Transcript 12.13.16 - OTPCx

Brook Etherington, MA
Vice President of The Opioid Treatment
Providers of Georgia
Medication Assisted Treatment
• Medication Assisted Treatment (MAT) – 3 FDA approved
medications used to treat opioid use disorder.
– Methadone
– Buprenorphine (Suboxone, Subutex)
– Naltrexone (Vivatrol)
• Opioid Treatment Program (OTP), Narcotic Treatment
Program (NTP) – Both refer to a treatment program
certified by the Substance Abuse and Mental Health
Services Administration (SAMHSA) to provide medicationassisted treatment for patients who are opioid addicted.
OTPs/NTPs have in house pharmacies and provide dosing
on site. Both medical and counseling services are available
in this type of facility. This does not refer to office based
physicians providing MAT with buprenorphine.
Treatment
• Administration of medication – “Dosing”
– administered or dispensed only by a practitioner licensed
under the appropriate State law and registered under the
appropriate State and Federal laws to administer or
dispense opioid drugs - 42 CFR 8.12
• Counseling
– “OTPs must provide adequate substance abuse counseling
to each patient as clinically necessary. This counseling shall
be provided by a program counselor, qualified by
education, training, or experience to assess the
psychological and sociological background of patients, to
contribute to the appropriate treatment plan for the
patient and to monitor patient progress.” - 42 CFR 8.12
– There must be at least one full-time counselor for every 50
patients. - 111-8-53-.10
Treatment
• Treatment Planning
– A complete individual treatment plan for each patient must be
developed within 30 days of admission. Patients must be involved in
the development of their treatment plans. Treatment plans must
document a consistent pattern of substance abuse treatment services
and medical care appropriate to individual patient needs. – 111-853.13
• Medical Monitoring
– Qualified medical staff will monitor the effectiveness of the
medications and adjust as necessary – “Dose Adjustments”
– Regular Physical Exams - “All patients must receive a physical
examination by the medical director, the program physician, or an
appropriately licensed and qualified member of the medical staff at
least annually.” - 111-8-53.13
– Laboratory Tests and Screening - including HIV status (if the applicant
consents to be tested), CBC and chemistry profile, and pregnancy, STD,
and Mantoux TB tests. - 111-8-53.12
Regulatory Process
• SAMHSA/CSAT - Federal:
– Accreditation Mandate
– Requires the position of State Opioid Treatment Authority
(SOTA)
• Drug Enforcement Administration – Federal
– Issues DEA # which allows programs to order medication
– Inspects every 2 years without fail
• Georgia Department of Community Health
– Designates the SOTA who works in DBHDD
– NTPs regulated by Healthcare Facility Regulation Division
• Georgia Board of Pharmacy
– Regulated by Georgia Drugs and Narcotics
Cost of Treatment
• All programs in Georgia are privately owned
and operated.
• Almost exclusively private pay
• $10 - $15 per day ($300 - $450 per month) is
the typical cost for methadone treatment
• $15 - $20 per day ($450 - $600 per month) is
the typical cost for buprenorphine treatment
• $800 - $1500 per month is the range for
Vivatrol treatment. Rarely used in NTPs due
to high cost
Cost of Treatment
• 70 NTPs in Georgia
• 3 NTPs are Medicaid providers
• 2 NTPs are contracted through the state to
provide subsidized treatment
• As of 2016, The state of Georgia has allowed
NTPs to apply to become Medicaid specialty
providers.
• Insurance companies will not work directly
with NTPs. Most do not consider MAT at an
NTP as a covered service.
Benefits of Treatment
• Illicit opioid drug use decreases
• IV drug use decreases
• Consumers report participating in illegal activities
less
• Crime rates decrease in areas where NTPs open
• HIV infection rates decrease
• Overdose rates decrease
• Drug related emergency room visits decrease
• Mortality rates decrease
In Support of NTPs
“Access to medication-assisted treatment can mean [the] difference between life or death.”
“Studies have shown that treatment plus medication can help save lives by preventing
overdose deaths. Medication-assisted treatment is the recognized standard of care for
opioid use disorders. ”
- Michael Botticelli
Director, White House Office of National Drug Control Policy
“Individuals with chronic relapsing diseases should have access to MAT. It’s just the
standard of care. We cannot diminish the importance of that.”
- Elinore McCance-Katz, MD, PhD
Former Chief Medical Officer, SAMHSA