Study: Long-term Abstinence Restores Impaired Brain Function and Structure in Patients With Heroin Use Disorder, but Questions Remain
When Agatha Christie’s famous Belgian detective, Hercule Poirot, attributed his investigative success to “the little grey cells”—components of the brain’s grey matter—he may well have been correct. He usually was. Today, neuroscientists delving into the comparatively neglected “other half of the brain” are defining the highly important roles of white matter. They’ve found that in…
DOJ Issues Guidance Underscoring ADA Protections for People Taking Methadone or Buprenorphine
The federal Department of Justice has ordered repeatedly that people in treatment or recovery on medications to treat opioid use disorder are protected by the Americans with Disability Act (ADA). This spring, the federal government issued guidance specifying this, and noting that entities covered by the ADA include the workplace, healthcare organizations, and the criminal…
AT Forum Newsletter – November 2020
Proposed bills would infuse opioid use disorder treatment with new funds
Two bills passed by Congress and heading to the Senate would be very helpful to opioid treatment programs (OTPs) and other treatment providers, and their patients. SOR reauthorization The State Opioid Response (SOR) grant program, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), is up for continuation thanks to a bill passed…
Continue Reading Proposed bills would infuse opioid use disorder treatment with new funds
AT Forum Newsletter – October 2020
To Mallinckrodt: Thank you from AT Forum
We all want to thank Mallinckrodt for almost 30 years of support. This wonderful company provided support from the beginning of the newsletter, which first came out in 1992 during the dark days for methadone and opioid treatment programs. At the time, the late Stewart B. Leavitt, Ph.D., with funding what was then called Mallinckrodt…
CODAC Works With BH Link For Behavioral Health 24/7 Urgent Care
Rhode Island supported the development of Behavioral Health Link, BH Link, a 24-7 urgent care program for addiction and mental illness. The goal is to divert patients from less effective, more expensive emergency room visits to an urgent care visit which would directly provide care. And CODAC Behavioral Healthcare, an opioid treatment program (OTP) with…
Continue Reading CODAC Works With BH Link For Behavioral Health 24/7 Urgent Care
AT Forum Newsletter – September 2020
Study: COVID-19 Threatens the Incarcerated With Loss of Life-Saving OAT Treatment
For people with opioid use disorder (OUD), getting into or staying in an opioid agonist treatment (OAT) program while in jail or prison has never been easy. But incarcerated populations now face a new challenge: the COVID-19 pandemic threatens access to treatment programs and their life-saving medications. Sachini Bandara, PhD, and her colleagues at Johns…
Continue Reading Study: COVID-19 Threatens the Incarcerated With Loss of Life-Saving OAT Treatment
Why OTPs Need To Stay In The Mix: The Shatterproof Yelp-like Pilot
When Shatterproof launched its new ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) project, funded largely by insurance companies, as a pilot in six states, opioid treatment programs (OTPs) of New York State said yes, they want to participate. The reason is not because OTPs are interested in having disgruntled patients post complaints in a…
Continue Reading Why OTPs Need To Stay In The Mix: The Shatterproof Yelp-like Pilot
New OTPs In Tennessee, Where Medicaid Now Covers Methadone/OTP
This summer, the Tennessee Health Services and Development Agency (HSDA) granted a Certificate of Need (CON) for the establishment of a new opioid treatment program (OTP) in Maryville, Blount County, Tennessee. Owned by The Patricia Hall Talbott Legacy Centers, LLC, a company named after the founder’s mother, and doing business as TLC Maryville, the Maryville…
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AT Forum Newsletter – August 2020
Pinnacle Ceo On Aegis Acquisition 2 Months Before Covid Hit
When Pinnacle Treatment Centers acquired California-based Aegis Treatment Centers this year, it gained 10,000 patients and 36 opioid treatment programs (OTPs) in its expansion. This move meant Pinnacle, based in New Jersey, now had a presence on the West Coast. Unbeknownst to staff and patients, of course, was that the transition would be accompanied by…
Continue Reading Pinnacle Ceo On Aegis Acquisition 2 Months Before Covid Hit
Can Jail-Based MMT Lower Costs and Help Prevent Recidivism?
Jail-based methadone maintenance treatment (MMT) sounds great in theory, but it’s rarely implemented. Yet opioid use disorders are common, with about 23% of state prisoners and 18% of federal prisoners reporting a history of opioid use. Tragically, once prisoners are released, loss of tolerance and the increased availability of potent synthetic opioids puts them at…
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AT Forum Newsletter – July 2020
Extended Methadone Take-homes During COVID: Nothing But Success
Since March, when the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed rules for methadone take-homes to decrease exposure to the coronavirus, opioid treatment programs (OTPs) have been exercising this unprecedented freedom. Specifically, SAMHSA said March 16 that all states with declared states of emergency may request blanket exemption (from SAMHSA) for all stable…
Continue Reading Extended Methadone Take-homes During COVID: Nothing But Success
STUDY: Saving Lives by Launching Buprenorphine Treatment in the ED: What Clinicians Need to Know
It’s a scene that’s repeated countless times every day across the U.S. Siren blaring, an ambulance jolts to a stop at the entrance to a hospital emergency department (ED). Two paramedics jump out, open the back door, retrieve a young man strapped on a gurney, and wheel the gurney into the ED. A doctor hurries…
AT Forum Newsletter – June 2020
STUDY: Is ACA Medicaid Expansion Fueling the Opioid Epidemic, or Is It Saving Lives?
This is such an important question to resolve! Especially now, with more than a dozen states yet to decide on Medicaid expansion, while studies—some pro, some con, fail to provide an answer. So many factors are in play, and the statistical analysis involved is intensive. Background The Patient Protection and Affordable Care Act (ACA) became…
AT Forum Newsletter – May 2020
How Stavros 24-7 Clinics Handle the Pandemic
When the pandemic hit the epicenter of New York City in mid-March, Nicholas Stavros’ 24-7 clinics across the country were already preparing. “We got in front of this right away,” said Mr. Stavros, CEO of Community Medical Services (CMS), based in Scottsdale, Arizona. CMS has programs in several states, so keeping up with federal regulatory…
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How the North Carolina SOTA Responded to the Pandemic
When the pandemic hit full force in mid-March, the State Opioid Treatment Authorities (SOTAs) had to move fast. They regulate opioid treatment programs (OTPs) in their respective states, and well knew that many patients had to visit the clinic frequently. “Social distancing” was possible, but “virtual” treatment was not. To get medication, the patients had…
Continue Reading How the North Carolina SOTA Responded to the Pandemic
STUDY: Risk Factors EDs Can Use to Identify Patients With Substance-Related Encounters Who Are at High Risk of Fatal Opioid ODs
Lacking alternative resources, many people with substance use disorders (SUDs) visit emergency departments (EDs), especially after an overdose (OD). This gives care providers an opportunity to provide referrals to treatment for those who need it. But EDs may lack the time and resources to select the patients at highest risk—those who could benefit from intervention.…
AT Forum Newsletter – April 2020
New Georgia OTP Takes Patients and Deals With the Pandemic
Gateway Treatment Centers in Ellijay, Georgia, opened January 7—just a few weeks before the pandemic hit. But it was prepared. The program currently has over 50 patients; 20% of the initial intakes were transfer patients. They were living in this county but having to drive close to an hour to get to treatment. The majority…
Continue Reading New Georgia OTP Takes Patients and Deals With the Pandemic
AATOD Concerns about Harm Reduction Initiative During Pandemic
During the week of April 6, a sign-on letter circulating in the harm reduction and patient advocacy fields provoked some strong feelings. The letter focuses on mistreatment of opioid treatment program (OTP) patients during the national emergency and the COVID-19 pandemic. Three of the signatories are the National Alliance for Medication Assisted Recovery (NAMA) (a…
Continue Reading AATOD Concerns about Harm Reduction Initiative During Pandemic
Provisions in CARES Act Affecting OTPs
The CARES Act revises 42 CFR Part 2 (confidentiality of substance use disorder patient records) eliminating consent, except for the first time, after which they can revoke it at any time. After almost 10 years, it looks as if confidentiality has finally met its match, in a killer pandemic. What the insurance industry, the American…
Study Report: Pharmacy-Based Methadone Distribution
Eight investigators from medical centers in the U.S. and Canada recently looked into methadone access in the U.S., and evaluated the current availability of methadone treatment for opioid use disorder (OUD). The current situation within the U.S. wasn’t encouraging: In 2017, drug overdose deaths in the U.S.—most of them related to opioids—totaled 70,237. Yet there…
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AT Forum Newsletter – March 2020
OTP Regulations Loosened Due to Pandemic
Opioid treatment programs (OTPs) that dispense methadone got a fast and clear release from regulations due to the coronavirus/COVID-19 pandemic. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued policies that give OTPs flexibility in take-homes. This limits the frequency of contact, contributing to the social distancing required…
AATOD Releases Guidance for OTPs on coronavirus/COVID-19
Make sure you have enough medication. Follow infectious disease protocols. Protect your workforce and patients. These are some of the recommendations from the American Association for the Treatment of Opioid Dependence (AATOD) on how Opioid Treatment Programs (OTPs) should respond to coronavirus/COVID-19 in their facilities. The guidance, issued March 20, came at the end of…
Continue Reading AATOD Releases Guidance for OTPs on coronavirus/COVID-19
AT Forum Volume 31, #1 December/January, 2020
Buprenorphine Effectively Treats OUD, But Most Patients Quit Treatment Too Early—Risking Relapse, Overdose, and Other Potentially Fatal Events
Here’s something most people in the field know: buprenorphine treatment lowers the risk of overdose and death in people with opioid use disorder (OUD). And here’s what many don’t know: most patients don’t remain in buprenorphine treatment long enough to benefit from it. Six months is the shortest time endorsed by the National Quality Forum,…
Explaining Quality of Care in New Jersey, as State Looks at More Regulations for OBOTs
“We’re penalized because we’re so highly regulated and there is little or no oversight over office-based opioid treatment.” This is Margaret B. Rizzo, executive director of JSAS HealthCare, an opioid treatment program (OTP) based in Neptune, New Jersey. But it could be almost anyone in the OTP world. In New Jersey, however, OTPs have provided…
Incarcerated People Are Entitled to Medications for Their OUD; So Why Aren’t They Getting Them?
There’s no question that opioid use disorder (OUD) is extremely common in incarcerated people. And yet, this group rarely receives medication treatment for OUD (MOUD). Moreover: Each year, about one-third of people who have a heroin addiction are incarcerated This pool—this target population, easy to access—presents an opportunity to help many people who need itMethadone, buprenorphine,…
Introducing Steve Woolworth, New Evergreen CEO
Steve Woolworth, PhD, the new CEO of Evergreen Treatment Services, has big shoes to fill. Molly Carney, the longtime CEO, is retiring, and Dr. Woolworth—at the helm of the Seattle, Washington-based opioid treatment program (OTP) for only six weeks when we interviewed him in February, was humble about his familiarity with the controversies of the…
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Lawmakers Urge DEA to Move on Mobile Vans, Telemedicine
Congress is getting annoyed with the stalling by the Drug Enforcement Administration (DEA) on mobile vans and telemedicine for treatment for opioid use disorder (OUD). A letter sent in January by Sen. Patty Murray (D-WA), Sen. Elizabeth Warren (D-MA), and Congresswoman Annie Kuster (D-NH), to Uttam Dhillon, acting administrator of the DEA, called out the…
Continue Reading Lawmakers Urge DEA to Move on Mobile Vans, Telemedicine
Study Favors Better Insurance Reimbursement for Methadone Maintenance
The problem of methadone underuse isn’t new—but the authors of a recently published paper offer ways to fix the situation; ways that are both new and innovative. If broad regulatory changes aren’t going to happen, they say, the solution may be to empower private insurers to make methadone more accessible to patients by, for example,…
Continue Reading Study Favors Better Insurance Reimbursement for Methadone Maintenance
Surprise Speaker at NYSAM Focuses on Advantages of Comprehensive Care
The surprise speaker was Mark W. Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). And he was standing in for Rep. Paul Tonko (D-New York), who couldn’t make it to the New York Society of Addiction Medicine (NYSAM) meeting on February 7. It was surprising for this reason: the…
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Three Separate Programs Under One OTP Umbrella at Behavioral Health Group
In Colorado, some opioid treatment programs (OTPs) governed by federal methadone regulations are combining the office-based opioid treatment (OBOT) protocol with OTP. This means that the patients in the OBOT program in the OTP can get a prescription for buprenorphine right away—just as if they went to a prescribing provider in the community. In Colorado,…
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Newsletter Archives
AT Forum Volume 30, #6 October/November, 2019
AATOD Conference Recap: ‘Out of the Shadows’
There were more than 1,800 attendees at the 2019 conference of the American Association for the Treatment of Opioid Dependence (AATOD), held October 19-23 at the Coronado Springs Resort in Orlando, Florida. Why was it memorable? Yes, it was Disney. Yes, the exhibit hall was splendid. And yes, the awards banquet was an experience for…
Continue Reading AATOD Conference Recap: ‘Out of the Shadows’
Top Honors at AATOD Award Ceremony Go to Gilbert Gerra, MD; Zachary Talbott
The crowning glory for many attendees of the American Association for the Treatment of Opioid Dependence (AATOD) is the award banquet. Not only is it a glamorous affair, at which women wear long gowns (if they choose) and glittery jewels, the food sumptuous and live music encouraging people to talk—but it is a chance for…
Continue Reading Top Honors at AATOD Award Ceremony Go to Gilbert Gerra, MD; Zachary Talbott
Mobile Vans a Hot Topic at AATOD–And Now
The open board meeting is the traditional opening work-sleeves session at the conference of the American Association for the Treatment of Opioid Dependence (AATOD). It’s held Saturday, the first day of the five-day conference. It’s a chance for the newly arrived attendees to get their bearings after traveling, and to hear from federal agencies and…
Telehealth Offers Best Opportunity for Treatment Expansion
There is great interest in telehealth in all of health care, including treatment for opioid use disorder (OUD). One of the trickiest aspects of telehealth, however, is that the delivery of medication involves very concrete mechanical requirements. You can’t send a medication to a patient by video. In the case of methadone, and, to a…
Continue Reading Telehealth Offers Best Opportunity for Treatment Expansion
New Face of Criminal Justice: Welcoming MAT
There is a growing partnership between corrections/criminal justice and treatment for substance use disorder (SUD)—especially, treatment for opioid use disorder (OUD). For example, the Florida Association of Drug Court Professionals sent its staff to the conference of the American Association for the Treatment of Opioid Dependence (AATOD). “This is a favorable move,” AATOD president Mark…
Continue Reading New Face of Criminal Justice: Welcoming MAT
Cannabis for OUD: Not so Fast, Politicians
Politicians like the idea of cannabis as a way to cure society’s opioid ills. It’s popular (almost everyone in health care, including many opioid treatment programs [OTPs], supports marijuana legalization). Whatever is popular with the people usually is popular with politicians. Take a year ago when New York Gov. Andrew Cuomo said that opioid use…
Report: Why OUD Statistics Continue to Worsen, and What OTPs Can Do to Help
The statistics tell the story: Rates of opioid use disorder (OUD) and its consequences continue to rise. Yet we have effective treatments: methadone, buprenorphine, and naltrexone. And data show that effective treatment reduces not only opioid use, but overdose deaths, and other consequences of opioid misuse. Moreover, we have opioid treatment programs (OTPs) that provide…
Continue Reading Report: Why OUD Statistics Continue to Worsen, and What OTPs Can Do to Help
Review Article: Methadone Legend Dr. Kreek on Opioid Addiction Treatment
Almost exactly a half-year ago we highlighted an excellent review article on opioid use disorder (OUD) by Drs. Carlos Blanco and Nora Volkow of the National Institute on Drug Abuse (NIDA) (https://atforum.com/?s=blanco+and+volkow+review). Now we’re featuring another review article from another legend in the field: Mary Jeanne Kreek, MD, who heads the Laboratory of the Biology…
Continue Reading Review Article: Methadone Legend Dr. Kreek on Opioid Addiction Treatment
AT Forum Volume 30, #5 August/September, 2019
When Early Dropout From Opioid Agonist Therapy Seems Likely, Identifying Problems and Taking Action May Help Keep Patients in Treatment
Too often, patients drop out early from opioid agonist therapy and lose the many benefits it offers. Is there some way to intervene early and retain patients? A new study in Drug and Alcohol Dependence suggests that, indeed, there may be. A group headed by Leigh V. Panlilio, PhD, a staff fellow at the National…
Vermonters Speak Out About MOUD in the State’s Hub-and-Spoke System
Vermonters didn’t hesitate when recently asked to share their opinions about the state’s hub-and-spoke (H & S) medication treatment for opioid use disorder (MOUD). Instead, they responded freely to open-ended questions and queries posed during in-depth interviews. Their perceptions and opinions are the subject of a recent study in Preventive Medicine: “Patient perceptions of treatment…
Continue Reading Vermonters Speak Out About MOUD in the State’s Hub-and-Spoke System
Relative Costs and Benefits of Methadone vs. Buprenorphine in OUD
It’s generally accepted that medication-assisted treatment (MAT) with methadone or buprenorphine is more effective than nonpharmacologic treatment in opioid use disorder (OUD). But what about the relative merits of methadone and buprenorphine in OUD? Important differences exist between the two medications in several key areas: underlying pharmacologic actions, dosing schedule, treatment-related resources needed, and costs…
Continue Reading Relative Costs and Benefits of Methadone vs. Buprenorphine in OUD
COMPA Members Use Telemedicine in Clinical Trial to Assess Hepatitis C Management in Methadone-Maintained Patients
Twelve opioid treatment programs (OTPs) in New York State are participating in a $7 million clinical trial integrating treatment of hepatitis C virus (HCV) infection in patients taking methadone. The clinical trial, “Comparison of Telemedicine to Usual Care for HCV Management for Methadone-maintained Individuals,” being carried out at the University at Buffalo (UB), is aimed…
AATOD Concerned About SAMHSA Proposal to Drop PDMP Restriction
The American Association for the Treatment of Opioid Dependence (AATOD) is concerned about recent initiatives that would reduce confidentiality for patients with opioid use disorder (OUD) who take methadone or buprenorphine. Specifically, two proposals from the Substance Abuse and Mental Health Services Administration (SAMHSA) would lead to opioid treatment programs (OTPs) sending information about their…
Continue Reading AATOD Concerned About SAMHSA Proposal to Drop PDMP Restriction
Providers Oppose Allowing Law Enforcement Access to Patient Records
Now that all the comments are in and counted, the votes are clearly against allowing law enforcement to have access to all patient records. The proposed change in 42 CFR Part 2, published by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the August 26 Federal Register, would allow the police to get…
Continue Reading Providers Oppose Allowing Law Enforcement Access to Patient Records
AATOD Conference: Out of the Shadows and the Continuum of Care
AATOD Conference: Out of the Shadows and the Continuum of Care Every 18 months the American Association for the Treatment of Opioid Dependence (AATOD) holds the premier meeting of opioid treatment programs (OTPs) and others—a gathering of clinicians, researchers, policymakers, patients, and others whose #1 concern is the treatment of opioid use disorders (OUDs). The…
Continue Reading AATOD Conference: Out of the Shadows and the Continuum of Care
CMS Proposes Rates for Medicare Reimbursement for OTPs
The federal government’s approval of Medicare reimbursement for opioid treatment programs (OTPs) was a huge win for patients and programs. Now, the details need to be worked out: in particular, how the bundled rate will be calculated. The reimbursement will take effect in January 2020. The federal Centers for Medicare & Medicaid Services (CMS) proposed…
Continue Reading CMS Proposes Rates for Medicare Reimbursement for OTPs
NIMBY Doesn’t Affect Only OTPs
Even buprenorphine treatment programs are being chased out of town—at least, if the towns have anything to say about it. This happened to ReVIDA Recovery Centers, which sought to move one facility after a fire destroyed the other one. ReVIDA had wanted to provide continuity of care for patients, but Morristown, Tennessee decided to deny…
CODAC To Provide Induction for MAT in Massachusetts Prisons
In another move toward expansion of opioid treatment programs (OTPs) in correctional settings, CODAC Behavioral Healthcare is now providing induction to (and maintenance on) medication-assisted treatment (MAT) in Massachusetts. The innovative program, begun in Rhode Island, where CODAC is based, started in Hampden County, Massachusetts, September 1. All three medications approved by the Food and…
Continue Reading CODAC To Provide Induction for MAT in Massachusetts Prisons
Rural Areas Have the Longest Drive Times for OTPs
It should come as no surprise that rural areas have longer drive times to opioid treatment programs (OTPs) than urban ones. A research letter published in the Journal of the American Medical Association analyzes 489 counties in Indiana, Kentucky, Ohio, Virginia, and West Virginia. For all counties, average drive time to the nearest OTP was…
Continue Reading Rural Areas Have the Longest Drive Times for OTPs
AT Forum Volume 30, #4 June/July, 2019
Why Patients With OUDs and Co-Occurring Mental Illness May Have a Better Chance in an OTP Than in Other Treatments
When a patient with an opioid use disorder (OUD) fails to respond to treatment—despite the best efforts of counselors in the substance use disorder (SUD) treatment program—the problem may be a co-occurring mental health disorder, perhaps one that hasn’t yet been diagnosed. Under federal law, opioid treatment programs (OTPs) using methadone or buprenorphine are required…
He Wanted to Live, But He Chose to Die—To Access Methadone
In a report published in the July issue of Health Affairs, addiction specialist Jessica L. Gregg, MD, told the poignant story of a patient she called James. She’d met James when he was hospitalized with hallucinations and headaches caused by brain cancer. Dr. Gregg had been called in because James was also having symptoms related…
Continue Reading He Wanted to Live, But He Chose to Die—To Access Methadone
Add ASAM to “X the x-waiver” Movement
For months, the position of the American Society of Addiction Medicine (ASAM) on the move to deregulate the prescribing of buprenorphine for opioid use disorder (OUD) has been unclear. However, in a quiet move—a statement by Margaret A.E. Jarvis, MD, ASAM board member, in her testimony before the Congressional Bipartisan Opioid Task Force on July…
Buprenorphine a Focus of AMA Opioid Task Force
A report out from the American Medical Association (AMA) this summer recommends closing the treatment gap to address the opioid epidemic. Buprenorphine was the main treatment focus. Noting that more than 66,000 physicians and other health care professionals now have a waiver to prescribe buprenorphine in-office for the treatment of opioid use disorder, the AMA…
Continue Reading Buprenorphine a Focus of AMA Opioid Task Force
Methadone Now Allowed in Upstate NY Prison, If Inmates Come From Rikers OTP First
A new program in New York has finally made it possible for methadone patients in the KEEP program at the New York City Rikers jail—the first behind-the-walls opioid treatment program (OTP) in the country—to continue their treatment if they are sentenced to incarceration upstate. The program, a partnership between NYC Health and Hospitals/Correctional Health Services,…
Continue Reading Methadone Now Allowed in Upstate NY Prison, If Inmates Come From Rikers OTP First
Role of Counseling in OTPs
Many people have questions about the role of counseling in methadone maintenance treatment, sometimes suggesting that nothing is needed but the medication itself. The Substance Abuse and Mental Health Services Administration (SAMHSA), which certifies opioid treatment programs (OTPs), has long recommended counseling be part of treatment in an OTP. While SAMHSA does not “require” this…
OTP Responds to Shooting at Baltimore Clinic Across the Street
Two people died after a shooting at the highly respected Man Alive opioid treatment program (OTP) in Baltimore on July 15—the shooter, and one other man. “Fortunately, these kinds of incidents are rare,” noted Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD). In fact, the late Ira Marion,…
Continue Reading OTP Responds to Shooting at Baltimore Clinic Across the Street
AT Forum Volume 30, #3 April/May, 2019
Susan Caille Emerson, 1951–2019
We have lost our publisher, Sue Emerson. It happened on April 18, following a short illness. Just a year or so earlier we’d celebrated an important milestone—Sue’s 25 years as publisher of Addiction Treatment Forum. Many of AT Forum’s readers didn’t know, or know of, Susan Caille Emerson. At one time Sue ran a “From…
Review Article: NIDA Experts Dr. Blanco and Dr. Volkow on Opioid Use Disorder
A new review paper by Carlos Blanco, MD, PhD, and Nora Volkow, MD, nicely summarizes current and future management of opioid use disorder (OUD)—as one would expect from two outstanding researchers. Dr. Blanco is Director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse (NIDA), and Dr. Volkow…
Continue Reading Review Article: NIDA Experts Dr. Blanco and Dr. Volkow on Opioid Use Disorder
Study: Medicaid Expansion Under ACA Can Increase Access to OAT—But Better Access May Be Within Reach
When Medicaid expansion was enacted under the Affordable Care Act (ACA), expectations were that patients with opioid use disorders (OUDs) in specialty substance use settings in expansion states would have better access to opioid agonist treatment (OAT). Several studies have now shown that to be the case. A new study provides additional verification—and offers suggestions…
42 CFR Part 2 Still Under Threat
Despite years of attempting to do away with the regulation that protects the confidentiality of substance use disorder (SUD) treatment records—with almost all treatment organizations piling onto the bandwagon—the insurance industry has still not managed to do so. The regulation, 42 CFR Part 2, has been chipped away at, allowing various exceptions, such as for…
Keeping All Three OUD Medications in Congress’ Eye
The key to keeping methadone and opioid treatment programs (OTPs) in the sights of appropriators is the phrase “all three medications” when referring to “MAT” (medication-assisted treatment) to treat opioid use disorder (OUD). That’s because there are only three medications approved by the Food and Drug Administration to treat OUD—methadone, buprenorphine, and naltrexone—and only one…
Continue Reading Keeping All Three OUD Medications in Congress’ Eye
OTPs, Profit, and Not-for-Profit: What’s the Fuss About?
Does for-profit status connote anything at all about the quality of treatment, about how well patients are cared for, about the responsibility of the program to the community, or about whether the program requires self-pay or takes insurance? It does not. “What I have found in my dual experience, as a patient advocate and as…
Continue Reading OTPs, Profit, and Not-for-Profit: What’s the Fuss About?
AT Forum Volume 30, #2 February/March, 2019
Medicare Part D Insurers Are Making the Opioid Crisis Even Worse: It’s Much Tougher Now to Prescribe Buprenorphine, Easier to Prescribe Opioids
Almost 90% of Medicare Part D insurance companies covered at least one buprenorphine product without restriction back in 2007—but in 2018, only 35% did so. Yet prescription opioids are covered—with no restrictions—in 93% to 100% of recently surveyed plans. The culprit appears to be controls insurance companies impose to hold down costs, such as prior…
Prior Authorizations of OUD Medications Are at Times Dangerous, and May Violate Federal Parity Laws; the SUPPORT Act Fails to Help
The SUPPORT for Patients and Communities Act—the massive piece of legislation signed into law on October 24, 2018—is not going to take care of the prior authorization problem. That means countless patients with opioid use disorders (OUDs) will still be unable to access treatment when they need it. Some will relapse; some will die. That’s…
Increasing Access to MAT: What Is the Role of Harm Reduction?
There are moves—important and funded ones—to support the expansion of medication-assisted treatment (MAT), but those moves apply mostly to office-based opioid treatment (OBOT) providers, not to opioid treatment programs (OTPs). “I suspect that the OBOTs are already the beneficiary of increased access to MAT, since they keep expanding the number of providers, who can be…
Continue Reading Increasing Access to MAT: What Is the Role of Harm Reduction?
Expanding OTPs Into Corrections in Maryland
One of the most important initiatives occurring in methadone treatment for opioid use disorders (OUDs) is taking place in prisons and jails. In many states, a person who was addicted to opioids and then became incarcerated was left to undergo cold-turkey withdrawal, with no treatment. Now, states and localities are starting to recognize the cruelty…
Continue Reading Expanding OTPs Into Corrections in Maryland
Corrections: Big Focus for OTPs
As authorities start recognizing the need to treat opioid-dependent detainees in jails and prisons, rather than let them detox cold turkey, the importance of opioid treatment programs (OTPs) to corrections is growing. Last fall, a federal court granted a preliminary injunction giving methadone treatment to an incarcerated patient. This was the first federal court—it was…
CMS and SAMHSA Visit OTPs in Preparation for Bundled Rate for OTPs
The federal Center for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have started preparations for setting a rate for Medicare payment for people 65 and over, AT Forum has learned. Thanks to the “SUPPORT for Patients and Communities Act” signed into law last year by President Donald…
Continue Reading CMS and SAMHSA Visit OTPs in Preparation for Bundled Rate for OTPs
AT Forum Volume 30, #1 January, 2019
Trouble Ahead: Shifts in Funding Limit Access to Methadone, Threaten Treatment Expansion
With opioid overdoses now killing more people than traffic accidents or HIV infection—more than 45,000 lives were lost to overdoses in 2017—you’d think that most people with opioid use disorder (OUD) could easily access treatment. But that’s not the case. Only a minority receive any substance use treatment, such as counseling or inpatient treatment; even…
When There Are Corporate Changes, Patient Treatment Should Continue Without a Hitch
There have been significant changes at Acadia Healthcare Company, which operates many opioid treatment programs (OTPs) among its 600 facilities. Last December, amid reports that the Nashville, Tennessee-based publicly traded company was possibly for sale, Joey Jacobs was fired as CEO and chairman of the board, replaced by Debbie Osteen, formerly with Universal Health Services.…
Continue Reading When There Are Corporate Changes, Patient Treatment Should Continue Without a Hitch
Cannabis and OTPs: What Next?
Not only is cannabis—marijuana—legalized for recreational use in many states; it’s also legal for medical use in even more states, and some states are even suggesting it can be used to treat opioid use disorders (despite the lack of scientific evidence supporting this as an indication). What’s an opioid treatment program (OTP) to do? We…
Alcohol: The Elephant In the OTP Room
The world of addiction has a deeply embedded image of the oft-cited elephant in the room: substance use disorder in a family member, a fellow employee, a loved one; bigger than life, but not mentioned. The elephant in the room. For opioid treatment programs (OTPs), the elephant is often alcohol, which, when combined with opioids…
Integrated Care Model in Canada Includes Pharmacy
Canadian Addiction Treatment Centres (CATC), based in Toronto, has over 14,000 patients, 80% of whom are taking methadone. Unlike in the United States, patients in Canada do not have to receive their medication within the treatment center — they can, if they choose, go to an outside (community) pharmacy with a prescription. But in the…
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Field Loses Pioneer and ‘Honorary Patient’ Tom Payte
James Thomas Payte, MD, died January 22 at the age of 87. A pioneer in the treatment of opioid use disorder with methadone, Dr. Payte was one of the very few individuals who were never in medication-assisted recovery themselves, yet inducted as an “honorary patient” by NAMA Recovery, recalled Zachary Talbott, CADCII, CACII, MATS, ICADC,…
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AT Forum Volume 29, #8 December 2018
The Shocking Facts About Opioid Deaths in the Very Young
Yale researchers have uncovered startling data about the number of children and adolescents (younger than age 20) dying from opioid poisoning. The general belief—until the Yale team delved into it—was that children and adolescents rarely die from ingesting illicit and prescription opioids. But the researchers found that most studies had looked at deaths related to…
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The “Three-Day Rule” Needs To Be Extended to Allow Longer Treatment With Methadone or Buprenorphine
In 2017, Gail Groves Scott, MPH, manager of the Substance Use Disorders Institute at the University of the Sciences in Philadelphia, wrote a passionate piece in the Philadelphia Inquirer about the importance of expanding existing Drug Enforcement Administration (DEA) rules to expand and relax hospital regulations. Ms. Scott sought to remove the “three-day rule,” which…
How OTPs Can Help Pain Patients With OUDS: SAMHSA
Can opioid treatment programs (OTPs) help pain patients who no longer need opioids for pain? Absolutely, says Elinore F. McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at the Department of Health and Human Services (HHS). “For overuse and misuse of pain medications over time, which may have been initiated for a…
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42 CFR Part 2 Still a Target for 2019
Perhaps the best example of what can happen to loss of confidentiality is the story of the Boston Medical Center nurse, who, doing exactly what the Surgeon General of the United States recommended, got a prescription for naloxone in case she needed to rescue anyone from an opioid overdose. She was denied life insurance, because…
In-House, On-Site Pharmacy Provides Convenience and Minimizes Stigma, Enhancing Retention
In opioid treatment programs (OTPs) in the United States, all pharmacy is “in-house,” meaning that patients are dispensed medication by nurses in the facility. There is no need to go to an outside community pharmacy—and for methadone, it’s not even legal for pharmacies to dispense for treatment of opioid use disorder (OUD). In Canada, however,…
AT Forum Volume 29, #7 November 2018
MATER Center Director, on the Importance of Dr. Finnegan’s Work—Which Continues—and the Need to Treat Mothers for Trauma
Loretta Finnegan, MD, a champion of medication-assisted treatment with methadone, developed her scoring system for newborns more than 40 years ago. The Finnegan Neonatal Abstinence Scoring System (FNASS) assigns a numerical score to 21 clinical signs, and babies are treated accordingly. Developing the test was an important step in making sure that these babies were…
Opportunities for Partnership Between OTPs and Prisons, Jails
Although the general attitude toward methadone and buprenorphine is not favorable on the part of many workers in correctional facilities, the trend is changing. This is partly due to the clear evidence that inmates with opioid use disorders (OUDs), once released, have greatly higher risks of overdosing than the general population, and partly due to…
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Caught in Chaos—When Pregnant Women With OUD Are Incarcerated; How OTPs Can Help
Case Report This is the story of a young woman with a 15-year history of severe opioid use disorder (OUD), intermittent hospitalization, and incarceration, who becomes pregnant. She has a history of trauma and mental health issues, and few social supports. Her story is the subject of a case report recently published in the Journal…
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DEA’s Foot-Dragging on Mobile Vans Gets Worse
More than two years ago, just before Donald Trump was elected president, Demetra Ashley, associate deputy assistant administrator of the office of diversion control with the Drug Enforcement Administration (DEA), told the American Association for the Treatment of Opioid Dependence (AATOD) that new licensing regulations that would provide for more mobile vans to provide methadone…
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AATOD Policy Paper Looks at Methadone and Buprenorphine, OTPs and DATA 2000 Practices
In a far-reaching policy paper to be published next year, a draft copy of which was obtained by AT Forum, the American Association for the Treatment of Opioid Dependence (AATOD) takes stock of the increasing prevalence of opioid use disorder (OUD). “Medications Used to Treat Opioid Use Disorder: Learning from Past Lessons to Guide Policy,”…
AT Forum Volume 29, #6 October 2018
Most Important Aspect of Congress’ Opioid Bill: Medicare for OTPs
The 660-page opioid bill that passed Congress and was signed October 24 by President Trump has important provisions for opioid treatment programs (OTPs). The most significant provision expands coverage to Medicare patients. Starting in 2020, Medicare will be required to pay a bundled rate for medication-assisted treatment (MAT) in an OTP. This means that when…
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42 CFR Part 2: It’s Still Under Threat, Misunderstood; But OTP Patients Need It!
42 CFR Part 2 protects the privacy of patient substance use disorder (SUD) treatment records. It’s been under siege for 10 years, but so far, it is still the law. H.R. 6082 would have replaced the confidentiality regulation, 42 CFR Part 2, with the Health Insurance Portability and Accountability Act (HIPAA). It would also have…
Continue Reading 42 CFR Part 2: It’s Still Under Threat, Misunderstood; But OTP Patients Need It!
When OTP Patients Face Surgical Pain, OTP and Surgical Staff Work Together to Help
Health care teams are brought up short when they see the words opioid use disorder on the chart, and the patient is scheduled for surgery. Suddenly what had seemed a simple procedure has turned into a real challenge. Key questions: Is the patient using illicit opioids? Is he in an opioid treatment program (OTP)? If…
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Toolkit Helps Women State Legislators With Opioid Bills
Healthy Women, a group that has been active for 30 years, is expanding its work around policy and advocacy, and recently released a toolkit for female state legislators to use in getting support for legislation to address the opioid epidemic. “The toolkit was designed as a way to get resources and insights to women legislators,”…
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In Memoriam: Bob Newman
I spent hours visiting with Robert Newman, MD, beloved methadone advocate, over the past 30 years. He gave me my first tour of a large opioid treatment program (OTP). He taught me priceless lessons about the value of integrity, and even though he was not a journalist but a physician, he understood journalism better than…
AT Forum Volume 29, #5 September 2018
Challenges to Hiring and Retaining Good Workers in OTPs
As the opioid crisis continues, opioid treatment programs (OTPs) are going to face big challenges in the workforce, experts say. “We’re going to face a lack of access, even in areas where there are a lot of programs,” said Zachary C. Talbott, a certified MAT advocate and member of the national board of directors of…
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BAART Sues California City Over NIMBY Blocking Of Clinic
This summer, Bay Area Addiction Research and Treatment (BAART) sued the city of Concord, California after a three-year effort to site its methadone clinic there. Amitai Schwartz represented BAART and BAART’s owner, BayMark Health Services. It is a classic case; everything seemed to be moving forward (with some hitches, of course), and after a few…
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Study: Lack of Nearby OTPs Puts Methadone Patients at Risk of Early Death
Under federal law, newly enrolled methadone patients must attend a methadone program six days a week, so caregivers can watch as patients are dosed. But here’s the problem: Because many new methadone patients don’t have an opioid treatment program (OTP) nearby, this need for daily attendance markedly affects adherence. In fact, 20% to 50% of…
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Expanding OTP Access In California, Where Waiting Lists Are Not Used
California technically doesn’t have waiting lists for opioid treatment programs (OTPs). When a program is full, the operator can ask the state for an increase in slots. If the request is granted—and it usually is—the program then pays for the extra slots in a new license. This flexibility is very helpful to OTP providers. “We…
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AT Forum Volume 29, #4 August 2018
Opioid Bills in Congress: Focus on Medicare and OTPs – Updated August 25, 2018
As the Senate gets ready to vote on opioid legislation, advocates urge people to contact their members of Congress to call for comprehensive coverage by Medicare for treatment for opioid use disorders. A demonstration project is not needed – we know treatment works. Seniors need it too. The House of Representatives, in H.R. 6, passed…
Continue Reading Opioid Bills in Congress: Focus on Medicare and OTPs – Updated August 25, 2018
42 CFR Part 2 Faces Tough Going in Congress
When the U.S. House of Representatives passed H.R. 6082 last June methadone patients worried that they would lose their confidentiality. The bill would remove a major portion of the protections of 42 CFR Part 2, the regulation requiring most substance use disorder (SUD) treatment providers to obtain patient consent before releasing their records, by allowing…
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How New York Uses Its STR Funds to Enhance Treatment
To use its more than $50 million in funding from the State Targeted Response (STR) to the Opioid Crisis, New York State first identified its highest need counties, then added access to treatment for opioid use disorders, mainly with medications. “The major thing we did on the treatment side was creating Centers of Treatment Innovation,…
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As the NAS Crisis Worsens, a New Study Offers Treatment Guidelines
The incidence of neonatal abstinence syndrome (NAS) has been climbing steadily, according to a 2016 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC). The report, published August 12, indicated that the number of NAS cases rose from 1.5 per 1,000 hospital births in 1999 to 6 per 1,000 in…
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Research Report: In Appalachia, Pregnant Women With OUD Encounter Barriers to Treatment
Appalachia is an area long known for beautiful scenery, coal mining, and devastating poverty. And now the area around central Appalachia has become the epicenter of the opioid epidemic. Four Appalachian states—Tennessee, Kentucky, North Carolina, and West Virginia—have been especially hard-hit in the epidemic. A team from Vanderbilt University in Nashville launched a study to…
West Virginia Leads the Nation With Its Opioid Problems; But Could Change Be Coming?
It’s a lovely state, nestled in the tree-covered Appalachian mountains—but West Virginia, the state hardest hit by the opioid crisis, faces serious problems. According to the state’s Opioid Response Plan, West Virginia has seen its opioid overdose rate quadruple since 2010, reaching 52 per 100,000 inhabitants. Far behind is second place Ohio, with an overdose…
AT Forum Volume 29, #3 April/May 2018
Has the Medicaid Expansion Issue Finally Been Settled? If so, What’s the Best Way to Make Expansion Work?
Much has been written about the impact of Medicaid expansion on the opioid crisis and access to medication-assisted treatment (MAT). A group associated with amfAR, the Foundation for AIDS Research, has helped put the issue to rest. Under lead author Alana Sharp, the group gathered data from all states, from 2011 to 2016—covering the years…
SAMHSA Gives No Information on How Many Patients Are on Buprenorphine or How Well They Are Doing
Opioid treatment programs (OTPs) must submit a plethora of information on their services to the Substance Abuse and Mental Health Services Administration (SAMHSA). Office-based outpatient treatment (OBOT) providers who prescribe buprenorphine must submit exactly nothing, it appears. On May 20, we asked SAMHSA, “How is office-based treatment with buprenorphine working, since the patient cap was…
Profiles of Today’s OTP Leaders
Plenty of opioid treatment program executives are leaders in the field, but their names don’t get out nearly enough. This article is meant to change that. The list of leaders isn’t exhaustive, but it includes some of those at the helm of the nation’s opioid treatment programs (OTPs). AT Forum asked the leaders what they…
Ann Jamieson
Ann Jamieson, MS, aged 46, is the Chief Operating Officer and Director of Professional Development for Maric Healthcare, a Tulsa, Oklahoma-based company operating OTPs across six states. Ms. Jamieson recently served as the Executive Director of Oklahoma Treatment Services, which runs seven OTPs in Oklahoma. Ms. Jamieson received a BS in Psychology from Louisiana State…
Jason Kletter
Jason Kletter, PhD, aged 47, is the President of BayMark Health Services, where he has worked for 25 years in operational, management, and executive roles. As his parents founded BAART (Bay Area Addiction Research and Treatment) in 1977, and added more programs, he grew up “hanging around” in the clinics, then working summers doing Medicaid…
Robert C. Lambert
Robert C. Lambert, MA, aged 54, president and executive director of Connecticut Counseling Centers, Inc., began as an entry level counselor in the center’s Methadone Maintenance Treatment Program (MMTP). He told AT Forum that he signed on immediately after graduating with a bachelor’s degree in psychology, “because it was the only decent position in the…
Christine Martin
Christine Martin, LMFT, CACII, aged 35, is director of clinical services for Center for Behavioral Health, North Charleston, South Carolina. She started working as an OTP counselor shortly after completing her Master’s degree program in marriage and family therapy. “Initially, I didn’t envision staying in the field, but it wasn’t long before I found myself…
Stacey Pearce
Stacey Pearce, aged 43, Chief Compliance Officer at Alliance Recovery Centers, in Georgia, started working in an OTP in 1995 as a part-time receptionist. “It was one of three jobs to pay my rent and bills,” she said. “I never had intentions of working in substance abuse treatment, and didn’t think I would make a…
Allegra Schorr
Allegra Schorr, aged 56, is president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA). Ms. Schorr has over 25 years of experience in health care and substance use treatment services. An owner and vice president of West Midtown Medical Group, an OTP, Ms. Schorr also represents New York State as a board member…
Nick Stavros
Nick Stavros, age 39, CEO of Community Medical Services, presided over the recent sale of the OTP platform to the private equity firm, Clearview Capital. The sale relieved the inactive owners of their equity in the company, and left Mr. Stavros as the largest individual owner. With Clearview leaving him at the helm as CEO,…
Zac Talbott
Zachary C. Talbott (“Zac”), aged 35, a native of Tennessee, is administrator and program director of Counseling Solutions Treatment Centers, based in Georgia. When he was at the University of Tennessee Knoxville College of Social Work, pursuing his Master of Social Work (MSW) degree, his addiction to prescription opioids and heroin spun out of control,…
States Are Legalizing Nonprescription Syringe Sales in Pharmacies; How Well Is That Working?
Nonprescription sales of syringes in pharmacies are being met with some enthusiasm, some resistance, and a tinge of stigma. But they offer an accessible, affordable, reliable way to lower the risks of HIV/AIDS and infectious hepatitis, and, if managed well, they can help control health care costs and save lives. Attitudes—and Consequences Some people sincerely…
Methadone Patients Don’t Feel “Disabled,” But They Do Have a Protected “Disability” Under the ADA
Patients in opioid treatment programs (OTPs) are protected under the Americans with Disabilities Act (ADA). This means that an employer can’t refuse to hire them just because they are in treatment with methadone. It means that towns can’t enact anti-OTP ordinances that make it impossible to site facilities. Do these things still happen? Yes, but…
OTPs in Florida: Needs-Assessment Changes Underway
Florida Governor Rick Scott signed HB 21 in March, providing more than $65 million to support opioid treatment. This included $16.5 million for medication-assisted treatment for opioid use disorders, and $14.6 million for enhancements to the substance use disorder system of care, according to David Frady, spokesman for the Department of Children and Families (DCF).…
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AT Forum Volume 29, #2 February/March 2018
AATOD Conference Recap: Field Has Funding, Now Needs Infrastructure
There were more than 2,000 attendees at the 2018 conference of the American Association for the Treatment of Opioid Dependence (AATOD), held at the Marriott Marquis in New York City in March. The five-day meeting was full of presentations, workshops, and formal and informal gatherings, where leaders and staffers in the field of treatment of…
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An Interview With Dr. McCance-Katz On Importance of Medications and Psychosocial Treatment
Elinore F. McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at the Department of Health and Human Services, and head of the Substance Abuse and Mental Health Services Administration (SAMHSA), is passionate about the importance of medication-assisted treatment (MAT) for opioid use disorders (OUDs). And she considers medications and comprehensive wraparound services…
Department of Justice Tells State Attorney General: ADA Protects People On MAT
For the first time ever, the Department of Justice (DOJ) has sent a letter to a state attorney general, stating that judges generally may not order people off addiction medications such as methadone or buprenorphine to get custody of their children—or for any other reasons. The Legal Action Center publicized the letter, which was issued…
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With “Open-Access,” Methadone Treatment Can Increase Patient Census and Eliminate Waiting Lists: Research
In a study of “open access” treatment with methadone maintenance, reducing barriers to treatment led to a tripling of the patient census and elimination of the waiting list, with all patients getting same-day treatment. There were no ill effects on the program’s financial stability. Facilities conducting the study include the APT Foundation, a not-for-profit opioid…
MAT During Incarceration Reduces Overdose Deaths
Medication-assisted treatment (MAT) for opioid use disorder provided to incarcerated individuals sharply reduced overdose deaths after the inmates were released, researchers in Rhode Island have found. The reduction was so large that it contributed to a greater than 12% overall population-level decline in overdose fatalities in the state, according to the study, which is published…
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MOTHER Study Babies Thrive at Three Years; AT Forum Talks With Lead Authors
It’s long been known that medication-assisted treatment (MAT), with adequate doses of methadone or buprenorphine, can stabilize women during pregnancy and prevent relapse. But a key question has confronted the addiction-treatment field for years: If mothers-to-be undergo MAT, will it affect their unborn babies? The MOTHER Study, an ongoing investigation that began in May 2005,…
Continue Reading MOTHER Study Babies Thrive at Three Years; AT Forum Talks With Lead Authors
When Mom Is Better Than Morphine: Shorten Stay and Decrease Costs For Babies With Methadone-Related NAS
When Loretta Finnegan, MD, a champion of medication-assisted treatment with methadone, developed her famous scoring system for newborns—more than 40 years ago—mother and infant dyad designed to determine the severity of neonatal abstinence syndrome (NAS) due to opioid withdrawal, it was an important step in ensuring that these babies were treated—usually with morphine. Using the…
AT Forum Volume 29, #1 December/January 2018
AATOD Board Meeting Features Visits With Lawmakers, ONDCP, DEA, and SAMHSA
The annual board meeting last December of the American Association for the Treatment of Opioid Dependence (AATOD) was more than just a meeting. Eight board members conducted a number of visits to Capitol Hill, educating Congressional representatives and staff. A key focus of these visits was getting reimbursement for Opioid Treatment Programs (OTPs) from Medicare…
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California Moving Forward on Hub and Spoke, Care Teams
California has embraced the hub-and-spoke concept in implementing its State Targeted Response (STR) to the Opioid Crisis funding from the 21st Century Cures Act. The hub-and-spoke system was established in Vermont almost 10 years ago, with funding from the Affordable Care Act. The hub is an opioid treatment program (OTP) that does evaluations and assessments…
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Vermont Hub-and-Spoke Evaluation: No Opioid Overdoses, and a Sharp Drop—96%—in Opioid Use
The hubs—OTPs—treat patients who have been assessed as needing the OTP level of care. These patients are given methadone, buprenorphine, or naltrexone. Patients in the spokes—physicians’ offices—are given buprenorphine or naltrexone. The study findings are in a 185-page report completed by Richard A. Rawson, PhD, a research professor with the Vermont Center on Behavior and…
How OTPs Can Help Reduce Stigma: The Boston Experience
Boston is not the only city with a powerful push by academics and providers for medication-assisted treatment (MAT), but it’s definitely one with a high profile. We talked with Janice F. Kauffman, RN, MPH, and Sarah Wakeman, MD, about how opioid treatment programs (OTPs), specifically, can help fight stigma against MAT. Education is important, but…
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Research Report: Getting More Methadone Patients Into HCV Treatment
Here’s an eye-catching statistic: only about 3% of the world’s population is infected with hepatitis C virus (HCV)—but the infection rate in methadone users is a mind-boggling 70% to 90%. This high rate of infection is especially surprising now that better treatments, including an oral medication, are available for HCV infection. The new treatments are…
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Moving Ahead on Methadone in Corrections
People who get incarcerated—in prisons or jails—tend to be people with more advanced addiction. If they have opioid use disorders, they typically spend their term without any opioids. When they are released, their tolerance has decreased, and if they relapse—which is likely—they may overdose. That danger was never as great as it is now, explained…
Poll: Americans Consider the Opioid Crisis a Major Problem—but Not a National Emergency
Results of Seven Merged National Polls, 2016 and 2017, New England Journal of Medicine – February 1, 2018 How serious is the opioid crisis? Data from the Centers for Disease Control and Prevention give an idea: The annual rate of drug overdose deaths involving synthetic opioids (other than methadone) rose on average 18% from 1999…
AT Forum Volume 28, #6 October/November 2017
AT Forum Turns 25: Reporting on Opioid Use Disorders and Medication-Assisted Treatment
For a quarter-century AT Forum has served as a source of support and encouragement for the opioid addiction community, as well as an advocate of medication-assisted treatment (MAT) and opioid treatment programs (OTPs). Much has changed during that time, and some things have come full circle. Back in the early 1990s, methadone was the only…
Health Care Uncertainty Leaves Questions for OTPs; Self-Pay May Continue
In one respect, opioid treatment programs (OTPs) have an advantage over most areas of health care, when it comes to uncertainty about insurance in the future. If even the worst scenario came to pass (zero coverage for treatment, and that is unlikely), it wouldn’t be an unusual situation for OTPs. Unfortunately, OTP patients are used…
Continue Reading Health Care Uncertainty Leaves Questions for OTPs; Self-Pay May Continue
Opioid STR Grant Funding Formula Stays in Effect for Year 2
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that the funding formula for the $1 billion Opioid State Targeted Response (STR) grant allocation formula will stay in place for the second year of the two-year program. SAMSHA made the announcement on October 30, to the relief of the state agencies that were not…
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24/7 Access to OTPs Opened in Arizona With Federal STR Funds
Arizona is using some of its Opioid STR (State Targeted Response) money, granted under the 21st Century Cures Act, to expand access to Opioid Treatment Programs (OTPs). Currently, one OTP has opened its doors 24/7 but the state’s plan is to have a total of five facilities—two of them OTPs, and three, crisis centers—able to…
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Older Adults with Opioid Use Disorders—The Forgotten Generation
They’ve been called a “growing and understudied population”—people who need treatment, yet find it hard to obtain or to pay for. So, many do without it. And, as time passes, they become increasingly vulnerable to physical and mental challenges. Who are they? They’re older adults who have opioid use disorders (OUDs). Recommendations from medical and…
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Need for Medicare Reimbursement for OTPs Cited in DC Briefing
Senior citizens are not immune from opioid use disorders (OUDs), but Medicare does not cover treatment in an Opioid Treatment Program (OTP). The American Association for the Treatment of Opioid Dependence (AATOD), Advocates for Opioid Recovery (AOR), and the Collaborative for Effective Prescription Opioid Policies (CEPOP), are trying to change this. AOR and CEPOP sponsored…
Continue Reading Need for Medicare Reimbursement for OTPs Cited in DC Briefing
FDA: Keep Patients on Methadone or Buprenorphine, Even if They Test Positive for Benzodiazepines
The practice of ending treatment if patients test positive for benzodiazepines was discouraged in no uncertain terms by the Food and Drug Administration (FDA) last fall. Then, FDA commissioner Scott Gottlieb, MD, issued a powerful twofold statement: Combining benzodiazepines and other central nervous system depressants is known to be dangerous, but kicking people out of…
How President Trump’s Opioid Commission Supports OTPs and Comprehensive Treatment
On November 1, the White House released the long-awaited final report on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The report contains some good news for opioid treatment programs (OTPs)–if the recommendations can be turned into reality. The 138-page report includes strong support for medication-assisted treatment (MAT), including the use of…
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“Adolescent Opioid-Related Deaths are Soaring…”— An Update
An article in our August-September newsletter on the rise in adolescent opioid-related deaths included recommendations from several government and medical sources—virtually all of them suggesting expanding access to medication to treat adolescents with opioid use disorder (OUD). If passed, legislation introduced in the US Senate on November 1—the YOUTH Act—would do exactly that. The YOUTH…
Continue Reading “Adolescent Opioid-Related Deaths are Soaring…”— An Update
NIDA Launches Tools for Assessing Adolescents’ Risk of Opioid Use Disorder, Opening the Door to Medication-Assisted Treatment
The National Institute on Drug Abuse (NIDA) has launched two online screening tools—BSTAD and S2BI—to assess the risk of substance use disorder in adolescents aged 12-17—and the timing couldn’t be better. With the introduction and expected passage of the Youth Opioid Use Treatment Help (YOUTH) Act, practitioners who treat adolescents will welcome evidence-based, scientifically validated…
Still Under a Moratorium, OTPs in West Virginia Finally Get Medicaid Payments
Last fall, West Virginia got its Medicaid 1115 waiver approved, allowing, among other things, Medicaid to pay for treatment in opioid treatment programs (OTPs). The state’s decade-old moratorium against any new OTPs still exists, however, and state officials don’t expect that to go away, even though the addition of Medicaid reimbursement will probably make treatment…
Continue Reading Still Under a Moratorium, OTPs in West Virginia Finally Get Medicaid Payments
AT Forum Volume 28, #5 August/September 2017
AATOD Releases Recommendations on Siting OTPs in Era of Growth
The American Association for the Treatment of Opioid Dependence (AATOD) has released recommendations on siting opioid treatment programs (OTPs). The guidelines are meant to encourage OTP sponsors to work with neighborhoods, local treatment programs, and local and state officials. The recommendations include: Focus on underserved areas. Good locations include those with high rates of overdoses,…
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FDA Says Benzodiazepine Use Not a Bar to Treatment With Methadone or Buprenorphine for Opioid Addiction
Citing the harms of untreated opioid use disorders, the federal Food and Drug Administration (FDA) says that benzodiazepine use should not preclude the use of medication-assisted treatment (MAT) for opioid addiction with methadone or buprenorphine. In a September 20 drug safety communication, the FDA states that “buprenorphine and methadone should not be withheld from patients…
It’s Official: Heroin Is Once Again More Popular Than Rx Opioids
Many health professionals have suspected it for a while, and now it’s official: a study published in October in Health Affairs, and written up by HealthDay, reports that heroin has once again become more popular than prescription opioid painkillers as the opioid of first use. This turnaround is reminiscent of the 1960s—but back then the…
Continue Reading It’s Official: Heroin Is Once Again More Popular Than Rx Opioids
Study Reveals Surprising Results: White Patients in OUD Treatment Are Significantly Less Likely to Receive Methadone or Buprenorphine
This was a study of specialty treatment for opioid use disorders (OUDs) in publicly funded programs in the U.S. Investigators at Johns Hopkins who turned up this unexpected finding published their study online July 11 and in the September 1 issue of Drug and Alcohol Dependence. (The term “specialty treatment programs” includes publicly or privately…
Adolescent Opioid-Related Deaths Are Soaring; We Can’t Wait “Until Things Get Worse”!
In September of last year, the American Academy of Pediatrics (AAP) issued a policy statement calling for making drug therapy available to adolescents with opioid use disorder (OUD). The statement caused hardly a ripple. Those who treat adolescents reported that some families, clinicians, even some patients, consider the medications—methadone, buprenorphine/naloxone, naltrexone—a last resort. Now, a…
SAMHSA Issues Brief Update on Use of Medication-Assisted Treatment
This update from the Substance Abuse and Mental Health Services Administration (SAMHSA) reports trends in the use of methadone, buprenorphine, and extended-release, injectable naltrexone—an option for treating opioid use disorder. Not included in the report are data from private physicians who aren’t affiliated with a treatment facility or program. Paralleling the recent increase in deaths…
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OTP Leader Ed Higgins Leaves Legacy for the Field
Longtime methadone and opioid treatment program (OTP) advocate and professional Edward J. Higgins died peacefully at home in Toms River, New Jersey on October 8. Mr. Higgins began working in methadone treatment in 1973. In 1984, as clinic director in charge of state methadone programs in Asbury Park and Toms River, he helped 13 methadone…
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AT Forum Volume 28, #4 June/July 2017
Expect Opioid STR Grant Money to Be Scrutinized After One Year
Of the $1 billion in federal grants going out to states in 2017 and 2018 to respond to the opioid epidemic, 80% must go to treatment. The grant money comes from the 21st Century Cures Act, signed by President Obama last December. Checks for the first year of the State Targeted Response to the Opioid…
Continue Reading Expect Opioid STR Grant Money to Be Scrutinized After One Year
Community Medical Services in Arizona: Working with Corrections, Drug Courts
It has become clear that many people with opioid use disorders (OUDs) end up in jails and prisons. Immediately cut off from their source, they go into opioid withdrawal. Some of these inmates become severely dehydrated. Some who do will die if their dehydration is left untreated. Opioid treatment programs (OTPs)—programs that offer methadone or…
Continue Reading Community Medical Services in Arizona: Working with Corrections, Drug Courts
Policies Limiting Rx Opioids Aren’t Working; It’s Time to Expand MAT and Evaluate Other Options
Prescription opioids are still getting much of the blame for the current opioid overdose crisis, yet heroin and synthetic opioids—fentanyl, carfentanil, and tramadol—have become the leading causes of opioid overdose deaths. The death rate from heroin and synthetic opioids other than methadone rose by more than 72% from 2014 to 2015, while overdose deaths linked…
Aegis Telehealth Makes Buprenorphine Treatment More Convenient for Patients
Imagine opioid treatment program (OTP) patients being able to get counseling and prescriptions from their own smartphone, while sitting in the comfort of their home. This is now reality for two OTPs operated by California-based Aegis Treatment Centers. “We’ve been practicing telemedicine for three years in our Fresno and Delano clinics,” said Alex Dodd, Aegis…
Continue Reading Aegis Telehealth Makes Buprenorphine Treatment More Convenient for Patients
Buprenorphine Reimbursement in OTPs Advances in California
Opioid treatment programs (OTPs) still use methadone as their main medication, especially in states where there is no reimbursement for the far more costly buprenorphine. New York was the first state to set up reimbursement for buprenorphine in OTPs, but California is now well on its way. Federal Medicaid Waiver Payments Jason Kletter, PhD, president…
Continue Reading Buprenorphine Reimbursement in OTPs Advances in California
Mobile Vans for OTPs: Getting Closer to Reality
The Drug Enforcement Administration (DEA) is not yet ready to talk about mobile vans. The agency is likely to release new licensing regulations, which will open the door to more mobile vans to provide medication-assisted treatment for opioid use disorders—most likely in conjunction with brick-and-mortar opioid treatment programs (OTPs)—sometime this fall. Demetra Ashley, associate deputy…
Continue Reading Mobile Vans for OTPs: Getting Closer to Reality
Faces & Voices of Recovery Honors Two OTP Leaders
At its July 17 “America Honors Recovery” gala, Faces & Voices of Recovery awarded Mary Jeanne Kreek, MD, and Mark Parrino, MPA, two top honors. Dr. Kreek, head of the Laboratory of the Biology of Addictive Diseases at The Rockefeller University in New York City, was presented with the William L. White Distinguished Lifetime Achievement…
Continue Reading Faces & Voices of Recovery Honors Two OTP Leaders
AT Forum Volume 28, #3 April/May 2017
Number of OTPs Tops 1,500 For First Time Ever
For the first time in the history of opioid treatment programs (OTPs)–federally regulated clinics that dispense methadone and other medications to treat opioid use disorders—there were more than 1,500 as of March, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). “This is the first time it has gone past 1,500,” said Mark…
Continue Reading Number of OTPs Tops 1,500 For First Time Ever
Amid Beltway Disarray, Field Sees Bright Spot in McCance-Katz Nomination
President Trump, along with Republican members of Congress, is calling for a repeal of the Affordable Care Act (ACA)—which many believe jeopardizes treatment coverage. And there’s the otherwise general chaos reported in the White House. Yet treatment for substance use is nevertheless going forward. Patients need help, and opioid treatment programs (OTPs) still work to…
Continue Reading Amid Beltway Disarray, Field Sees Bright Spot in McCance-Katz Nomination
AATOD, Acadia, and 433 Others Protest Health Care Bill as Destructive to Opioid Treatment
President Trump promised to repeal the Affordable Care Act (ACA), and although it took some negotiating, he got what he wanted from the House of Representatives on May 3. That’s when the House passed the American Health Care Act (AHCA), repealing key provisions of the ACA. Many organizations in the treatment field, including the American…
SAMHSA Issues Opioid STR Grants
On April 19, the federal Department of Health and Human Services (HHS) released the first round of funding for the two-year State Targeted Response (STR) to the Opioid Crisis grants: $485 million for the first year of the program. The funding went to the single state authorities (SSAs) in charge of the Substance Abuse Prevention…
Research Results: Lowering the Risks of Death for Patients Receiving Methadone or Buprenorphine
Evidence is growing that two key factors help determine the risks of death in patients being treated for opioid dependence: which medication the patients are—or have been—taking, methadone or buprenorphine; and whether the patients are currently in or out of treatment. A new study that has delved into these two factors suggests ways of lowering…
Poll: The Public Speaks Out About Opioid Misuse
Results of a Poll Released by the American Psychiatric Association (APA) -May 1, 2017 To get some perspective on this story, let’s picture a teenager who has a painful backache and accepts some hydrocodone (Vicodin) capsules from a friend. When those are gone, other friends share pills that they’ve been prescribed or they’ve obtained illicitly.…
Continue Reading Poll: The Public Speaks Out About Opioid Misuse
Report from NASADAD – ONDCP to State Directors: Increase Access to Treatment
Single state authorities (SSAs) are on the front lines of the opioid epidemic. They’re in charge of overseeing the Substance Abuse Prevention and Treatment (SAPT) block grants, as well as the $1 billion in opioid treatment funds to be provided over the next two years by the 21st Century Cures Act. A key task: make…
Continue Reading Report from NASADAD – ONDCP to State Directors: Increase Access to Treatment
When Facing NIMBY, Be Transparent: The Lesson From Buffalo, NY
Not in my back yard (NIMBY)—that’s how to best describe the feeling in local neighborhoods where residents say they support treatment for substance use disorders, but—not near the school, not near their house, and so on. The word “methadone” strikes particular fear in these neighborhoods, so opioid treatment program (OTP) sponsors spend a great deal…
Continue Reading When Facing NIMBY, Be Transparent: The Lesson From Buffalo, NY
AT Forum Volume 28, #2 February/March 2017
AATOD Issues Five-Year Plan: Bottom Line Focus Is Still on Stigma
The five-year plan of the American Association for the Treatment of Opioid Dependence (AATOD) has a goal of increasing access to care in opioid treatment programs (OTPs). Treatment “wherever it is needed”—in the United States and in the world—with the aim of patient care, is a theme running throughout the document. The first strategic five-year…
Continue Reading AATOD Issues Five-Year Plan: Bottom Line Focus Is Still on Stigma
Study: Benzodiazepines + Prescription Opioids = Caution Needed!
Benzodiazepines help patients cope with severe anxiety, panic disorder, or sleep problems; prescription opioids can help relieve severe pain. When prescribed appropriately and with sufficient monitoring, either medication is relatively safe, especially for short-term use. If a health professional decides a patient needs the benefits of dual therapy—an opioid plus a benzodiazepine—careful monitoring becomes especially…
Continue Reading Study: Benzodiazepines + Prescription Opioids = Caution Needed!
California Will Use Cures Act $80 Million To Expand Treatment With Hub-And-Spoke System
The Cures Act, signed in December 2016 by President Obama, gave $920 million over a two-year period to states to devote to opioid use disorder treatment. States submitted their applications for funding to the Substance Abuse and Mental Health Services Administration (SAMHSA), and are already making plans with what to do with their money. California…
SAMHSA Develops MAPS Project to Determine Where OTPs Are Needed
The Center for Behavioral Health Statistics and Quality (CBHSQ) has been hard at work determining where in each state opioid treatment programs (OTPs) are needed, due to lack of services. CBHSQ is a division of the Substance Abuse and Mental Health Services Administration (SAMHSA). The maps won’t be ready for public distribution until later this…
Continue Reading SAMHSA Develops MAPS Project to Determine Where OTPs Are Needed
Buprenorphine Dispensing Problems in Virginia: Coal Country Rules
The Virginia Board of Medicine, backed by the state, has banned the use of buprenorphine with the exception of treating pregnant patients in both office based opioid treatment (OBOT) programs and in opioid treatment programs (OTPs). OTPs may use the mono-product for on-site administration but no longer may use it for take-homes. Part of a…
Continue Reading Buprenorphine Dispensing Problems in Virginia: Coal Country Rules
Why Women Use—and Misuse—Opioids
How different are women from men, when it comes to using—and misusing—opioids? More different than you might think, it turns out, according to CDC Vital Signs, a publication of the Centers for Disease Control and Prevention. Women are more likely than men to have chronic pain, and to use prescription opioids for longer periods, in…
Tennessee Bill Would Place Full Liability on OTPs for Car Accidents
A bill winding its way through the Tennessee legislature would make opioid treatment programs (OTPs) liable for any injury or death caused by a patient who had just received methadone. This is similar to laws that hold restaurants and bars liable for injuries or deaths caused by people driving drunk after consuming alcohol at their…
Continue Reading Tennessee Bill Would Place Full Liability on OTPs for Car Accidents
Mobile Vans: Not Ready for Prime Time
Yes, there are regulations in preparation to address the use of mobile vans to dispense medication-assisted treatment. When connected to brick-and-mortar opioid treatment programs (OTPs), these vans can help patients who don’t have transportation, as we reported in our recap of the American Association for the Treatment of Opioid Dependence (AATOD) conference last year. At…
AATOD Issues Benzodiazepine Guidelines
On April 6, the American Association for the Treatment of Opioid Dependence (AATOD) released its long-awaited report, Guidelines for Addressing Benzodiazepine Use in Opioid Treatment Programs (OTPs). The guidelines can be downloaded at: http://www.aatod.org/guidelines-for-addressing-benzodiazepine-use-in-opioid-treatment-programs-otps/. The purpose of the AATOD report is to offer guidance, instead of restrictive procedures, to help OTPs treat these patients. The report…
AT Forum Volume 28, #1 December/January 2017
Final Rule For 42 CFR Part 2 Retains Core Confidentiality Protections
The final rule on 42 CFR Part 2, issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) in January, essentially keeps the confidential protections that were in the proposed rule. We talked with Karla Lopez, senior staff attorney at the Legal Action Center, about how the final rule affects opioid treatment programs (OTPs).…
Continue Reading Final Rule For 42 CFR Part 2 Retains Core Confidentiality Protections
AATOD’s Goal of Doubling Number of OTPs Has Strong SAMHSA Support
Over the next three years, the number of opioid treatment programs (OTPs) in the country will double, from 1,400 to 2,800, pledges Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). Announced at last fall’s AATOD conference, the expansion plan certainly makes sense: the opioid epidemic has been increasing,…
Continue Reading AATOD’s Goal of Doubling Number of OTPs Has Strong SAMHSA Support
$1 Billion for Opioids from Cures Act, but ACA Repeal Could Undercut the Benefits
In December, the 21st Century Cures Act was signed by President Obama, providing $1 billion over two years to address opioid addiction. The law also provided $4.8 billion to the National Institutes of Health for research, such as for the “cancer moonshot.” However, the possibility that the Affordable Care Act (ACA) will be repealed creates…
Continue Reading $1 Billion for Opioids from Cures Act, but ACA Repeal Could Undercut the Benefits
Legal Action Center: Free Toolkit Will Help Challenge Criminal Justice and Child Welfare Agencies Who Require Patients to Stop Taking Methadone and Other Medication-Assisted Treatment
A new toolkit from the Legal Action Center can help patients, especially those taking methadone, understand their rights when they are told that they must stop taking their medication in order to keep custody of their children or avoid incarceration. Many times, these patients don’t have a lawyer, but even if they do, the lawyers…
Research Results: Opioid Agonist Treatment Versus Detoxification in Lowering the Costs of Crime
A recent study compared opioid agonist treatment (OAT) and detoxification in patients with opioid use disorders. The goal was to see which treatment approach is associated with costs of crime. A team of six investigators, supported by a grant from the National Institute on Drug Abuse (NIDA), led the study. They published their findings last…
Virginians Vote: Support Treatment—Not Jail—For Drug Users*
Treatment, not jail time—that’s what most people who misuse opioids should be offered, say Virginia voters. More than 6 out of 10 Virginians recently polled favored treatment instead of arrest and criminal charges for heroin users, and more than 7 out of 10 also chose treatment for prescription drug abusers. The 38% who identified themselves…
Continue Reading Virginians Vote: Support Treatment—Not Jail—For Drug Users*
Fighting Stigma: Down With “Drug Users”; Up With . . ?
There’s a movement afoot to banish short, snappy, offensive terms like “addict,” “drug users” and “abuse,” and replace them with terms unlikely to perpetuate stigma. And it’s not only about stigma. It is more medically accurate to use “substance use disorder” because that is the language of DSM-5, and is the correct diagnostic term. But…
Continue Reading Fighting Stigma: Down With “Drug Users”; Up With . . ?
AT Forum Volume 27, #6 October/November 2016 Newsletter
Election: OTPs Should Be Vigilant, But Optimistic
How will the election of Donald Trump as president of the United States, with far-ranging changes in administration officials and policy, affect opioid treatment programs (OTPs)? There are many questions about the future, with Mr. Trump having said little in terms of concrete plans. Drug policy reform may take a turn away from the “we…
Continue Reading Election: OTPs Should Be Vigilant, But Optimistic
AATOD Conference Recap
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…
AATOD Plenaries: Standing-Room-Only Interest in OTPs, MAT
Mark Parrino, MPA, made no secret of his plan to double the number of opioid treatment programs (OTPs) within three years, from 1,400 to 2,800. He mentioned it at every opportunity during the recent conference of the American Association for the Treatment of Opioid Dependence (AATOD). Vickie L. Walters, LCSW-C, opened the standing-room-only plenary session…
Continue Reading AATOD Plenaries: Standing-Room-Only Interest in OTPs, MAT
Top Honors at AATOD Award Ceremony Go to Michael Botticelli, Others in Field
A centerpiece of the American Association for the Treatment of Opioid Dependence (AATOD) is the award banquet, honoring leaders for their work in the field. It was no surprise that Michael Botticelli, director of the White House Office of National Drug Control Policy (ONDCP), received the Friend of the Field award at the Baltimore Marriott…
Continue Reading Top Honors at AATOD Award Ceremony Go to Michael Botticelli, Others in Field
Introduction: The AATOD White Papers
Produced by the American Association for the Treatment of Opioid Dependence (AATOD) under a contract with the Substance Abuse and Mental Health Services Administration, three white papers provide comprehensive models of how opioid treatment programs (OTPs) can ensure high-quality care and continuity of services. We summarize the white papers in this issue, focusing on the…
Health Homes in Vermont: Start Some Patients on Buprenorphine in OTPs, Transfer to OBOT (Part I in a Series of AATOD White Papers)
The American Association for the Treatment of Opioid Use Disorders (AATOD) this year issued three landmark white papers on improving access to medication-assisted treatment (MAT) for opioid use disorders (OUDs). Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the white papers can serve as guidelines for treatment providers addressing the opioid epidemic…
How OTPs Can Integrate Care With Other Health Care Providers (Part II in a Series of AATOD White Papers)
The second white paper issued this year by the American Association for the Treatment of Opioid Dependence (AATOD) focused on coordination of care. Essential steps include integrating service delivery between opioid treatment programs (OTPs) and DATA (Drug Addiction Treatment Act) 2000 practices, and between OTPs and primary and behavioral health services. In “The Opioid Treatment…
Criminal Justice System: The Need to Educate the Courts, Corrections, and the Child Welfare System (Part III in a Series of AATOD White Papers)
The American Association for the Treatment of Opioid Dependence (AATOD) issued three white papers this year that focus on methadone and buprenorphine treatment for opioid use disorders (OUDs). The papers were funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). This white paper, the third in the series, shows how opioid treatment programs…
Surgeon General’s Report Focuses on Science, Medications
The U.S. Surgeon General’s report on alcohol and drugs—the first ever devoted to this topic—should be a reference document for every opioid treatment program (OTP) and treatment provider in the country. The report, released November 17 by the Office of the Surgeon General, Vivek H. Murthy, MD, MBA, is comprehensive, accurate, and written by the…
Continue Reading Surgeon General’s Report Focuses on Science, Medications
Innovative OTP Integrates Buprenorphine Maintenance Treatment; Patients and Caregivers Benefit
An innovative hospital, one of the largest in New York City, has successfully integrated buprenorphine maintenance treatment (BMT) into its established opioid treatment program (OTP), giving patients and health care providers new choices in therapy.* A report published online October 17 in Psychiatric Services in Advance (ps.psychiatryonline. org) describes the new arrangement between the OTP…
AT Forum Volume 27, #5 August/September 2016 Newsletter
Vermont’s Hub-and-Spoke System Could Be Model for OTPs
In Vermont’s opioid treatment system, devised ingeniously by Gov. Peter Shumlin with Affordable Care Act funding more than five years ago, opioid treatment programs (OTPs) are the hubs, and office-based physicians prescribing buprenorphine are the spokes. This hub-and-spoke system has solved two massive problems for office-based opioid treatment (OBOT) providers: 1) the OTPs are the…
Continue Reading Vermont’s Hub-and-Spoke System Could Be Model for OTPs
NIMBY: Even in an Opioid Epidemic, OTPs and Patients Fight an Uphill Battle
Opioid treatment programs (OTPs) across the country have been engaged in battles to locate, in the case of new facilities, and to expand, in the case of already existing ones. The problem isn’t with federal regulators, who are mainly supportive of OTPs. Rather, the barriers come from the very communities where treatment is needed. This…
Continue Reading NIMBY: Even in an Opioid Epidemic, OTPs and Patients Fight an Uphill Battle
Patient Advocate Calls On Federal Government to Fight NIMBY
Jocelyn Woods, MA, executive director of the National Alliance for Medication Assisted Recovery (NAMA-R), has a lot to say about NIMBY-ism. As the lead advocate for OTP patients, she shared her thoughts with AT Forum. “Research was conducted decades ago showing that methadone reduces crime and public health problems,” she said. “Even more importantly, for…
Continue Reading Patient Advocate Calls On Federal Government to Fight NIMBY
Health Policy Takes Aim at Two Epidemics—OUD in Pregnancy and NAS in Newborns
A comprehensive review article in Obstetrics and Gynecology summarizes troubling data on the epidemic of opioid use disorder (OUD) during pregnancy, and the subsequent sharp rise in the incidence of neonatal abstinence syndrome (NAS) (withdrawal symptoms in newborns). The article also evaluates recent policy decisions and discusses their implications. Opioid treatment programs (OTPs) have a…
Continue Reading Health Policy Takes Aim at Two Epidemics—OUD in Pregnancy and NAS in Newborns
RI Health Homes Initiative: Improving Wellness for The Patient, And The Bottom Line for Medicaid
People with opioid use disorders are a small percentage of Medicaid enrollees, but they represent a significant percentage of costs in terms of emergency department utilization and repeat hospital admissions. By using opioid treatment programs (OTPs) as these patients’ “health homes,” the Centers for Medicare & Medicaid Services (CMS) is hoping that these costs can…
Marijuana Testing: Advice From SAMHSA and the Joint Commission
In this day of medical marijuana in some states, and recreational marijuana as well, what is a treatment program to do when it comes to testing for the drug. We checked with the Joint Commission and with the Substance Abuse and Mental Health Services Administration (SAMHSA). Both say the same: test at admission, and from…
Continue Reading Marijuana Testing: Advice From SAMHSA and the Joint Commission
AT Forum Volume 27, #4 June/July 2016 Newsletter
Tennessee Patients’ Lack of Access at Root of Georgia’s OTP Moratorium
Georgia’s 67 opioid treatment programs (OTPs) aren’t enough to treat everyone in the state who needs it, but some of the need appears to be coming from Tennessee—a neighboring state that doesn’t have enough treatment programs of its own. There are also cries of unethical marketing from some programs in the northwestern corner of Georgia,…
Continue Reading Tennessee Patients’ Lack of Access at Root of Georgia’s OTP Moratorium
Tips From Top OTP Executives on Recruiting and Retaining Counselors
Finding and keeping good counselors in an opioid treatment program (OTP) isn’t easy, no matter what state you’re in. Salaries need to keep pace with the high cost of living in metropolitan areas, where many OTPs are located—something that’s very difficult for many programs. But offering benefits such as training can help, especially when the…
Continue Reading Tips From Top OTP Executives on Recruiting and Retaining Counselors
Early Intervention for OTPs: Education and Awareness Needed
Why don’t more patients go to opioid treatment programs (OTPs) earlier in their disease? For several reasons. First, the guidelines of the Substance Abuse and Mental Health Services Administration (SAMHSA) require that patients have a one-year history of opioid addiction before entry into an OTP. However, “history” is not well defined. “It does not stipulate…
Continue Reading Early Intervention for OTPs: Education and Awareness Needed
OTPs Should Not Report Patient Information to PDMPs, But Should Use PDMPs For Patient Care
The Substance Abuse and Mental Health Services Administration (SAMHSA) regulates opioid treatment programs (OTPs) and promulgates 42 CFR Part 2, the confidentiality rule protecting patient records. When state prescription drug monitoring programs (PDMPs) came along—and they now exist in every state except Missouri—SAMHSA was put in the position of trying to determine where OTPs fell:…
Research Results: Prescription Drug Monitoring Programs Help Reduce Opioid-Related Deaths
On July 14 Sen. Joe Manchin (D-WV), along with Sens. Amy Klobuchar (D-MN) and Angus King (I-ME), introduced the Prescription Drug Monitoring Act, to require all states that receive certain federal funding to make their program data available to other states. The bill was introduced just after the Senate passed the Comprehensive Addiction and Recovery…
Recently Released Resources
Whitepaper: “Models of Integrated Patient Care through OTPs and DATA 2000 Practices” available for download at: http://atforum.com/2016/07/aatod-issues-first-whitepapers-otp-patient-quality-care-continuity-services/ Source: American Association for the Treatment of Opioid Addiction (AATOD) – July 2016 Whitepaper: “Integrated Service Delivery Models for Opioid Treatment Programs in an Era of Increasing Opioid Addiction, Health Reform and Parity” available at: http://www.aatod.org/wp-content/uploads/2016/07/2nd-Whitepaper-.pdf Source: American Association…
AT Forum Volume 27, #3 April/May 2016 Newsletter
Longtime Confidentiality Rule: SUD Consent Provisions Up for Change
In a process that began six years ago and is likely to continue for months, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) is proposing to revise the confidentiality regulations governing substance use disorder (SUD) treatment records, also known as 42 CFR [Code of Federal Regulations] Part 2. The current rule, first promulgated…
Continue Reading Longtime Confidentiality Rule: SUD Consent Provisions Up for Change
AATOD Responds to HHS Buprenorphine-Cap Proposal
Opioid treatment programs (OTPs) have been concerned about a proposal to raise the number of patients a physician can treat with buprenorphine, because they want to make sure patients receive adequate services. The federal government, which underwrote the development of buprenorphine, was concerned as well. So, when treatment with buprenorphine was established under the Drug…
Continue Reading AATOD Responds to HHS Buprenorphine-Cap Proposal
Counseling in OTPs: A Necessary Part of Treatment with Medication
Counseling is a required component of an opioid treatment program (OTP) under the Substance Abuse and Mental Health Services (SAMHSA) guidelines. It’s also what differentiates the kind of medication-assisted treatment methadone patients receive in an OTP from the office-based opioid treatment (OBOT) buprenorphine patients receive. But what is counseling? In many cases, it depends on…
Continue Reading Counseling in OTPs: A Necessary Part of Treatment with Medication
Psychosocial Intervention and Medications in Treating Opioid Use Disorders: A Review
Opioid overdose rates have risen to epidemic levels, underscoring the need for comprehensive treatment of opioid misuse. Effective medications are available, but there’s “a dearth of empirical research on the optimal psychosocial interventions to use with the medications.” That’s according to the findings from a literature review recently published in the Journal of Addiction Medicine.…
When OTP Patients Are in the Criminal Justice System: Collaborate and Communicate
Drug courts, corrections, and in fact the entire criminal justice system is undergoing a sea of change relative to medication-assisted treatment (MAT) for opioid addiction. Not long ago, judges dismissed out of hand any recommendation to divert an offender from prison or jail to outpatient treatment with methadone. Inside prison and jail, methadone treatment was…
Continue Reading When OTP Patients Are in the Criminal Justice System: Collaborate and Communicate
A Significant Decline in Criminal Charges Seen With Methadone Treatment—not With Buprenorphine Treatment
A key goal in addiction treatment is to reduce the criminal activity associated with substance use disorders. Several studies have shown that a reduction does occur with methadone treatment, but less has been reported about buprenorphine treatment. The authors of the current study compared criminal charges in patients two years before and two years after…
AT Forum Volume 27, #2 February/March 2016 Newsletter
Methadone or Buprenorphine? Letting Patients Choose May Improve Outcomes
Although either methadone or buprenorphine can treat opioid use disorders effectively, patients may have good reasons to prefer one or the other. Giving patients a choice, when possible, can lead to better outcomes. But patients don’t always have a choice about treatment—and even when they do, they may not realize it. The availability of a…
Continue Reading Methadone or Buprenorphine? Letting Patients Choose May Improve Outcomes
Joint Commission Makes Key Changes in Accreditation Standards for OTPs
A host of changes in accreditation standards are coming for opioid treatment programs (OTPs) from the Joint Commission. The standards are based on the Substance Abuse and Mental Health Services (SAMHSA) guidelines, published in March of 2015, “Federal Guidelines for Opioid Treatment Programs” (http://www.samhsa.gov/newsroom/press-announcements/201503270300). SAMHSA established the accreditation requirement in 2001 to help OTPs improve…
Continue Reading Joint Commission Makes Key Changes in Accreditation Standards for OTPs
How Treatment in an OTP Is Paid for: It Costs a Lot More Than the Price of the Medication
A December 30 article in Modern Healthcare blithely described the cost of methadone—the medication—as $4,000 a year, and went on to repeat the error several times, calculating that the medication costs $76 a week (http://www.modernhealthcare.com/article/20151230/NEWS/151239992). Methadone actually costs less than $7 a week. Although the article had a bottom-line message that was correct—that this amount…
Employment Rights for People on MMT: SUDS, HIV, Hepatitis
Five years ago, the U.S. Equal Employment Opportunity Commission (EEOC) ordered Hussey Copper to pay $85,000 because the Leetsdale, Pennsylvania-based company refused to hire a job applicant who was in methadone maintenance treatment. Donald Teaford was offered a job as a production laborer, but the offer was rescinded—and this was illegal. The offer was conditional…
Continue Reading Employment Rights for People on MMT: SUDS, HIV, Hepatitis
Success Story: Advocate Opens First OTP, Second to Open This Spring
Counseling Solutions opened its first opioid treatment program (OTP) in Chatsworth, Georgia, in February, with the second, in Murphy, North Carolina, set to open this summer. Zachary Talbott, CMA, with his business partner Keith Jones, started the process in May of 2015, going through all of the steps—community approval, then accreditation by the Joint Commission,…
Continue Reading Success Story: Advocate Opens First OTP, Second to Open This Spring
Death of an Important Voice in the Addiction Field: Stewart Leavitt Leaves a Legacy
When Stewart B. Leavitt, PhD, died in February at age 70, the methadone maintenance field lost an important advocate. The founding editor when AT Forum was first published in 1992, Dr. Leavitt followed his vision—one of open, targeted communication—for the next 15 years. “Our goal is to serve as reporters of what has happened, what…
Continue Reading Death of an Important Voice in the Addiction Field: Stewart Leavitt Leaves a Legacy
AT Forum Volume 27, #1 December/January 2016 Newsletter
Medicaid Coverage of Methadone Essential in Treatment Access for Opioid Use Disorders: Study
States that have Medicaid funding for methadone treatment are far more likely than states without such funding to have Medicaid-enrolled patients in treatment programs, researchers have found. In 17 states, however, Medicaid does not pay for methadone treatment. For the study, “Medicaid Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction…
AATOD Board Meeting With Federal Officials: Buprenorphine Cap Main Issue
The two-day meeting of the board of directors of the American Association for the Treatment of Opioid Dependence (AATOD), which took place in December in Washington, DC, was an opportunity for opioid treatment programs (OTPs) to learn about plans and to share their concerns with regulators. Many policy topics were discussed, including the exemption process…
Continue Reading AATOD Board Meeting With Federal Officials: Buprenorphine Cap Main Issue
Administrative Withdrawal: Discharging OTP Patients for Nonpayment
Opioid treatment programs (OTPs), like other health care providers, are not required to provide patient care without charge. If a patient can’t pay, and has no insurance and no Medicaid coverage, the OTP can—humanely—withdraw the patient from methadone. Key parts of this story are Medicaid expansion and Medicaid payment for OTP services—both are state-by-state policies.…
Continue Reading Administrative Withdrawal: Discharging OTP Patients for Nonpayment
Stigma Article Series: Part I – Patients With Opioid Addiction Continue to Face Stigma
Publisher’s Note: Despite the current buzz about the expansion of opioid-agonist treatment, stigma continues to prevail. This is the first in a series of four articles exploring the causes and consequences of stigma in opioid addiction, and offering suggestions from experts on ways to minimize its effects. Epithets—junkie, crackhead, stoner—they’re only words, but they’re “dismissive…
Stigma Article Series: Part II – Watch Your Language! Stigmatizing Patients Who Have Addiction Disorders Can Worsen Clinical Care
In two editorials published soon after he was appointed senior editor of the Journal of Addiction Medicine, Richard Saitz, MD, MPH, FACP, DFASAM, briefly discussed a topic that is timely and among his favorites: terminology that stigmatizes people who use addictive substances—specifically, opioids. International Anti-Stigma Statement His first editorial, published online in November 2015, introduced…
Stigma Article Series: Part III – News Media Contribute to Stigma Directed at People Who Misuse Opioids
On December 1, Psychiatric Services in Advance, an online service of the American Psychiatric Association, published “Criminal Activity or Treatable Health Condition? News Media Framing of Opioid Analgesic Abuse in the United States, 1998-2012.” The study is summarized below. Study DetailsNational and regional news stories reviewed: 673 – Newspaper articles, 437; television transcripts, 236 Methods…
Stigma Article Series: Part IV – Fighting Stigma Against Opioid Treatment Programs: People and Education Are Needed
The best way to fight stigma against opioid treatment programs (OTPs) is to bring the programs themselves out in the open—and that’s finally starting to happen. “OTPs set themselves up like they’re in a back alley somewhere,” said Wilma Townsend, MSW, the top methadone patient advocate expert at the Substance Abuse and Mental Health Services…
Patient Advocates: Leading Peer Specialists in OTPs
The growth of the patient advocate movement in opioid treatment programs (OTPs) is a benefit for patients and for management. Patient advocates will be the leaders of the peer specialists who will provide essential support for patients. Two well-known patient advocates are Zac Talbott, MSW, CMA, who just opened his own OTP, Counseling Solutions of…
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AT Forum Volume 26, #6 October/November 2015 Newsletter
The Intersection of Pain and Addiction: OTPs Brace For More Patients
The ongoing efforts to reduce prescribing of opioids should have an effect on opioid treatment programs (OTPs), because some of the patients who are being told they can’t get prescriptions anymore are addicted, officials and experts told AT Forum last month. “I think OTPs have an opportunity here to partner with not just pain specialists,…
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Mark Parrino: Policy Responses to Opioid Epidemic Should Include Comprehensive Treatment
During the past year, key government agencies, medical associations, policy makers, the media, and families have finally realized that we’re in the midst of the worst opioid addiction crisis in our nation’s history. Record numbers of people are overdosing and dying. We can’t read a newspaper or watch television without learning about the tragic effects…
Barriers to OTP Expansion
There’s a question on the minds of everyone who is involved with opioid treatment programs (OTPs) and reads the headlines: If we’re in such a dire opioid epidemic, why hasn’t methadone treatment, proven effective for more than 50 years, been expanded? We contacted Robert Lubran, MS, MPA, director of the division of pharmacotherapies at the…
Providing Naloxone to OTP Patients and Family Members: A Good Idea
Five patients at the opioid treatment program (OTP) where Jana Burson, MD, serves as medical director have rescued people—not patients—with naloxone they obtained from her OTP. “That’s a powerful agent of change for the person who does the reviving,” said Dr. Burson, because the rescuer is an OTP patient – and maybe the person rescued…
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Profiling and Comparing Opioid Users: A Possible Tool for Intervention
In the August/September issue of the Addiction Treatment Forum newsletter we discussed a review article, “Long-Term Course of Opioid Addiction,” published in the Harvard Review of Psychiatry. The article highlighted recent research suggesting that the profiles of opioid users (e.g., sociodemographics, other drug use, and services used) vary, according to the type of opioid used—heroin…
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Beny Primm Leaves Legacy of Wisdom and Compassion in Methadone Treatment and HIV/AIDS
Beny Primm, MD, a leader in the treatment of opioid addiction and AIDS, died October 16 at the age of 87 after a long battle with kidney disease. He left a legacy of care for patients in the earliest days of HIV/AIDS, before physicians even had a name for the symptoms they were seeing in…
AT Forum Volume 26, #5 August/September 2015 Newsletter
ASAM, Federal Officials Join to Promote MAT for Opioid Use Disorders
On September 24 the American Society of Addiction Medicine (ASAM), with the support of top federal health officials, released a mobile application and pocket guide to accompany its National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. The practice guideline was released last spring, but the September meeting…
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In The Age of Parity, Payers Still Put Up Barriers to OTP Reimbursement
Medicare, Medicaid, and commercial insurance—all three programs are putting up barriers to reimbursement for treatment in an opioid treatment program (OTP), but the situation is getting better, at least in states that expanded Medicaid. Parity doesn’t apply to Medicare, so that presents a huge problem for patients who are covered by Medicare because of age…
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Counties to Get the Purse Strings for SUD Services Under California Waiver: OTPs, Already In a Good Spot, Worry About Changes
A massive change in the way California Medicaid pays opioid treatment programs (OTPs) and other programs for services related to substance use disorder (SUD) was set in motion in August when the federal government approved the state’s Section 1115 waiver, allowing it to give counties control. This will shift the contracting and reimbursement from the…
Methadone Split-Dosing: Less NAS, Better Maternal Recovery
Cases of neonatal abstinence syndrome (NAS)—a group of withdrawal symptoms that sometimes afflict newborns—increased about threefold between 2000 and 2009, reflecting a fivefold rise in pregnant women’s use of illicit drugs and prescription opioids. NAS has long been a concern to staff in opioid treatment programs (OTPs). The baby’s symptoms may include tremors, difficulty sleeping,…
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John McCarthy, MD, ABPN, Answers Questions About the Methadone Split-Dosing Protocol
AT Forum: Your protocol for pregnant patients at the Bi-Valley clinic calls for giving split methadone take-home doses. How do you manage the safety issues involved? Dr. McCarthy: Take-home doses clearly need to be monitored. What’s most important is to know every patient in the program, and her home situation. This is where a dedicated…
Opioid Addiction: A Review of Long-Term Patterns and Consequences
Despite widespread news coverage, extensive research, and effective treatments, opioid addiction is reaching new heights—not only in the U.S., but in many parts of the world. According to data from the National Survey on Drug Use and Health, in 2014about 1.9 million people in the U.S. had substance use disorders related to opioid prescription pain…
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OTPs Can Help Support Primary Care Buprenorphine Prescribers
Opioid treatment programs (OTPs) can do “all the heavy lifting” when it comes to counseling and wraparound services for patients with opioid use disorders (OUDs), and can expand access to care and treatment in the community by collaborating with primary care prescribers, according to Kenneth B. Stoller, MD, assistant professor of psychiatry and behavioral sciences…
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AT Forum Volume 26, #4 June/July 2015 Newsletter
Retrospective: Vincent Dole Would Be Disappointed In the Stigma MMT Patients Face Today
Twenty years ago, AT Forum published an interview with Vincent P. Dole, MD, about his vision for methadone maintenance treatment (MMT). The interview was full of hope that methadone treatment would be better accepted in coming years. Dr. Dole’s hope was that the younger generation of physicians would be better educated about MMT, easing access…
SAMHSA Awards $11 Million in Grants to Treat Opioid Use Disorders
In late July the Substance Abuse and Mental Health Services Administration (SAMHSA) announced which 11 states were the winners of about $1 million each in grant funding to expand treatment for opioid use disorders. The Targeted Capacity Expansion grants are going to the single state agencies (SSAs) with authority over the Substance Abuse Prevention and…
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To Reduce Opioid Treatment Program Legal Liability, Practice Good Medicine— And Document It
If your patient tests positive for illicit drugs while in treatment at your opioid treatment program (OTP), you need to take steps—and document those steps—to avert that patient’s unhealthy behavior. If you don’t, and the patient gets in an accident, and someone is injured, you are liable—even if the injured person is the patient himself…
ASAM Guideline Shows What It Takes To Treat Opioid Use Disorders: Medications and Support
In May, the American Society of Addiction Medicine (ASAM) issued a practice guideline on medications for treating opioid use disorders. Meant to guide clinicians in prescribing pharmacotherapies—methadone, buprenorphine, naltrexone, and extended release naltrexone—the 170-page guideline is an important contribution to the field. Along with the Treatment Research Institute, ASAM developed the guideline using a consensus…
Don’t Ignore Benzodiazepines in the Opioid Epidemic: Massachusetts
In April of 2014, Richard D. Lewis posted “Opiates and benzos: A deadly cocktail of drugs” on southcoasttoday.com. South Coast is the southern coastal region of Massachusetts. The article showed clearly that it is benzodiazepines combined with opioids, not opioids alone, that are causing many overdose deaths. Mr. Lewis updated that article in an August…
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New Medications for Hepatitis C Gradually Making Interferon a Drug of the Past
Interferon, a traditional medication sometimes used in combination with ribavirin or other medications to treat hepatitis C infections, has unpleasant side effects, including nausea, fatigue, and depression, creating many compliance problems for patients in opioid treatment programs (OTPs). Newer medications, such as Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir) have side effects that are similar…
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AT Forum Volume 26, #3 April/May 2015 Newsletter
Methadone Dose-capping Still Continues in Practice, If Not in Policy
Dose-capping—limiting the amount of methadone a patient can take on a daily basis—was ruled “contrary to the current state of the medical literature and the principle of individualized treatment” in 2007 by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the Federal Guidelines for Opioid Treatment. So it’s surprising that it still goes…
Continue Reading Methadone Dose-capping Still Continues in Practice, If Not in Policy
Success! New York Medicaid to Reimburse OTPs for Buprenorphine
Opioid treatment programs (OTPs) are finally able to bill Medicaid for buprenorphine treatment in New York, Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA, formerly the Committee of Methadone Program Administrators), announced in April. Under the new rules, OTPs will be reimbursed $7.01 for 8 mg of buprenorphine, using supply…
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Access to HCV Screening, Testing, and Medications for Patients in Opioid Treatment Programs (Part III in a series)
What can patients in opioid treatment programs (OTPs) expect when seeking screening, v testing, and medication for hepatitis C virus (HCV) infection? Their former or current high-risk status as people who inject drugs (PWIDs) entitles many OTP patients to free screening and testing. The Affordable Care Act (ACA) covers the tests because the U.S. Preventive…
CMS Proposes Extending Parity to Medicaid Managed Care
On April 6, just after the national meeting of the American Association for the Treatment of Opioid Dependence (AATOD), the federal government issued a proposed rule that would bring Medicaid managed care in line with parity regulations that govern commercial insurance. The long-awaited proposed rule, issued by the Centers for Medicare & Medicaid Services (CMS),…
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Opportunities for Medication-Assisted Treatment Access and Expansion: The Time Is Right
The heroin and prescription-opioid epidemic are intersecting with the Affordable Care Act and parity, creating new access to treatment. This is an exciting time for opioid treatment programs (OTPs), says Gabrielle de la Gueronniere, national policy director for the Legal Action Center (LAC). The LAC recently released a report on medication-assisted treatment (MAT), showing that…
AT Forum Volume 26, #2 February/March 2015 Newsletter
SAMHSA Proposed Budget Encourages MAT for Treating Opioid Use Disorders
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released its budget request for fiscal year 2016, with some good news for opioid treatment programs (OTPs). Some key areas of the proposed SAMHSA budget relate specifically to opioid use disorders. We talked with Barbara Cimaglio, deputy commissioner of the Vermont Department of Health, the…
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To Be Part of Integrated Health Care, You May Need an Electronic Health Record and an In-House Clinic
Electronic health records (EHRs) are needed when opioid treatment programs (OTPs) work in coordination with other health care providers─which isn’t very often. But that’s starting to change. Kenny House, LCAS, CCS, vice president of clinical services for Coastal Horizons Center, an OTP based in Wilmington, North Carolina, has been in the thick of EHRs since…
Good News for Patients in Opioid Treatment Programs: Treatments for Hepatitis C Infection Are Becoming Affordable (Part II in a series)
The outlook for patients in opioid treatment programs (OTPs) who need affordable treatment for hepatitis C virus (HCV) infection has improved markedly since we reported two months ago, when the highly effective new medications cost $83,000 to $95,000 for a 12-week course. Under fire for high prices, and competing with each other, Gilead Sciences and…
Lawyers in Kentucky Drug Court Case Wants Physicians, Not Judges, to Decide on MAT
A landmark lawsuit aimed at getting Kentucky drug courts to accept medication-assisted treatment (MAT) for opioid use disorders was filed March 9 by Lexington-based attorney Mark Wohlander and Ned Pillersdorf of Paintsville, Kentucky. Mr. Wohlander talked to AT Forum shortly after the filing about his hopes for the lawsuit, which was filed on behalf of…
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Legal Action Center Report: Medication-Assisted Treatment a Key Solution to the Opioid Epidemic
The Legal Action Center released a report in March focusing on medication-assisted treatment (MAT). The report stressed that MAT is a key solution to the opioid epidemic that is raging across the country. The report, “The Case for Expanding Access to Medication-Assisted Treatment to Address the Heroin and Opioid Epidemic,” shows that there are clear…
Jerry Rhodes, from CRC to Acadia, Muses on Future of the Field
When Acadia Healthcare announced that it planned to acquire CRC Health Group last year, CRC CEO Jerry Rhodes continues championing opioid treatment programs (OTPs). At CRC, there was a robust network of OTPs, particularly with the acquisition of HabitOpco, as well as a diversified line of inpatient treatment programs. Mr. Rhodes has a vision for…
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AT Forum Volume 26, #1 December/January 2015 Newsletter
Health Care Reform One Year Later: Medicaid Much Better Than Commercial Insurance for Opioid Treatment Programs
A year ago, the Affordable Care Act (ACA), with the expansion of Medicaid and the inclusion of private insurance subsidies, took effect. In the states that expanded Medicaid, this has been a boon to opioid treatment program (OTP) patients, in some cases, but not all. And in the states that didn’t, it hasn’t. And even…
Overcoming Obstacles to Opioid Treatment Expansion: The North Dakota Example
We’re well into one of the worst opioid addiction epidemics in recent memory, and one would expect that opioid treatment programs (OTPs) would be rapidly expanding to meet the demand. But instead, it’s physicians’ office practices using buprenorphine to treat patients that seem poised for growth, although precise numbers are lacking. Why aren’t more OTPs…
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For-Profit Opioid Treatment Programs Leading the Growth Curve
If it weren’t for proprietary financing interests, there would be little growth in opioid treatment programs (OTPs), according to Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). The reason for this is partly funding, but there are still barriers based on stigma. Despite those barriers, for-profit providers can…
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A Tough Challenge for Opioid Treatment Programs: Linking Hepatitis C Patients With Affordable Testing and Treatment Services
Finally, there’s good news for the many patients in opioid treatment programs (OTPs) who are infected with hepatitis C virus (HCV). New medications with success rates ranging from 90 percent to close to 100 percent are replacing older treatments—interferon injections and ribavirin—that required lengthy therapy, had an average cure rate of only 40 percent, and…
Thanks To ADA Lawsuit, Johnson City, Tennessee May Open Doors to Opioid Treatment Programs
Tri-Cities Holdings has been trying to site an opioid treatment program (OTP) in Johnson City, Tennessee, and finally, things are looking up. After a federal Department of Justice investigation and a series of court hearings focusing on Johnson City’s violation of the Americans with Disabilities Act (ADA) in discriminating against people seeking treatment for addiction,…
California’s Reaction to Obamacare: Medi-Cal Better Than Commercial Plans
Alex Dodd, president and CEO of Aegis Treatment Centers, divides Obamacare─the Affordable Care Act (ACA)─into Covered California, which is commercial insurance with subsidies for people earning up to 400 percent of the federal poverty limit, and expanded Medi-Cal (California’s Medicaid program). He’s thrilled about both, and although there are a few more challenges on the…
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NJ Supreme Court Rules Pregnant Woman on Methadone Not Guilty of Child Abuse
A December 22 unanimous ruling by the New Jersey Supreme Court reversed a lower court decision, which had found that a mother could be charged with child abuse and neglect if her baby was born with neonatal abstinence syndrome (NAS), a predictable and easily treatable condition. In effect, the New Jersey Supreme Court found that…
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How Opioid Treatment Programs Can Prepare For and Manage DEA Inspections
Mark W. Caverly, who was an investigator for 31 years, in charge of diversion policy with the Drug Enforcement Administration (DEA), was policy chief of diversion control when he retired from the DEA. He is now senior controlled substance compliance consultant with BuzzeoPDMA, a Cegedim Relationship Management company, consulting with manufacturers, pharmaceutical companies, hospitals, and…
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AT Forum Volume 25, #4 October/November 2014 Newsletter
Kade Appointed Acting Director of CSAT in Wake of Clark’s Retiring
Daryl W. Kade, MA, has been appointed acting director of the Center for Substance Abuse Treatment (CSAT) for the Substance Abuse and Mental Health Services Administration (SAMHSA). H. Westley Clark, MD, former director, retired suddenly, effective October 3. Ms. Kade will be acting director until a permanent director is found. Ms. Kade was director of…
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Increasing the Buprenorphine Patient Cap: Threat to Patient Care
Over the summer, steps have been taken to increase the “cap”—the number of patients a physician can treat—with buprenorphine/naloxone. The American Association for the Treatment of Opioid Dependence (AATOD), opioid treatment programs (OTPs), and other national organizations watched the proceedings with concern, because there is no validation of whether most office-based physicians are providing comprehensive…
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“The Talk”—When Patients Want to Switch from Methadone to Buprenorphine
Most advocates in the field oppose the idea of a stable patient who is doing well on methadone switching to buprenorphine provided by an office-based physician. If treatment in an opioid treatment program (OTP) is working well, and the patient is in successful recovery, why jeopardize this by switching to office-based opioid treatment (OBOT), they…
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Research: Buprenorphine Treatment for Opioid Addiction: Opportunities, Challenges, and Strategies
Buprenorphine/naloxone has been available in the U.S. for both opioid treatment programs (OTPs) and office-based opioid treatment (OBOT) since 2003. While OBOT physicians can prescribe the medication, OTPs must dispense it. Costs and reimbursement problems have been the main barriers to its use in OTPs. Although more than 15,000 physicians are certified to prescribe buprenorphine…
Primary Care Clinic Next to Opioid Treatment Program Provides Stigma-free Care
In Texas, people in the uninsured and indigent population die on average 29 years sooner because they don’t have access to primary care, says Allison Greer, BBA, vice president with the Center for Health Care Services (CHCS). A San Antonio-based community mental health center that runs an opioid treatment program (OTP), and an outpatient mental…
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Attracting New Patients to Your Opioid Treatment Program: The Importance of Word of Mouth and Referrals
In many parts of the country, how to market to attract new patients to opioid treatment programs (OTPs) is a moot point. There are waiting lists lasting for months. The demand for treatment is such that the only programs that are able to grow are those in urban areas like New York City and Baltimore.…
AT Forum Volume 25, #3 Summer 2014 Newsletter
AATOD Policy Paper: Raising Buprenorphine Patient Cap Could Hurt Patient Care
The opioid overdose epidemic has led to a call by some to raise the 100-patient cap on buprenorphine, which can be dispensed and prescribed by office-based physicians. Even before Sen. Ed Markey of Massachusetts proposed a bill in July allowing physicians to treat an “unlimited” number of patients with buprenorphine, the American Association for the…
Continue Reading AATOD Policy Paper: Raising Buprenorphine Patient Cap Could Hurt Patient Care
Changes in Confidentiality Regulations Would Hurt Opioid Treatment Program Patients, Damage Privacy
The long process of reviewing 42 CFR Part 2, the regulation that governs confidentiality of alcohol and drug abuse treatment records, is underway. The law and regulation date from the 1970s, and prohibit any substance use disorder (SUD) treatment provider receiving federal funds from disclosing the identity of any patient without the written consent—on paper—of…
ONDCP’s Michael Botticelli on the Importance of OTPs in Treating Opioid Use Disorders
Michael Botticelli, acting director of the Office of National Drug Control Policy (ONDCP) and a longtime friend of medication-assisted treatment (MAT), dating from his years heading the Massachusetts Bureau of Substance Abuse Services, gave AT Forum an exclusive interview this summer on how opioid treatment programs (OTPs) effectively treat their patients who have opioid use…
Medicaid Managed Care, New Insurance Rules Coming to New York Opioid Treatment Programs
There are big changes coming up for opioid treatment programs (OTPs) and other substance use disorder (SUD) programs in New York State. Starting next year, the longstanding fee-for-service Medicaid reimbursement system will be replaced by managed care; also starting next year, new insurance legislation to protect SUD patients is expected to be enacted. Henry Bartlett,…
Research Report: Dosage Trends in Methadone Maintenance Treatment Programs: Significant Improvement, But Still Below Evidence-Based Standards
The sharp rise in heroin use and prescription opioid abuse in recent years underscores the need for effective treatment for opioid addiction. Yet previous studies have shown that most methadone maintenance treatment (MMT) programs—the primary treatment for opioid use disorders—haven’t provided doses that meet evidence-based standards, 80 mg/day and above. Evidence-based standards are interventions backed…
Research Report: Patients Treated With Methadone vs. Buprenorphine: Differences in Demographic Characteristics and Treatment Outcomes
A study published online May 12, 2014 in Substance Abuse compared demographic characteristics and treatment outcomes of 252 patients enrolling in a methadone maintenance treatment (MMT) program with those of 252 buprenorphine patients starting treatment in an internal medicine practice affiliated with a medical school. The authors planned the study as “a real-life comparison,” where…
Life Concerns of Prescription Opioid and Heroin Users—What Are They, and How Do They Differ?
The daily worries and instabilities that plague opioid-dependent patients can make it difficult for providers to deliver effective long-term substance-abuse and medical treatment. Lack of information about patients’ life concerns leaves providers without direction about key issues that may cause patients to leave treatment. In the first study to classify life concerns in drug users,…
AT Forum Volume 25, #2 Spring 2014 Newsletter
SAMHSA Accreditation Guidelines for Opioid Treatment Programs: Final Version Out Within a Year
The draft accreditation guidelines for opioid treatment programs (OTPs) released last spring (see AT Forum July 19, 2013) by the Substance Abuse and Mental Health Services Administration (SAMHSA) are still going through the review process within the federal government, and will be out no later than next April, AT Forum has learned. “We have gotten…
The Joint Commission Issues Revised Standards for Opioid Treatment Programs
Working closely with the Substance Abuse and Mental Health Services Administration (SAMHSA), The Joint Commission has revised several standards for Opioid Treatment Program (OTP) accreditation. For The Joint Commission to be allowed to accredit OTPs, accreditation standards must be in alignment with SAMHSA’s regulations and guidelines. The Joint Commission, to keep up with SAMSHA regulations…
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Providing Buprenorphine in an Opioid Treatment Program: Challenges and Opportunities
When the federal government said in December of 2012 that opioid treatment programs (OTPs) can dispense take-home doses of buprenorphine with fewer restrictions than are placed on take-home doses for methadone—in particular, no waiting period (http://atforum.com/2013/02/otps-can-now-dispense-buprenorphine-take-homes-with-no-waiting-periods/), there was an expectation that patients and treatment providers would be interested in buprenorphine. But there was also a…
New Methadone Safety Guidelines Published for Opioid Addiction and Chronic Pain Management
In recent years the safety of methadone has been questioned by data indicating a large rise in the number of methadone-associated overdose deaths occurring at the same time as a marked increase in methadone use to treat chronic pain. Between 2008 and 2011, several medical groups issued methadone safety guidelines to address the increased mortality.…
Tennessee Law Puts Pregnant Women on Medication-Assisted Treatment for Opioid Addiction in Danger of Arrest
As of July 1, a pregnant woman who gives birth in Tennessee to a baby who has neonatal abstinence syndrome (NAS), a transient and easily treatable condition, could be arrested for assault. Many women in opioid treatment programs (OTPs) are likely to deliver a baby with NAS, so the American Association for the Treatment of…
Project Lazarus Brings Opioid Treatment Program to Wilkes County Along With Naloxone Kits
Project Lazarus, a nonprofit organization based in Moravian Falls, North Carolina, is best known nationally for its work on making the overdose-reversal medication naloxone more available. But the organization, under the guidance of CEO Fred Wells Brason II, was also instrumental in bringing the first opioid treatment program (OTP) to Wilkes County North Carolina. It…
The M.A.R.S. Peers Model at Work in Medication-Assisted Treatment for Opioid Addiction
The M.A.R.S. Project is the only federally funded program that provides peer recovery support to patients in medication-assisted treatment (MAT) for opioid addiction. Funded by the Substance Abuse and Mental Health Services Administration, M.A.R.S. is conducted in collaboration with the substance abuse division of the Albert Einstein College of Medicine in New York City, Yeshiva…
Study Suggests Chronic Pain is Widespread and Undertreated in MMT Programs By Guest Author Stewart B. Leavitt
Pain is a worldwide epidemic and more than a third of all adults, or 100 million persons, in the U. S. alone suffer from chronic pain conditions of some sort, as estimated by the U.S. Institute of Medicine (IOM 2011). Even more troubling, newly published research suggests that the prevalence of clinically significant, persistent pain…
AT Forum Volume 25, #1 Winter 2014 Newsletter
From the Publisher—Special Issue on Recovery From Opioid Addiction
For six decades methadone maintenance has been an approved treatment for opioid addiction. People who are taking methadone are no different from those who manage their diabetes by taking insulin: they are in recovery. Yet some policymakers—and even some medical, and yes, some addiction authorities—don’t believe it. Although that may change as more and more…
Continue Reading From the Publisher—Special Issue on Recovery From Opioid Addiction
Walter Ginter on the Importance of Peers in Recovery With Medication-Assisted Treatment
Stigma is a common theme among people seeking recovery from the disease of opioid addiction, but it’s particularly poignant for people in medication-assisted treatment (MAT), because stigma can itself prevent recovery from taking place. People who don’t understand MAT—and that’s a big group, including many employers, politicians, and even friends and family members—don’t believe methadone…
Interview: Zac Talbott on Being a Patient and Certified Advocate for Medication-Assisted Treatment
Patients and other individuals who are advocates are a growing force in medication-assisted treatment (MAT) for opioid dependence, providing information and support to patients as well as assistance to opioid treatment programs (OTPs). Advocates also are an essential link between patients and OTPs. They are not as well known as they should be, there aren’t…
Recovery Transformation in Philadelphia OTPs: Person-centered, not Patient-centered
Over a decade ago, Philadelphia’s public health system moved toward recovery for mental health and addiction services. On the mental health side, there had been a belief that recovery wasn’t possible, especially for people with serious mental illness. On the addiction side, recovery was already in wide parlance, but the system was set up to…
Continue Reading Recovery Transformation in Philadelphia OTPs: Person-centered, not Patient-centered
Patients in Methadone Maintenance Treatment Face Obstacles and Stigma When Joining 12-Step Groups
It’s ironic—and disappointing—that patients in methadone maintenance treatment (MMT) who join mainstream addiction recovery groups face considerable stigma and daunting obstacles from professionals and from other patients, rather than the helping hand they might reasonably hope for and expect. This became evident in the first in-depth survey detailing the experiences and perceptions of MMT patients…
Is Maternal Methadone Treatment Child Abuse and Neglect? New Jersey Supreme Court to Weigh In
One year after the New Jersey Supreme Court ruled that a pregnant woman did not commit child abuse just because she tested positive for cocaine, the state has brought a similar case to the court: that of a pregnant woman who was in methadone treatment in an opioid treatment program (OTP). This January, experts in…
Guidance Provided for Safe Methadone Induction and Stabilization in OTP Patients By Guest Author Stewart B. Leavitt
Expert opinion from ASAM stresses safety during MMT start-up For roughly half a century, methadone dispensed in federally certified opioid treatment programs (OTPs) in the United States has been a well-studied, effective, and relatively safe addiction therapy. Yet, there have been ongoing incidents of methadone-associated overdoses and deaths, largely due to its widespread prescription…
AT Forum Volume 23, #4 Fall 2013 Newsletter
Methadone vs. Buprenorphine: How Do OTPs and Patients Make the Choice?
Opioid treatment programs (OTPs) have always been able to dispense buprenorphine on the same basis as methadone, but now they can dispense take-home buprenorphine more liberally than take-home methadone. This has given rise to many questions about how new patients should be selected for which medication—the appeal of take-homes is clear, but that doesn’t necessarily…
Continue Reading Methadone vs. Buprenorphine: How Do OTPs and Patients Make the Choice?
Treatment of Opioid Dependence: A Call for an Evidence-Based Approach
Despite decades of accumulated data on the effectiveness of medication-assisted treatment (MAT), gaps remain between evidence-based standards and current practices. The authors of a recent study attribute these gaps largely to “regulatory constraints and pervasive suboptimal clinical practices.” The study appeared in August in Health Affairs; the authors are affiliated with U.S. or Canadian medical…
Continue Reading Treatment of Opioid Dependence: A Call for an Evidence-Based Approach
OTPs as Health Homes: Extra Money for Care Management
Some states are making opioid treatment programs (OTPs) health homes under a federal strategy that is part of the Affordable Care Act (ACA). Under the initiative, which comes from the Centers for Medicare and Medicaid Services (CMS), states can pay OTPs extra money to serve as “health homes” for their patients, meaning that the OTPs…
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NIMBY and Other Problems: Still an Uphill Battle For OTPs, But Hope Seen In Patient Advocacy
The NIMBY (Not In My Back Yard) syndrome is one significant challenge for opioid treatment programs (OTPs), which can’t operate if they can’t get approval from municipalities. Methadone maintenance treatment has been proven effective and producing good outcomes for five decades, but that isn’t preventing politicians from pandering to prejudice and discrimination. Still, the field…
Keeping OTP Patients in Treatment Longer: Methadone vs. Buprenorphine
Data from the first large randomized U.S. trial comparing treatment retention of methadone and buprenorphine patients confirm what a Cochrane review—generally considered the Gold Standard—and other studies have found: treatment retention is much higher with methadone than with buprenorphine, although the two are equally effective in suppressing illicit opioid use. The current study is actually…
Continue Reading Keeping OTP Patients in Treatment Longer: Methadone vs. Buprenorphine
Meaning and Methadone: A Model for Promoting Adherence in MMT, Based on Patients’ Perceptions
The prevailing dosing model in methadone maintenance treatment (MMT) supports adjusting methadone doses downward, based on signs of opioid intoxication, or upward, based on withdrawal signs or patients’ reports of craving or illicit opioid use. But a recent study, carried out at the Albert Einstein College of Medicine (AECOM) and Montefiore Medical Center, suggests that…
In California, a Focus on Getting OTP Patients Enrolled in Medicaid
Opioid treatment programs (OTPs) have many patients—childless adults, mainly men—who have not been eligible for Medicaid. They are self-paying for their treatment. In these weeks before the Affordable Care Act (ACA) takes effect and self-paying patients can be covered under its Medicaid expansion provision, some OTPs are working feverishly to make sure that these patients…
Continue Reading In California, a Focus on Getting OTP Patients Enrolled in Medicaid
AT Forum Volume 23, #3 Summer 2013 Newsletter
From the Publisher: The Story for OTPs This Summer: Health Care Reform
In the summer 2013 issue of AT Forum, one theme keeps coming up—and driving—the story for opioid treatment programs (OTPs). It is health care reform—the Affordable Care Act (ACA), which goes into full-implementation mode in January 2014. Patients are going to be signing up for Medicaid and commercial insurance, which will reimburse OTPs for services…
Continue Reading From the Publisher: The Story for OTPs This Summer: Health Care Reform
What’s New in the Draft Opioid Treatment Program Federal Guidelines: Midlevel Providers and the Importance of Recovery and Retention
Under the federal draft guidelines for opioid treatment programs (OTPs) issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) May 16, nurse practitioners (NPs) and physician assistants (PAs) are explicitly given a much bigger role in methadone induction and dosing, something that medication-assisted treatment (MAT) advocates hope will be embraced by state accreditation…
Increased Demand for Treatment Under the ACA: How OTPs Should Prepare
With the Medicaid expansion and insurance exchanges of the Affordable Care Act (ACA) due to take effect January 1, 2014, and enrollment starting October 1, 2013, opioid treatment programs (OTPs) are gearing up for the expected increased demand for services. But they can’t expect patients to just show up—they need to make sure that they…
Continue Reading Increased Demand for Treatment Under the ACA: How OTPs Should Prepare
Good News and Bad News for Opioid Treatment Programs in California
Heading into the first year of the Affordable Care Act (ACA), Jason Kletter, PhD, president of BAART Programs, a drug-treatment provider, describes the California reimbursement situation for opioid treatment programs (OTPs) as good news and bad news. “The good news is that California has elected to implement the Medicaid expansion, and that methadone is a…
Continue Reading Good News and Bad News for Opioid Treatment Programs in California
ASAM: States and Insurance Companies Limit MAT in Face of Opioid Abuse Epidemic and ODs
Medication-assisted treatment (MAT) is being thwarted by state governments and insurance companies, the American Society of Addiction Medicine (ASAM) warned in a scathing report released June 20. The report, which details practices by governments, Medicaid, and insurance companies, shows that by restricting the use of methadone, buprenorphine, and naltrexone, policymakers are doing nothing to stave…
Philadelphia Releases Benzodiazepine Draft Guidelines for MAT
Important guidelines to help opioid treatment programs (OTPs) determine how to handle benzodiazepine use by their patients have been developed by the Institute for Research, Education and Training in the Addictions (IRETA) for the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Roland Lamb, MA, director of the DBHIDS Office of Addiction Services,…
Continue Reading Philadelphia Releases Benzodiazepine Draft Guidelines for MAT
No Evidence to Support QTc-Interval Screening in Methadone Maintenance Treatment: Cochrane Review
“Methadone represents today the gold standard of efficacy for the pharmacological treatment of opioid dependence,” states the newly published (June 20) Cochrane Review on QTc interval screening for cardiac risk in methadone treatment. The review goes on to say that “methadone, like many other medications, has been implicated in the prolongation of the [QTc] interval…
SAMHSA’s New Medical Director Will Focus on Medical Treatment of Addiction
Elinore McCance-Katz, MD, PhD, the first medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), shared with AT Forum her view of her new role in an interview in late June. She focused on opioid treatment programs (OTPs) in our discussion, but she is bringing to the agency a renewed concentration to…
Continue Reading SAMHSA’s New Medical Director Will Focus on Medical Treatment of Addiction
From “Angels” to “Liquid Handcuffs”—MMT Patients Use Metaphors as Tools to Aid in Recovery
Investigators in this study explored the experiences of patients in methadone maintenance treatment (MMT) for opioid addiction in order to better understand the challenges of maintaining a sustainable recovery. Study participants used spontaneous, picturesque metaphors to illustrate their experiences, feelings, challenges, and successes, enabling investigators to identify key turning points in substance dependence and recovery.…
AT Forum Volume 23, #2 Spring 2013 Newsletter
Bob Newman is Retiring, But You Haven’t Heard the Last From Him
Legendary methadone treatment advocate Robert G. Newman, MD, is retiring. But, he hastens to add, he is not leaving the field. “What I’m leaving,” he told AT Forum in February, “is the office.” Dr. Newman announced via a January 26 e-mail that he would be giving up his “formal role” as director of Beth Israel’s…
Continue Reading Bob Newman is Retiring, But You Haven’t Heard the Last From Him
Two Kinds of Roles for OTP Peers under the Affordable Care Act
Peers—patients in medication-assisted treatment (MAT) who are in recovery—are gradually being enlisted into the workforce, thanks to the Affordable Care Act (ACA). Two kinds of roles are surfacing: recovery coaches, and “navigators” who help enroll uninsured people in private insurance through health insurance exchanges. The recovery coaching idea is not new, but the navigator one…
Continue Reading Two Kinds of Roles for OTP Peers under the Affordable Care Act
NASADAD Issues Consensus Statement Endorsing Medication-Assisted Treatment
The top state officials in substance abuse treatment approved a consensus statement in December that states that medication-assisted treatment (MAT) should be paid for by public and private health insurance plans. This was the first time that the board of directors of the National Association of State Alcohol and Drug Abuse Directors (NASADAD) approved a…
Continue Reading NASADAD Issues Consensus Statement Endorsing Medication-Assisted Treatment
NASADAD Prescription Drug Inquiry Reveals SSAs Very Concerned About Prescription Drug Misuse and Abuse
Prescription drug abuse—something a whole industry of monitoring and law enforcement is growing up around—is a public health problem first, according to the state substance abuse officials responsible for treatment and prevention. That said, these same directors—the single state agencies (SSAs) with authority over the Substance Abuse Prevention and Treatment block grant—also want to participate…
Seeking and Getting Substance Abuse Treatment: Barriers Women Face
Our first article in this series, “Becoming Addicted: It’s Different—and Riskier—for Women,” delved into the vulnerabilities that challenge women who have an opioid use disorder (OUD). Now we examine the potentially daunting barriers women face in seeking and getting substance abuse treatment. Some barriers are largely internal, based on the woman’s attitudes; others are generated…
Continue Reading Seeking and Getting Substance Abuse Treatment: Barriers Women Face
Why MMT Patients Exchange Prescription Drugs
Patients in methadone maintenance treatment (MMT) exchange a variety of prescription drugs—but little is known about why this happens, and how common it is. Given the risks of this practice—drug interactions, side effects, addiction, antibiotic resistance, birth defects, and possible interruption of MMT—a group affiliated with Butler Hospital and Brown University, Providence, RI, decided to…
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From the Editor – Maine Continuing to Push for Caps on Medication-Assisted Treatment
First, Maine imposed two-year caps on methadone and buprenorphine treatment, if paid for by MaineCare, the state’s Medicaid program. The caps were due to take effect January 1, but treatment advocates were able to work out a medical-necessity exemption, which said that as long as patients were doing well, they could stay past the two-year…
AT Forum Volume 23, #1 Winter 2013 Newsletter
OTPs Can Now Dispense Buprenorphine Take-Homes with No Waiting Periods
As of January 7, 2013, opioid treatment programs (OTPs) can now dispense buprenorphine take-homes, with no predetermined waiting period for stable patients. The Substance Abuse and Mental Health Services Administration (SAMHSA) at last issued its final rule giving OTPs the welcome flexibility this past November, and the rule was published in the Federal Register December…
Continue Reading OTPs Can Now Dispense Buprenorphine Take-Homes with No Waiting Periods
Buprenorphine vs. Methadone
Buprenorphine and methadone, both being opioids, activate the opioid (mu) receptors on nerve cells. And both drugs have long half-lifes, meaning that they’re long-acting medications. The half-life can vary from 24 to 60 hours for buprenorphine, and from 8 to 59 hours for methadone. (The half-life is the amount of time a drug stays in…
History of Buprenorphine
Buprenorphine has been in active use for 10 years as a treatment medication for opioid addiction. As explained by Nicholas Reuter, MPH, senior public health analyst with SAMHSA’s Center for Substance Abuse Treatment (CSAT), the development of buprenorphine was preceded by the development and approval by the Food and Drug Administration (FDA) of levo-alpha-acetyl-methadol (LAAM).…
Promise of Health Care Reform for Opioid Treatment Programs Dimmed by State Discrimination
Health care reform will bring increased access to opioid treatment programs (OTPs), but not as great an increase as the federal government keeps saying it will be. The impediment is the states—specifically, the anti-methadone states, which many are in one way or another. Either they won’t let Medicaid pay for methadone maintenance, or they won’t…
Chronic Pain in Opioid Treatment Program Patients Typically Untreated
Many patients in opioid treatment programs (OTPs) are likely to have chronic pain, but in many, that pain will not be adequately treated, in part because there are so many problems balancing the methadone they are given for opioid dependence with the types of medications needed to treat pain. “Most physicians in an OTP have…
Continue Reading Chronic Pain in Opioid Treatment Program Patients Typically Untreated
Drug Addiction: It’s Different—and Riskier—for Women
When it comes to drug addiction, gender does make a difference. Women start using substances and become addicted differently from men. Their addiction progresses faster, they find it harder to quit, they recover differently from men, and they relapse for different reasons. These gender differences have a substantial impact on treatment for substance abuse. But…
Continue Reading Drug Addiction: It’s Different—and Riskier—for Women
Admissions for Combined Benzodiazepine and Narcotic Pain Reliever Abuse Rise Sharply
In ten short years, substance abuse treatment admissions for combined benzodiazepine and narcotic pain reliever abuse jumped a startling 569.7 percent—from 5,032 in 2000 to 33,701 in 2010—while all other admissions dropped 9.6 percent. These figures come from the Treatment Episode Data Set (TEDS) Report issued December 13 by the Substance Abuse and Mental Health…
MMT Patients Need Physical Activity; Brief Interventions Could Help
Physical activity is so important for patients in methadone maintenance treatment (MMT). They’re already at increased risk of physical and mental health disorders, including chronic pain and sleep problems. Lack of enough physical activity carries additional risks: cardiovascular disease, various psychiatric disorders, high blood pressure, diabetes, osteoporosis, obesity, and colon cancer. Given the importance of…
Continue Reading MMT Patients Need Physical Activity; Brief Interventions Could Help
AT Forum Volume 22, #3 Summer 2012 Newsletter
Methadone Dosing During Pregnancy: Does Anyone Have a Clue? John J. McCarthy, MD, Guest Author
Methadone treatment of the pregnant, opioid-addicted mother is routinely cited in research studies as causing a neonatal abstinence syndrome (NAS). But this is an oversimplification of the effects on the fetus of the mother’s drug use before, and sometimes during, methadone treatment. There are limits to what we really know about the effects of opioid…
Hearing Bad Things about Methadone Treatment? Thank “Dr. Drew”
Why is it that most opioid-dependent patients aren’t enrolled in medication-assisted treatment (MAT), despite its proven effectiveness? One reason is the link between so-called reality television and negative perceptions about methadone and buprenorphine. That’s the thinking of the authors of “Messages About Methadone and Buprenorphine in Reality Television: A Content Analysis of Celebrity Rehab with…
Continue Reading Hearing Bad Things about Methadone Treatment? Thank “Dr. Drew”
Habit OPCO Helps Educate the Criminal Justice System about Medication-Assisted Treatment
Although it’s well known that many people wind up in the criminal justice system because they are addicted to opioids, there is still work to be done in educating the system about the value of medication-assisted treatment (MAT). Jonathon Wasp, MS, director of Pennsylvania operations for Habit OPCO opioid treatment programs (OTPs), has a background…
OTP Victory in Berwyn Hoped to Discourage Other Localities From Discriminating
The city of Berwyn, Illinois will never pick a fight with an opioid treatment program (OTP) again. In July, it settled with Elizabeth Buonauro and Sal Sottile, current owners of an OTP in Evanston, Illinois that will now be allowed to open a second clinic in Berwyn, for $650,000. The saga is one of discrimination…
Continue Reading OTP Victory in Berwyn Hoped to Discourage Other Localities From Discriminating
AATOD Issues Prescription Monitoring Program Guidelines for OTPs
The American Association for the Treatment of Opioid Dependence (AATOD), issued guidance this June to opioid treatment programs (OTPs) encouraging them to “utilize prescription monitoring programs (PMPs) as an additional resource to maximize safety in patient care pursuant to applicable state guidelines.” When OTPs do access state PMP data bases, they should do so for…
Continue Reading AATOD Issues Prescription Monitoring Program Guidelines for OTPs
PMPs Need to be More ‘User-Friendly’ for Physicians, Study Finds
There are barriers to prescribers’ use of prescription monitoring programs (PMPs), according to researchers from the American College of Medical Toxicology (ACMT). In a June 21 New England Journal of Medicine Perspective article, Jeanmarie Perrone, MD, and Lewis Nelson, MD, found that PMPs, with some simple improvements, could be much more useful to physicians. The…
Continue Reading PMPs Need to be More ‘User-Friendly’ for Physicians, Study Finds
Federal Government Tests New PDMP Projects in Indiana and Ohio
A new pilot program launched by the federal Department of Health and Human Services (HHS) will make prescription drug data available to prescribers and pharmacists in both ambulatory and emergency departments in Indiana and Ohio. The pilot projects, which will be run by the Office of the National Coordinator for Health Information Technology (ONC), will…
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Study Finds Methadone Take-homes Reduce Acute Care Hospitalizations
It’s been known that among patients receiving methadone maintenance treatment (MMT) for opioid dependence, take-home privileges and methadone doses of at least 80 mg/day are associated with better treatment outcomes. But what hasn’t been known is whether patients with take-homes also have fewer acute care admissions, and consequently lower health care costs, or whether they…
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AT Forum Volume 22, #2 Spring 2012 Newsletter
AATOD Conference a Resounding Success
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…
Some OTPs Discharge, Others Taper for Illicit Benzodiazepine Use
Benzodiazepine use and abuse by patients on methadone is a pressing concern for opioid treatment programs (OTPs) because of potentially dangerous drug interactions, especially during induction, so it was a natural selection for a “hot-topic” meeting at the American Association for the Treatment of Opioid Dependence (AATOD) conference in April. Ron Jackson, MSW, LICSW, moderated…
Continue Reading Some OTPs Discharge, Others Taper for Illicit Benzodiazepine Use
Innovative Massachusetts Federally Qualified Health Center Expands OTP Services
For 3 years, Lifeline, an opioid treatment program (OTP) of Stanley Street Treatment and Resources (SSTAR) has been providing methadone treatment at its site in the South End of Fall River, Massachusetts. In 1990 SSTAR became a federally qualified health center (FQHC) providing methadone, primary care, and behavioral health care to their OTP patients. SSTAR…
Continue Reading Innovative Massachusetts Federally Qualified Health Center Expands OTP Services
CODA Credits Its Research Department for Winning SAMHSA Award
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…
Continue Reading CODA Credits Its Research Department for Winning SAMHSA Award
A Call for OTPs to Step up Rapid HIV Testing
The Substance Abuse and Mental Health Services Administration (SAMHSA) and their Addiction Technology Transfer Center (ATTC) network, along with the National Institute on Drug Abuse (NIDA), are urging substance abuse treatment programs to step up rapid testing for HIV during the time patients are in treatment programs. Patients in substance abuse treatment are at high…
Continue Reading A Call for OTPs to Step up Rapid HIV Testing
Prisoners Taking Effective Methadone Doses Report to Methadone Treatment Programs After Release
“To be effective, [opioid addiction] treatment must begin in prison and be sustained after release through participation in community treatment programs.”—Nora D. Volkow, MD, Director, National Institute on Drug Abuse (NIDA)a A simple goal, but rarely achieved. So it’s refreshing to hear of a detention system that actually views incarceration as “an opportunity for prevention…
Stop Stigma Now: Small Organization Rises to Raise Funds for Methadone Treatment PR Campaign
Stop Stigma Now, a small group of retired opioid treatment program (OTP) providers has a big—and honorable—goal: eradicating stigma against the methadone treatment field. It began about five years ago with the closure of the Mount Sinai Narcotics Rehabilitation Center in New York City, recalls Joycelyn Woods, project coordinator with the National Alliance for Medication…
AT Forum Volume 22, #1 – Winter 2012
Denying Medication-Assisted Treatment (MAT) in the Criminal Justice System—Is It Legal?
Denying access to medication-assisted treatment (MAT) for opioid addiction has been a long-standing practice throughout the criminal justice system, with devastating consequences—unnecessary incarceration, increased spread of HIV, hepatitis, and other infectious diseases; drug overdose, sometimes fatal; and recidivism rather than recovery. Many arrestees and inmates in U.S. facilities are addicted to opioids, yet a December…
SAMHSA Panel: No Mandatory ECG Testing for OTP Patients
A panel convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) has stopped short of recommending mandatory electrocardiograms (ECGs) on patients treated with methadone in opioid treatment programs (OTPs). In “QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel,” published November 3 in the Journal of Addictive Diseases, the…
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Prospective Employer $37,500 for Not Hiring Methadone Patient
The U.S. Equal Employment Opportunity Commission (EEOC) on January 23 announced that the United Insurance Company of America will pay $37,500 to Craig Burns, whom the company refused to hire because his pre-employment drug test was positive for methadone. Mr. Burns, a patient in an opioid treatment program (OTP) since 2004, was offered a job…
Continue Reading Prospective Employer $37,500 for Not Hiring Methadone Patient
Vermont to Expand Medication-Assisted Treatment for Opioid Addiction Using a Managed Care Approach
Vermont is embarking on an ambitious initiative to expand medication-assisted treatment (MAT) in response to the state’s prescription opioid addiction epidemic. The expansion represents the first phase of a larger plan for Vermont to develop an integrated treatment continuum for other substance abuse and co-occurring mental health disorders through a managed care approach. MAT caseloads…
Patient Advocacy Group Works to Improve Treatment in NY OTPs
A new group, VOCAL-NY, modeling themselves after some of the aggressive organizations that brought attention to the AIDS crisis in New York, is focusing their attention on methadone maintenance treatment in opioid treatment programs (OTPs). Last year, a group of VOCAL members went to the state capitol to get the attention of Gov. Andrew Cuomo…
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RESEARCH REPORT: Study Finds No Evidence That Methadone Was Cause of Driving Accidents
A research report from Norway published in the December 11, 2011 issue of Addiction found that men taking methadone for opioid addiction were more than twice as likely as the general population to be involved in motor vehicle accidents with personal injury. However, there was no evidence that the methadone itself caused the accidents. The…
PRACTICE POINTERS: How to Effectively Treat Veterans Using Medication-Assisted Treatment
At the end of 2011, veterans from Iraq returned home, many of whom will require treatment for their addiction to prescription opioids. Also at year’s end, the federal government issued a proposal to lift the ban on the military paying for medication-assisted treatment (MAT) with methadone and buprenorphine. In order to help opioid treatment programs…
Improving Public Health Worldwide Through Medication-Assisted Treatment
Finding ways to improve public health while controlling costs is a major concern in today’s global health care environment. Given the large number of chronic and acute health problems linked with opioid dependence, one effective approach is to provide better access to medication-assisted treatment (MAT).This is according to Thomas F. Kresina, PhD, and Robert Lubran,…
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AT Forum Volume 21, #4 – Fall 2011
CSAT: Accessing Prescription Drug Data to Maximize OTP Patient Safety
Prescription drug monitoring programs (PDMPs), electronic databases of prescriptions submitted by dispensers (pharmacies and practitioners who dispense out of their office) and run by state agencies, are useful to help coordinate care, prevent doctor-shopping, deter prescription drug abuse, and assist law enforcement authorities in preventing diversion. As of September 2011, 36 states have operational PDMPs,…
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U.S. Drug Strategy Focuses on Prescription Drug Abuse
The federal government has proposed a 19-percent increase in funding for domestic prevention, treatment, and enforcement dealing with the abuse of drugs, including prescription drug misuse. The increased availability of pain medications and the misconception they are safer than illicit drugs, even if taken improperly, have led to a dramatic rise in prescription drug abuse,…
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Florida Pill-Mill Crackdown Increases the Need for OTPs
The 2011 national drug strategy singled out South Florida as the epicenter of the Nation’s prescription drug abuse epidemic, due to a tremendous growth in “pill mills.” Between January and June of 2010, Florida practitioners purchased more than 40 million oxycodone pills, compared with only 4.5 million bought by practitioners in the rest of the…
Continue Reading Florida Pill-Mill Crackdown Increases the Need for OTPs
Why Primary Care Doctors Are Walking Away From Buprenorphine
Primary care physicians in Vermont are walking away from prescribing Suboxone, saying that they are ill-equipped to treat the many problems of the opioid-addicted, the Burlington Free Press reported this fall. One physician, John Matthews, MD, with the Health Center in Plainfield, summed it up by saying the eight-hour course required by the federal government…
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ASAM Recognizes Addiction as a Brain Disease, Supporting the Need for Medication-Assisted Treatment
On August 15 the American Society of Addiction Medicine (ASAM) published its new definition of addiction—one that contradicts some prevailing beliefs. The Society holds that addiction is not a behavioral disorder, nor is it a form of “self-medication” for easing emotional pain. Addiction is a single disease of the brain comprising a group of disorders…
New Resource – Principles of Addiction Medicine: The Essentials
A new handbook from the American Society of Addiction Medicine (ASAM), Principles of Addiction Medicine: The Essentials, provides a quick reference on virtually all addiction medicine topics. This 600-page handbook extracts and summarizes key clinical points from each chapter of Principles of Addiction Medicine, 4th Edition, and presents them in an easily readable manner. The…
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Methadone Treatment Expansion in Baltimore Reduces Waiting Lists
Baltimore, once called by the Drug Enforcement Administration the “heroin capital of the U.S.,” no longer deserves that epithet, says Yngvild Olsen, MD, MPH, medical director and vice president of clinical affairs at Baltimore Substance Abuse Systems, Inc. (BSAS). More heroin users are getting into treatment, including methadone maintenance, thanks to Maryland’s newly expanded Primary…
Continue Reading Methadone Treatment Expansion in Baltimore Reduces Waiting Lists
Methadone Clinic Wins NIMBY Battle
A victory in Warren, Maine for CRC Health Group is a victory for methadone clinics seeking sites across the country. It also means that a community that was staunchly opposed to a methadone clinic will have the chance to see how an opioid treatment program (OTP) can operate as a good neighbor. After a yearlong…
EEOC Sues Employer for Discriminating Against Methadone Patient
The federal agency charged with keeping discrimination out of the workplace has good news for methadone patients in medication-assisted treatment. In a lawsuit filed last summer by the U.S. Equal Employment Opportunity Commission (EEOC) against United Insurance, a Chicago-based company, the federal government is fighting for the rights of people in methadone treatment for opioid…
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AT Forum Volume 21, #3 – Summer 2011
We’re Going Green and Interactive!
Back in the summer of 1992, we published the premier edition of the Addiction Treatment Forum newsletter. With our next edition, Fall 2011, we’re going exclusively electronic—so this, our 70th newsletter, is the last printed version you’ll receive. And it’s one of our best. We’re excited about going green, going electronic, and keeping pace with…
Implementing EHR Systems in OTPs: Potential Roadblocks and Lessons Learned – An Interview with Lawrence S. Brown, Jr, MD, MPH
Despite government incentive programs and a 2014 deadline for establishing a fully electronic health record (EHR) system, most health care transactions continue to be carried out manually, on paper. Among impediments to EHR implementation: Financial—What will it cost? Training—How to prepare employees for advanced technology? Selecting a program—Outside vendors, an in-house system, or a combination?…
Buprenorphine Diversion May Signal Need For More MAT and Greater Oversight
As more buprenorphine is prescribed in physicians’ offices to treat opioid addiction, the potential for diversion and misuse increases. But people buying buprenorphine on the street are not generally doing so for its euphoric effects. Most are taking it because they are dependent on heroin or prescription opioids, or both, and want to prevent withdrawal…
Continue Reading Buprenorphine Diversion May Signal Need For More MAT and Greater Oversight
How Methadone Treatment is Funded in OTPs
Over the years AT Forum readers have asked how methadone maintenance (MM) treatment in opioid treatment programs (OTPs) is funded, and why some patients pay for their treatment while others receive it free. The answer depends on the patient’s income and insurance status, the state’s funding scenario, and even the program’s status (profit or not-for-profit). MM…
Advocates Help New Moms in Methadone Treatment Fight Child Protective Services
After more than 50 years of evidence showing that methadone maintenance (MM) treatment works, the courts—both civil and criminal—are making decisions only a doctor should make, telling patients to stop taking their legally prescribed methadone. These decisions are coming down particularly hard on women, who in some cases are being told by Child Protective Services…
Continue Reading Advocates Help New Moms in Methadone Treatment Fight Child Protective Services
Prescription Opioids Account for a Greater Share of Treatment Admissions
Over a ten year-period, admissions to substance abuse treatment for opioids, attributable mainly to prescription opioids, rose from 8 percent in 1999 to 33 percent in 2009, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Overall, opioids accounted for 21 percent of all treatment admissions—second after alcohol (42 percent) and followed by…
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Economic Impact of Illicit Drug Use in the U.S.
Societal costs of illicit drug use were $193 billion in 2007, according to a report out this spring from the National Drug Intelligence Center, part of the federal Department of Justice. Included were costs due to crime ($61 million), health costs ($11 billion), and productivity costs ($120 billion). Public costs of specialty treatment totaled $3.3…
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Substance Abuse Treatment Admissions for Benzodiazepine Abuse Triple
The number of patients admitted to substance abuse treatment who report benzodiazepine abuse tripled from 1998 to 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported in June. In 1998, benzodiazepines were involved—not necessarily as the primary drug of abuse—in 22,400 admissions. Ten years later, this number had grown to 60,200. Benzodiazepines were rarely the only drug used, or…
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Study: Benzodiazepine Use by OTP Patients May Indicate Untreated Anxiety
A recent study based on an anonymous survey of methadone patients in a Baltimore, Maryland opioid treatment program (OTP) found that more than half of benzodiazepine users attending group meetings had started using these drugs after entering methadone maintenance (MM) treatment. The authors caution that their study results should not be used to make clinic…
Continue Reading Study: Benzodiazepine Use by OTP Patients May Indicate Untreated Anxiety
