Today an extraordinary project conducted by the National Association for State Alcohol and Drug Abuse Directors (NASADAD) and the American Association for the Treatment of Opioid Dependence (AATOD) revealed how many programs and patients are in Opioid Treatment Programs (OTPs).
All 1,826 OTPs were surveyed; the response rate was 85%. From that response, the census retrieved non-identified information on 512,224 current (on January 1, 2021) patients and what medication they were taking. For 510,557 patients, the census captured information on what formulation of medication the patients were taking.
All three medications approved by the Food and Drug Administration to treat opioid use disorder were included in the survey: methadone, buprenorphine, and naltrexone.
The vast majority – 93% – of patients were taking methadone; 91% [of those or of total?] were taking the liquid formulation of methadone; 6.25% were taking diskets, and 1.79% tablets.
That’s 476,763 patients taking methadone for their OUD.
Only 7% of the patient population was taking buprenorphine. Less than 1% were taking naltrexone.
Of those patients taking naltrexone, the majority, tk, were taking Vivitrol; the rest were taking oral naltrexone.
The census is a “head-by-head count” of the number of patients receiving medication for opioid use disorder (MOUD) in OTPs as of January 1, 2021. Every OTP was contacted for the survey, which was funded by the Opioid Response Network (ORN), a project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The results and report were released today, December 5, at 1:00 p.m. Eastern Time.
This is the first time ever which the number of programs and patients in them have been tabulated along with the formulation of medication in use.
The State Opioid Treatment Authorities (SOTAs) were key in collecting the data from OTPs. NASADAD organizational structure includes the Opioid Treatment Network consisting of SOTAs from all the states and territories.
The Code of Federal Regulations Title 42, Part 8, Medication Assisted Treatment for Opioid Use Disorders defines a “State Authority” for governing the treatment of opioid addiction with an opioid drug.” In most states, this authority is granted to the Single State Agency (SSA) for alcohol and other drugs. The specific responsibilities for overseeing OTPs are designated to a State Opioid Treatment Authority (SOTA).
Most important was the need to get accurate patient data, which is what made the process so labor-intensive. Many agencies don’t have the full, accurate information about programs or patients, said Mark Parrino, president of AATOD, in an interview with AT Forum. Also participating in the interview were Douglas Fuller, Ph.D., associate director of research and program applications at NASADAD, and Melanie Witter, deputy executive director of NASADAD, as well as NASADAD executive director Rob Morrison.
The survey was conducted using a web-based instrument designed to be completed in 10 minutes, said Dr. Fuller. Included in the survey were two main items:
OTP reference information (name, where located, total number of patients enrolled as of that date), and a breakdown of how many patients are on each of the medications and the formulation of medication in use.
“We targeted the entire universe of SAMHSA-certified OTPs,” said Dr. Fuller, noting that the SOTAs in every state were asked to contacted, provided information concerning the study, and asked to contact their OTPs and request they complete the brief survey .
SOTAs and OTPs didn’t require much convincing, said Ms. Whitter. “They saw the value in doing this.” It took time, and there were multiple approaches used to obtain and clean the data.
SOTAs as a whole were very supportive, said Dr. Fuller. “They communicated with the OTPs, and many maintained contact with NASADAD concerning the response rate in their state.”
There was back-and-forth communication directly with NASADAD research staff as well, with NASADAD staff working with OTPs to ensure the submission of their data. said Dr. Fuller.
This is partly why the process took so long – and also, the sheer number of OTPs involved made the task labor intensive.
More research will be needed, as the number of OTPs and patients has grown since the census was taken – which was in the middle of the pandemic.
The researchers, for comparison purposes, used NSSATs 2020, to see what differences exist for patients in treatment and the medications in use between 2020 and 2021.
The good news
More programs and more patients were served on January 1, 2021 than during the NSSATS study from 2020, which is “good news,” noted Ms. Whitter.
In comparison to 2020 NSSATS, their estimate was 311,000 OTP patients taking methadone; the NASADAD/AATOD survey found 476,000, a notable increase. About 37,000 OTP patients were taking buprenorphine in the census – the same as NSSATS 2020. The census found only 1,988 OTP patients taking naltrexone, while the NSSATs estimated 3,800.
Why were there differences between the census and NSSATs? Mr. Parrino speculated that there were two possible reasons:
- as time progressed, new programs opened and more patients were served.
- The fentanyl influence Mr. Parrino noted that illicit fentanyl has changed the needs of patients. Now, those who are dependent on fentanyl, with its very high opioid content, need something stronger than buprenorphine, which has a dosage ceiling. Methadone allows OTPs to adjust doses upward, which is necessary in order to achieve stability and to retain the patient.
Stay tuned for more.