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Letter from Stop Stigma Now 
President: Sy Demsky

A belated happy holidays and wishing you a great, Happy New Year.

The year 2019 has been a very successful year for Medication Assisted Treatment (MAT). Stop Stigma Now (SSN) continues to do its job in helping to educate the public by  getting the message out, that “medication assisted treatment saves lives.”

In 2018 and 2019, SSN’s many volunteer staff (Brenda Davis, Robert Lubran, Joyce Woods, Val Bonilla, Calvin Anderson, Dan McGill, Susan Ohanesian, Steve Rabinowitz and Joe Lunievicz) attended three different conferences distributing over 25,000 pieces of educational materials to 34 different states.

The International AATOD Conference in Orlando, FL attracted over 2,000 people in the field. They welcomed our materials and thanked us for attending the conference. Mark Parrino, president of AATOD as always, brought together people from all over the world. What a great job Mark does.

The high point was attending the Nation Drug Court Professionals Conference of 5,500 people in Baltimore/Washington. As you have probably been aware, the courts had not been supportive of MAT. Well, that certainly seems to have changed.                                                                                          

Since 2015 the national governing bodies of treatment courts in the United States, the National Association of Drug Court Professionals (NADCP) and the National Drug Court Institute (NDCI) have endorsed MAT as best practices for opioid treatment. And the Bureau of Justice Assistance (BJA) and SAMHSA, the largest funders of treatment courts, have mandated treatment courts funded by them to offer MAT as an option or lose their funding.                                                                                             

Although most of the attendees who talked with us have accepted MAT as a treatment option, stigma still remains a barrier from other team members, participants, and providers, especially abstinence-based program providers. Team members (e.g. judges, defense counsel, DAs, coordinators, social workers and other court professionals) were very eager to communicate with us and learn as much as they could about MAT.                                                                                                                                         
There was one other major issue: the courts as a whole were using Vivitrol as their only choice for treatment. SSN supports the use of Vivitrol, but not as the only or best choice for many patients with an opioid use disorder. This leaves people with moderate or severe opioid use disorder without any other option.

Why is this happening? For one, Vivitrol is easier to dispense administratively by the courts and methadone/buprenorphine is much more regulated. Secondly, there are not enough clinics/programs/prescribing physicians in the country to meet the needs of the thousands of people looking to enter treatment needing a viable evidence-based treatment tailored to their needs. In many states,   patients may have to go 50 to 100 miles to get to a clinic, or even travel to a different state to receive their medications.

This is a problem that WE must help find a solution by advocating for the opening up of additional clinics or by permitting dispensing by nurse practitioners in way out parts of the country by the use of telehealth models.

Stop Stigma now operates in 12 different states.  Our volunteers in each new state will become the liaison to SSN and receive materials to share with their state. The latest members are Dr. Kelsey Lamb of Michigan, Dr. Kenneth Zoucha of Nebraska, and Sue Ellen Wilkerson from Arkansas. We welcome them.
 
There is still much work to be done in order to guarantee that every person seeking treatment will be able to find treatment…easily. 

From the Editor: Robert Sage, Ph.D.

Welcome to the first newsletter of 2020.

For this edition, we have included the first in a series of reports on public policy issues that affect MAT and general addiction services, prepared by Steven Rabinowitz, SSN Board Chair of our Public Policy Committee.  Included also are articles that address recommendations to states for increasing access to Methadone Treatment, the affect of Medicaid expansion in those States under the Affordable Care Act that increased the prescribing of buprenorphine, and the role of a mobile van addiction center in Philadelphia that is battling stigma and overdoses
.
Two articles written by patients are also included in this edition, one describing the personal benefits of MAT treatment and another describing the benefits and issues related to pregnancy and childbirth, both of which can be helpful in addressing stigma issues. Further, we have included a message from AATOD that summarizes the issues and accomplishments related to MAT that have been addressed in 2019

As always, we welcome your comments and suggestions, and are always interested in receiving articles from our readers for us to review and consider for inclusion in our newsletter.
  

We're a 501(c)3 organization and in need of your support. Please consider becoming a member and receive member benefits. 
UNITED STATES GOVERNMENT
Office for National Drug Control Policy
Substance Abuse and Mental Health Services Administration
US Surgeon General
National Institute on Drug Abuse
Addiction Technology Transfer Center Network
National Institute of Health
Federal Drug Administration (FDA)
 
ORGANIZATIONS
 American Association for the Treatment of Opiate Dependence
American Society for Addiction Medicine
American Medical Association
New York Academy of Science
National Alliance for Medication Assisted Recovery
Harm Reduction Coalition
Legal Action Center (New York & Washington, DC)
National Alliance for Pregnant Women
National Assn of County Behavioral Health and Developmental
Disability Directors
Faces and Voices of Recovery
National Alliance of Advocates for Buprenorphine Treatment
The Rockefeller University of New York
Partnership for Drug Free Kids
National Association of State and Alcohol Abuse Directors
 
INTERNATIONAL ORGANIZATIONS
 World Health Organization
United Nations Office on Drugs and Crime (UNODC)
UNAIDS
International Doctors for Healthy Drug Policies (IDHDP)
Global Commission on Drug Policy
Open Society Institute
European Opiate Addiction Treatment Association
International Harm Reduction Coalition
Canadian Centre on Substance Abuse
European Association for the Treatment of Addiction
International AIDS Society
International Society of Addiction Medicine
Society for the Study of Addictions
(L-R) STOP STIGMA NOW president Sy Demsky, AATOD president Mark Parrino, and Stop Stigma Now Board Member Joe Lunievicz were on hand for the AATOD conference in Walt Disney World, Florida in October 2019. 
STOP STIGMA NOW had a booth at the AATOD conference in October 2019, giving away buttons, stickers, and sharing our mission's goals. 
(L-R) STOP STIGMA NOW Board Members Joyce Woods and Brenda Davis with Michael McKinney with Liberation Program Inc. and Stop Stigma Now President Sy Demsky. 
MAT in the News 

Opioid Treatment Is Used Vastly More in States
That Expanded Medicaid

An article by Abby Goodnough of the New York Times, citing a study, outlines how states that have expanded Medicaid are witnessing an increased use of opioid treatment prescriptions, such as buprenorphine. The article breaks down the reasons for such increased access to the "anti-craving drug." 
Read More
Massachusetts: Expanding and Ensuring Access to Care

A study by James Bell and John Strang shows strong evidence showing medication-assisted treatment to be the most effective way in stemming the rise from opioid use disorder, with recommendations by Bell and Strang to expand such programs that allow the use of methadone to break free from opioids. 

Read More
MAT Center Fights Stigma, Shame, and Rising Overdoses in South Philly
A report by the Philadelphia Inquirer profiles a group of doctors from the University of Pennsylvania offering free treatment to users from a van in one area of Philadelphia hit hard by the opioid crisis. 
Read More
A Message From AATOD President Mark Parrino
Dear Colleagues,
 
All of us at AATOD wish our planning partners and friends around the world a joyous holiday season. 2019 has been a remarkable year and a great deal has been accomplished. We need your support to
continue this critical work in 2020. Your support in the past has helped us expand access to quality Opioid Use Disorder treatment, which has been our hallmark since 1984.
 
Our country is now in the third wave of the opioid epidemic. As readers know, the epidemic began with the overprescribing of opioids to treat pain. It then morphed into a heroin misuse problem and now it is a problem of fentanyl with methamphetamines. Our work with the RADARS system has identified that many more new patients are being admitted to OTPs with fentanyl as the leading opioid being used. Treatment programs are expanding admissions to OTPs with innovative designs like the 24/7 OTP, operated by Community Medical Services in Phoenix, Arizona.
 
On the positive side, we have been engaging with a number of parties, moving AATOD's strategic agenda forward
. I am asking you to make a contribution to AATOD as a way to continue this critical work in organizing treatment providers, advocates, and all interested stakeholders. Your donation may be fully tax deductible since AATOD is a tax exempt organization under section 501(c)(3) of the IRS code.

The following highlights what has been achieved in 2019.
 
AATOD Conference
We just convened another successful AATOD Conference in Walt Disney World, with just under 1,800 participants over the course of five days. The content was rich and gave direction to our associates throughout the United States and abroad. I am grateful to Dave Kneessy, our Conference Chair, and all of the Committee Chairs and their members for organizing a great Conference on behalf of our Association.
 
Implementation of OTP Medicare Rate
CMS Medicare issued a public notice on November 1, 2019, finalizing the Medicare rate for Medicare eligible patients to participate in OTPs. CMS Medicare clearly listened to our concerns, which were submitted on September 27, 2019 along with 11 comprehensive reports from state member chapters.
 
Subsequently, the basic rate was increased significantly to $207.00 per patient per week, which will cover all of the federally approved medications in addition to the clinical support services.
 
CMS Medicare will also release a separate rate package for different regions of the country before the end of the current calendar year. The rate goes into effect on January 1, 2020. It is anticipated that thousands of new patients will enter treatment and will be able to remain in treatment without fear of losing their benefits. This represents a major breakthrough for our field and for patients, who are seeking access to care.
 
Medicaid Rate Implementation
As I mentioned in my opening speech at the Walt Disney World Conference on October 21, 2019, five states implemented new Medicaid rates for OTPs since we last convened in New York during March 2018. The states include Indiana, Illinois, West Virginia, Kentucky and South Carolina.
 
We will continue to work with CMS Medicaid to encourage the 11 remaining states to implement Medicaid coverage.
 
Criminal Justice
We have worked with our partners in the criminal justice system over the course of the last several years. This was evident during our Conference in Walt Disney World since the National Commission on Correctional Health Care and the Florida Drug Court Association chose to convene special preconference sessions during the five day event.
 
The National Commission on Correctional Health Care discussed models of care behind the walls and the drug court training also featured how drug court judges and their staff can work to better understand the use of federally approved medications to treat opioid use disorder. Both represented major breakthroughs in anticipation of our expanding this work in 2020.
 
This work will fulfill our vision of initiating the transition of inmates with opioid use disorder into a regimen of treatment with medication and clinical services and the transition through a "warm hand off" to an OTP/DATA 2000 practice. Once again, as this work expands, thousands of inmates with opioid use disorder will be treated and will continue their care in outpatient settings upon release.
 
Confidentiality Protections
Our Association has joined with the Legal Action Center, Faces and Voices of Recovery, NAMA Recovery, Treatment Communities of America and other entities in supporting the core confidentiality protections, which patients have enjoyed for 40 years.
 
We have been clear in advocating for these continued protections since there are ominous signs that various sectors of law enforcement will try to seek access to patient information if OTPs are compelled to share data with Prescription Drug Monitoring Programs. We understand that there are some authorities that would like to cross match patient's information with outstanding warrants. This is not the reason that PDMPs were established.
 
Policy Statements
AATOD has issued a number of policy statements and articles during 2019 in support of providing access to comprehensive treatment for opioid use disorder. We will continue to advocate for holistic care so that patients will get the treatment that they need once they are admitted to an OTP. We are also working with our international partners in the World Federation for the Treatment of Opioid Dependence to develop standardized quality assurance measures. We are doing this under the aegis of the United Nations Office on Drugs and Crime and the World Health Organization.
 
Maintaining Current Licensure Standards
Additionally, we are working with a number of our policy partners to continue offering quality care within the OTP setting and DATA 2000 practices. We oppose the deregulation of OTPs or DATA 2000 practices, although the requirements of operating an OTP are far more stringent and enforced when compared to DATA 2000 practices.
 
This is why we are opposing the Tonko legislation and its Senate companion bill and why we will continue to advocate for maintaining the quality of care that patients need when they are admitted to treatment.
 
Please be as generous as you can in 
making a donation to AATOD. There are different funding levels outlined, and we are grateful for whatever you can afford to give. We hope that you will consider joining AATOD's President's Club, which has been an opportunity for the past several years, by providing a donation of $1,000.00 or more. The President's Club provides access to invitation only conference events and direct access to me when administrators/OTP sponsors have specific policy related questions.
 
As indicated on our website, you can also elect to be listed as a donor to AATOD in a special section. Please give this request every consideration so that AATOD may continue its work to preserve the future for our patients and our system of care.
  
Sincerely yours,
Mark W. Parrino, M.P.A.
President
American Association for the Treatment of Opioid Dependence (AATOD)
225 Varick Street, Suite 402
New York, NY 10014
Ph: 212.566.5555, x200
Fax: 212.366.4647 

 

"Six Ways Methadone
Changed My Life "

This first-person account of a pregnant Michigan woman's decision to stay on methadone while pregnant was featured on The Fix, among the six things told by Mary Elizabeth. Hear what the end result was for her pregnancy. 
Read More

Methadone Barriers Persist Despite Decades of Evidence  

This report by Alainda McBournie, Alexandra Duncan, Elizabeth Connolly, and Josh Rising of Health Affairs breaks down the significant barriers put in place for methadone, despite evidence proving to be one of the most effective ways to treat opioid abuse. 

Read More

Greetings From
Little Rock, Arkansas 

By Sue Ellen Rail-Wilderson, Ph.D. 

We may be a small state, but are doing big things in response to the opioid crisis.

Within the University of Arkansas for Medical Sciences is the Psychiatric Research Institute.  There you will find the Center for Addiction Services and Treatment (CAST), the clinic where I have worked as the Pharmacist in Charge since 2001.  This is where Medication Assisted Treatment is provided to individuals suffering from Opioid Use Disorder.
 
Along with providing the best care for our patients when they walk through the door, we are trying to make a difference in other ways as well:
 
Visually showing the patients we want to work together to stop stigma that is attached to this disease, along with the treatment for their disease, by creating a bulletin board, featuring the National Organization, Stop Stigma Now.
 
Reaching out to rural health communities and other health professionals through a statewide program called Project Echo. This is a weekly video conference that consists of various presentations and case studies related to Opioid Use Disorder. The presentations are given by psychiatrists, addiction psychiatrists, social workers, counselors, pharmacists, and peer support specialists.
 
Through Medication Assisted Treatment Recovery Initiative for Arkansas Rural Communities -MATRIARC, our addiction psychiatrist and program director, Dr. Michael Mancino, offers free consultations to physicians, physician assistants, APRNS, and other mental health professionals that are providing medication assisted treatment.  He does this by telephone, available during work hours Monday through Friday.
 
Along with MATRIARC, Dr. Mancino provides eight hour training courses around the state of Arkansas to train other physicians to receive their MAT waiver. He speaks at local and state levels about this disease and the treatment for the disease, educating at every turn, and is a true champion in our state.
 
I appreciate the wonderful organization Stop Stigma Now, and especially grateful to Sy for always sending out more buttons and literature. As I proudly wear my Stop Stigma Now button,  I continue to increase awareness in Arkansas about opioid use disorder  and that medication assisted treatment saves lives. Recently I was interviewed on TV along with our State Drug Director  as part of Arkansas's effort to address stigma. I believe that as a health professional, it is our responsibility to do what we can to remove this barrier of stigma.
 
Sue Ellen Rail-Wilkerson, Ph.D. is with the University of Arkansas for Medical Sciences, the Psychiatric Research Institute, and the Center for Addiction Services and Treatment.

AT Forum News Updates

Addiction Treatment Forum editor Alison Knopf shares some other articles on the subject of medication-assisted treatment, which include:

Walk-in Clinics for Opioid Addiction Offer Meds First, Fast 
Opioid Addiction Treatment Center Planned to Come to Maryville
'First Shot is Free': Hundreds Incarcerated in Michigan Offered Opioid Blocker Shots 
LCBHS Brings Buprenorphine and Naltrexone To The Fight Against Opioid Addiction 
Health Department to coordinate Drug Response in 2020
The 'Opioid Workforce Act' Hopes To Increase Ranks In Fighting The Opioid Epidemic 
Help Is on the Way: Medicare Coverage of Opioid Treatment Programs 
Private Coverage of Methadone in Outpatient Treatment Programs 
In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
Opioid Use Disorder and Treatment: Challenges and Opportunities 
 

SSN Response to News Article: "Walk-in Clinics for Opioid Addiction Offer Meds First, Fast"
By Carla K. Johnson, from AP National News, Dec. 18, 2019

From News Article: "The opioid crisis now kills more Americans than car crashes and is estimated to cost more than $500 billion a year. The epidemic is driving new treatment strategies for the 2 million Americans addicted to opioids including an approach that begins with rapid access to medicine that prevents withdrawal sickness.  Early research suggests the approach can change lives. Every time she got out of jail, Jamie started hustling again for heroin, driven by an addiction she didn’t understand.  “You want to get clean so bad. You know something’s killing you and you can’t stop,” said the 33-year-old who used heroin for 10 years.  This spring was different. While in a jail work-release program, she took buprenorphine. It quieted a voice in her brain that told her to keep using.  When she got out of jail, she headed for an Olympia clinic where a doctor is working to spread a philosophy called “medication first.” The surprising approach scraps requirements for counseling, abstinence or even a commitment to recovery. Early research suggests the medication approach can change lives. But it can be a tough sell. Nearly two-thirds of U.S. treatment centers don’t offer anti-addiction medication."

Response from Stop Stigma Now: Faced with an opioid addiction epidemic killing so many people, treatment providers are looking for better ways to help.  Counseling has been of great importance, assisting many in treatment programs that include medication.  But to reach even more of those suffering opioid addiction, a medication first approach could be helpful. 

It remains something of a shock to learn a majority of treatment programs in this country continue to deny their patients the benefits of medication.  These abstinence based programs refuse to accept the best, tested medical treatment which demands the availability of medication.

Massachusetts: Expanding and Ensuring Access to Care 

MAT in Long Term Care 
Massachusetts OTP providers have been participating in a focused work group with the Association of Behavioral Healthcare, Healthcentric Advisors and skilled nursing facilities in a partnership to meet the needs of the patients in skilled nursing facilities who could benefit from or require continued medication assisted treatment. The work group has identified the various challenges in treating the OUD population  while in skilled nursing facilities ranging from MAT access, transportation, monitoring, communication, to the lack of policy and procedures needed specific to this population. Most recently, we have expanded our collaboration to include the Bureau of Health Care Safety & Quality on a pilot project to strengthen MAT in Long Term Care. The project aims to improve coordination across the continuum of care for patients with complex medical needs and co-occurring opioid use disorder, through the development of policy, protocols and best practices. 

Medication-Assisted Treatment (MAT) in the Department of Justice/House of Corrections (DOJ/HOC)
Following a Supreme Court  decision in a case brought by an incarcerated person with Opioid Use Disorder (OUD), the Commonwealth of Massachusetts in October 2018 implemented the CARE Act, which mandated correctional facilities to provide access to all forms of MAT starting September 1, 2019. After the successful treatment of this first individual, who received MAT at the Essex County House of Correction, a pilot program was established to work through issues and roadblocks to successful statewide implementation. Multiple stakeholders were involved in the process, include county and state correctional officials, federal and state regulators, and an MAT provider. Acadia Healthcare, the MAT provider, developed a plan, in partnership with the Houses of Correction and Wellpath, a national healthcare service organization, to provide two full-service opioid treatment programs (OTPs) in the Essex County and Middlesex County Houses of Correction as well as an interim plan, approved by the DEA and Massachussets DPH, to ensure treatment of inmates until the program space could be built within the houses of correction. In addition to these two full-service sites, there are multiple other pilot sites. Since September 1, 2019, nearly 100 people in both Essex County and Middlesex County Houses of Correction have received full OTP treatment services, including MAT medications (methadone and buprenorphine) and counseling. In addition, Acadia has partnered with two other facilities in the Boston and Springfield, MA areas to provide continuity of care for patients receiving MAT upon their release from incarceration. 
Read Here
Newsletter published by David Cruz. If you have any comments about our newsletter please email our editor, Robert Sage at resage@gmail.com
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