whenever an OTP is proposed, the neighborhood doesn’t want it. “You can’t have it both ways,” Mr. Parrino said.
While there were clear issues brought up at the open board meeting, SAMHSA support for OTPs was present during the conference. Dr. Johnson spoke about the importance of treatment at one of the plenaries, and at the policy luncheon.
As the future of federal strategy plays out in the wake of the surprise election victory of Donald Trump, states and OTPs will be looking at how to best expand. In the meantime, the record attendance at AATOD—almost 1,800 people—shows that the commitment to treating opioid use disorders in OTPs is strong.