eSolutions: Medication Assisted Treatment: An Adjunct to Addictions Treatment
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
In This Issue:
Feature Article: Medication as an Adjunct Treatment for Addictions
Quick Tips: Prime the Pump for MAT
Grantee Spotlight: Tarzana Treatment Center: Early Adopters Demonstrate MAT’s Potential
By Mady Chalk, PhD, MSW, senior advisor, and Aaron Williams, MA, director of training and technical assistance for substance abuse, CIHS
Medication assisted treatment (MAT) is the use of pharmacological medications, in combination with counseling and behavioral therapies, to provide a ‘whole patient' approach to the treatment of substance use disorders.
— Substance Abuse and Mental Health Services Administration (SAMHSA)
More than 2.7 million American adults receive treatment for substance use disorders, many of whom live with co-occurring mental illnesses. Alcohol and drug addiction cost American society $193 billion annually, according to a 2011 White House Office of Drug Control Policy report. In response to this, significant scientific and clinical advances over the past decade have produced medications to treat substance use disorders.
The U.S. Food and Drug Administration has approved six medications indicated to treat substance use disorders. Oral naltrexone, disulfuram (Antabuse), and methadone have also long been available for use to treat alcohol and opioid addictions. Over the past decade, FDA approved three additional medications: buprenorphine to treat opioid addictions in 2002, acamprosate to treat alcohol addiction in 2004, and extended-release naltrexone (Vivitrol) to treat alcohol addictions in 2006 and opioid addictions in 2010. Two of the newer medications — buprenorphine and Vivitrol — are referred to as “office-based” medications because they can be prescribed and administered in a physician’s office rather than in a specialty treatment or opiate treatment program. While the pipeline contains promising pharmacological therapies, no medications are currently available to treat methamphetamine or cocaine addictions.
As effective as treatments for other chronic conditions such as diabetes, asthma, and hypertension, substance use treatments that include medication give well-trained providers new tools to fight addiction by expanding the range of treatment options for patients with opioid and alcohol addictions. For patients, these medications help reduce drinking and drug use, avoid relapse, achieve and maintain control over behaviors that can lead to relapse, and maintain adherence to other treatment components that lead to sustained recovery (e.g., counseling, lifestyle changes).
Despite their proven effectiveness as a treatment adjunct, national data shows discouragingly low MAT usage rates in community treatment settings. Many reasons contribute to low rates of adoption, including:
- Lack of staff understanding of the medications;
- Organizational philosophy/staff beliefs about use of medications;
- Cost of medications; and
- Lack of appropriate staffing.
While efforts continue to overcome these challenges, many community behavioral health providers are adding medications to their treatment regimens with great success. With imminent changes to the healthcare landscape, including the emergence of health homes, numerous opportunities exist for providers to consider integrating medications into addiction treatment. Offering a full range of effective treatments options, including medications, to patients maximizes consumer choice and encourages improved outcomes, as no single approach is universally successful or appealing to all patients. Given that addictions result from a combination of neurobiological, psychological, and social problems, medication use does not conflict with other support strategies that focus on abstinence and addictions’ behavioral and social components. Indeed, these treatment approaches share the same goals while addressing difference aspects of substance use dependence.
As you consider incorporating medications into treatment regimes, CIHS and SAMHSA have a number of useful resources, including:
CIHS MAT webpage
SAMHSA’s TIP 43: MAT for Opioid Addiction in Opioid Treatment Programs
SAMHSA’s TIP 49: Incorporating Alcohol Pharmacotherapies into Medical Practice
MAT for Opioid Addiction: Facts for Families and Friends
SAMHSA Division of Pharmacologic Therapies: Pharmacotherapy for Substance Use Disorders
SAMHSA Advisory: An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People with Opioid Dependence
SAMHSA Division of Pharmacological Therapies
Contact CIHS for technical assistance in implementing MAT.
Before your organization implements medication assisted treatment (MAT) or coordinates such care for patients, you will want to prime the wheel for success. Here are a few ‘quick tips’ based on information in NIATx’s excellent Getting Started with Medication Assisted Treatment:
- Educate your board, staff, and other stakeholders on MAT’s benefits. Many of the best clinicians received training in abstinence-based treatment. Some reticence may relate to a lack of understanding of the benefits of using medication as an adjunct to other treatments. Share resources, information, and success with your stakeholders to get their buy-in.
- Engage your community. Some members of your medical and health community may feel reluctant to or even oppose the use of medication to help treat substance use disorders. Communicate MAT’s merits through editorial and press coverage in local media outlets. Share clinical features, data, and — perhaps most importantly — stories of individuals who benefited from incorporating medications into their battle against addiction.
- Learn how to pay for MAT services. Acquaint yourself with third-party insurance formularies and Medicaid pre-authorization protocols, determine what budget adjustments might be necessary under your grant, look into patient assistance programs, and explore other possible payment methods. Once you know how to pay for these therapies, implementation is steps away.
- Find prescribers. If your organization employs medical staff, you may already have prescribing and dosing capacity. Either way, it is viable to seek additional sources in your community. Contact your community health center, your patients’ primary care physicians, pharmaceutical manufacturers, and/or your local American Medical Association, American Association of Pediatrics, or American Osteopathic Academy of Addictions Medicine chapter for help locating qualified physicians. You can also check out the American Society of Addiction Medicine’s membership directory and SAMHSA’s Bupernorphine Physician and Treatment Program Locator to locate physicians and treatment programs in your area.
- Acquaint yourself with state regulatory requirements for MAT services and licensing standards. Learn your state’s regulations and accreditation requirements for patient care, operations, and professional certifications and competencies to help ensure you fully comply with requirements. Find other provider organizations that provide MAT services in your area — they can help you learn how to comply.
- Learn how to sustain MAT services. Substance use disorders are chronic illnesses that can require long-term treatment and support. Learn the proper dosing and duration of specific medications and keep up with new research through NIDA’s Clinical Trial Network. Also, develop relationships with 12-step and other recovery support programs in your area.
For more information, check out SAMHSA’s Treatment Improvement Protocols (TIPs) on MAT and the CIHS MAT webpage for a variety or resources. You can also contact CIHS for technical assistance.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration (PBHCI) grantees. Each issue of eSolutions profiles a grantee’s work.
Tarzana Treatment Center: Early Adopters Demonstrate MAT’s Potential
A.C. is a 54-year-old Hispanic male with multiple chronic conditions, including bipolar disorder, major depression, hypertension, diabetes, obesity, and a 30-year history of opioid abuse. He also has a long history of incarceration.
A.C. is also success story.
He is now medically and psychiatrically stable. Following the incorporation of Medication-assisted Treatment (MAT) into his treatment plan, A.C. has significantly decreased his urges to use. He has defied the odds, living well past the life expectancy of people living with co-occurring mental illness, addiction, and chronic health conditions.
A.C. represents but one example of the many successes reported by Tarzana Treatment Center, an integrated behavioral health provider organization offering a full continuum of inpatient, residential, day, and outpatient care, as well as sober housing, throughout Los Angeles County. Tarzana measurably impacts the lives of so many with their innovative use of MAT, recognizing the benefits of combining MAT with other services for achieving significantly better treatment outcomes for their consumers.
This forward-thinking organization was an early adopter of MAT for alcohol and opioid addictions, and has a long history of using medication to ease the discomfort associated with alcohol and drug withdrawal, including:
- Methadone to ease withdrawal in inpatient detoxification.
- Buprenorphine for opiate detoxification, following FDA approval in 2003.
- Vivitrol to reduce cravings in patients with alcohol dependence, beginning in 2008.
Tarzana recognizes the importance of ongoing focus on public education, advocacy, and policy change for MAT to ensure that they continue to encourage success stories like A.C.’s. A few of Tarzana’s many successful efforts have included:
- Providing leadership in California to address policy change and education around MAT, including educating on the need for increased accessibility;
- Working with the Department of Healthcare Services to ensure reimbursement of MAT by Medi-Cal, Medicare, and private insurers;
- Partnering with a SAMHSA-funded drug court to pilot MAT; and
- Participating in a University of California Los Angeles MAT research study addressing client outcomes on Vivitrol.
SAMHSA Issues Updated Working Definition of “Recovery”
SAMHSA issued an updated working definition of recovery from mental illnesses and addictions that incorporates comments received on its initial working definition released in December 2011. The working definition is the product of a yearlong effort by SAMHSA and partners from the behavioral health and other fields to develop a definition that captures the common experiences of those recovering from mental illness or addiction. Major guiding principles support the recovery definition.
AHRQ Creates Facebook Page to Help Latinos “Take the Reins” of Their Healthcare
A new AHRQ Facebook page connects Spanish-speaking visitors to health information videos and publications that explore treatment options for conditions ranging from cancer to diabetes to depression. AHRQ intends the page to be a cornerstone of their efforts to highlight the Effective Health Care Program’s growing array of Spanish-language publications and was launched as part of the Toma las riendas ("Take the Reins") campaign.
AHRQ Releases Early Evidence on the Patient-Centered Medical Home
AHRQ released a report on the early evidence for patient-centered medical homes in February 2012. The report looks at more than 480 practices, and summarizes the findings on pages 9-10.
Hogg Foundation to Fund Providers’ Integrated Efforts in Texas
Non-profit primary and behavioral health providers in Texas can submit proposals for integrated health care planning and implementation activities under a Hogg Foundation program to support providers’ efforts to integrate behavioral and physical healthcare services. The foundation hopes to make integrated healthcare Texas’ standard practice. View proposal details, including eligibility, deadlines and submission information.
HHS Unveils Collection of Personal Videos and Stories of Americans Helped by the ACA
MyCare is a new educational initiative from the U.S. Department of Health and Human Services to help inform Americans about new programs, benefits, and rights under the Affordable Care and Act. Individuals are encouraged to share their own stories by using the Twitter hash tag #MyCare or by visiting www.facebook.com/HealthCareGov. MyCare commemorates the two-year anniversary of the healthcare law. View the videos or learn more about MyCare.
NIMH to Fund Innovative Approaches to Mental Healthcare
The National Institute of Mental Health has announced the availability of $3 million to provide 6-8 grants to organizations that take an innovative and impactful approach to improving access and quality of mental healthcare. Applications are encouraged from organizations that can demonstrate a plan for using actionable information to improve health outcomes. Letters of intent are due May 22, 2012.
Electronic Health Records Incentive Program
Comments Solicited on Notices of Proposed Rulemaking for Stage 2
On March 7, the Centers for Medicare & Medicaid Services (CMS) released a Notice of Proposed Rulemaking (NPRM) for Stage 2 of the Electronic Health Record (EHR) Incentive Program. In addition, the Office of the National Coordinator for Health Information Technology (ONC) simultaneously released an NPRM that specifies the ‘Standards, Implementation Specifications and Certification Criteria for EHR Technology’ for 2014. CMS and ONC will accept comments on these NPRMs until May 7, 2012.
HRSA Webinar on CMS’ Meaningful Use Stage II Proposed Rule
The Health Resources and Services Administration’s Office of Health Information Technology and Quality will host an exclusive webinar featuring lead CMS staff who will provide an overview of the Meaningful Use Stage II Proposed Rule. Staff will also be available to address specific questions from safety net providers. HRSA encourages all safety net providers to participate in this call to learn more about this proposed rule. Submit questions to firstname.lastname@example.org. (All HRSA HIT and Quality Webinars can be found at www.hrsa.gov/healthit).
Visit the CIHS website regularly for upcoming webinars.
April webinar topics will include primary care partners’ role in treating consumers with serious mental illness. Registration for this and other webinars will be available soon at www.integration.samhsa.gov.
Also, check out CIHS’ webinar recordings and presentations, including:
Webinar: Chronic Pain: An Approach for Community Health Centers
Recorded: Tuesday March 6, 2012
Webinar: Motivational Interviewing for Better Health Outcomes
Recorded: February 23, 2012
Webinar: Addressing Obesity and Chronic Illness among People with Mental Illnesses: What Works?
Recorded: February 13, 2012
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Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.integration.samhsa.gov , e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; eSolutions Editor: Heather Cobb
The SAMHSA-HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.