The new Drug Enforcement Administration (DEA) regulations allowing brick-and-mortar opioid treatment programs (OTPs) to dispense methadone in vans took effective July 28. The American Association for the Treatment of Opioid Dependence (AATOD) is holding a free webinar on how to use “mobile vans,” as the lingo goes, on August 11.
“The expanded use of mobile vans will extend the reach of OTPs in rural and other underserved areas of the United States,” said Mark Parrino, AATOD president, in announcing the webinar. “ We have been communicating with representatives from the Department of Agriculture, which has funding to purchase such vans as long as OTP operators use these vans in rural settings,” he said. “We have also been in communication with SAMHSA [Substance Abuse and Mental Health Services Administration], so that OTPs can gain access to purchase and operate such vans using SAMHSA funds in suburban and urban areas, serving individuals, who are not able to travel to OTPs.”
The vans, like OTPs themselves, are not limited to dispensing methadone – although that was the big barrier medication in the DEA’s viewpoint. The other two approved medications to treat opioid use disorder – buprenorphine and naltrexone – can also be dispensed.
Using such vans will also work well in correctional settings, said Mr. Parrino, by providing “increased access to the three federally approved medications to treat opioid use disorder.” Inmates could start treatment (induction) in these vans, and maintained in the vans, until they are released, where they would be treated in the corresponding OTP.
Satellite units
AATOD has also been in discussion with the federal agencies of jurisdiction to “encourage the use of satellite medication units, operating under the aegis of OTPs,” said Mr. Parrino. “Unlike mobile vans, the satellite medication units are fixed brick and mortar sites.” Satellite units are already allowed under under existing SAMHSA regulations, Mr. Parrino noted. But in this case, the states may be holding up their expansion, so AATOD is “encouraging OTPs to work in conjunction with the State Opioid Treatment Authorities to expand the use of such mobile vans and medications units.”
AATOD is developing policies to “make existing OTP regulations more flexible in a post COVID-19 environment,” said Mr. Parrino.
Amid calls to make methadone easier to get, AATOD has been working to achieve a balancing act. Having OTP patients linked to methadone or buprenorphine diversion would be devastating to the treatment itself. The COVID-19 pandemic has been an experimental proving ground, however, to show that additional flexibility with take-home medications and the use of telehealth can be effective.
In addition, AATOD is working with Johns Hopkins to look at making methadone accessible in pharmacies for clinically stable patients, as long as the patients remain in the OTPs. “We look forward to learning more about the success of this approach,” said Mr. Parrino.
The August 11 webinar features
- speakers who have been operating mobile van services for many years;
- details on federal and state funding support in developing such van systems;
- the cost of purchasing such vans from leading manufacturers;
- updates on reimbursement mechanisms to support the use of such vans for patients, who have Medicaid/Medicare eligibility; and
- developing Best Practice Guidelines in using such vans to extend the reach of OTPs.
The OTP system can expand access to care while preserving the comprehensive nature of treatment, said Mr. Parrino, recognizing that addiction is not treated, especially at the beginning stages, by medication alone.
“It is understood that we should use our recently learned experiences from the COVID-19 pandemic as a means of providing more flexible care to our patients,” concluded Mr. Parrino. “AATOD will work with our provider and policy partners in order to make the best use of these new opportunities. We recognize that we may not always agree on how to achieve these goals through certain policy partners but our Association is extremely clear on the need to preserve the integrity of care while expanding access to care during a time when fentanyl use is on the rise and we are treating patients with greater opioid tolerance.”
Speakers at the webinar, which takes place August 11, 12:00-2:00 pm, are:
- Claire Brennan
Chief of the Liaison Section for the Diversion Control Division
Drug Enforcement Administration (DEA) - Michael Santillo
Chief Executive Officer
John Brooks Recovery Center - Sean Soth
Director of Health Integration & Innovation
Evergreen Treatment Program - Cathy Perez
Director of Strategic Initiatives
Evergreen Treatment Program
- Dr. Patti Juliana
Director of the Division of Pharmacologic Therapies (DPT)/ SAMHSA/CSAT
Substance Abuse and Mental Health Services Administration (SAMHSA) - Anne Herron
Director of the Office of Intergovernmental and External Affairs &
Acting Director of the Office of Financial Resources
Substance Abuse and Mental Health Services Administration (SAMHSA)
To register for the webinar, go to https://us02web.zoom.us/webinar/register/WN_Wo6HqcIfQ56Bps4siiFMCQ
