The Role of OTPs (opioid treatment programs) in Managed Care

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The Role of OTPs (opioid treatment programs) in
Managed Care

• Improved outcomes and lower costs.

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Changes in Brain Chemistry

• Drugs of abuse produce their effects by altering
  brain chemistry and structure.
• Neurotransmitters and associated receptors
  responsible for everyday functions are altered by
  the consumption of drugs.
• When the drug being abused is an opiate, these
  changes can be very long lasting.

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Hypothesis 1964

• Heroin (opiate) addiction is a disease a
  metabolic disease of the brain with resultant
  behaviors of drug hunger and drug
  self-administration, despite negative
  consequences to self and others. Heroin
• addiction is not simply a criminal behavior or
  due alone to antisocial personality or some other
  personality disorder.
• (Dole, Nyswander and Kreek, 1966, 2006)

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Vincent P. Dole, MD - Marie Nyswander, MD -
Mary Jeanne Kreek, MD
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After decades of research and clinical experience
and after hundreds of peer reviewed studies in
scholarly journals the evidence is clear that the
best clinical outcomes for the chronic long-term
opiate addict are achieved when addiction
medicines are used as part of a comprehensive
approach to treatment. This is particularly true
if the measure of success is long term abstinence
from illicit opiates.
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When a provider (or treatment modality) claims to
have a high degree of success in treating
chronic, long-term, opiate addiction how can I
decide if I should believe them?
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• What not to believe
• Anecdote
• Testimonials Rallies
• Almost anything which begins .I can tell you
  from my personal experience.
• So-called data which is self-generated and
  which has not been subject to academic and/or
  peer review, and which has not been published in
  respected scientific journals.

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• Real proof consists of
• Peer-reviewed outcome studies published in
  scholarly journals.
• Repeated outcome studies by a wide-range of
  scientists over time which point to a continued
  and repeated result. Not One and done.
• Medication Assisted Treatment for opiate
  addiction meets this standard!

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NIH Consensus Statement

• The National Institutes on Health in 1997
  concluded that Methadone combined with
  attention to medical, psychiatric, and
  socioeconomic issues, as well as drug counseling,
  has the highest probability of being effective
  in the treatment of opiate addiction.

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• Two Recent Studies in Support of Medication
  Assisted Treatment
• Assessing the Evidence Medication Assisted
  Treatment with Methadone
• Assessing the Evidence Medication Assisted
  Treatment with Buprenorphine

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To Find All Three Studies Go To www.compa-ny.o
rg Once on the website go to the News section
and find each study under the heading Research
in Support of Medication Assisted Treatment.
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Use of Methadone in the Treatment for Opioid
(Heroin) Addiction

• Number of patients currently in treatment
• 212,000 (USA)
• gt500,000 (worldwide)
• Methadone is a medication used in the
  detoxification maintenance treatment of opioid
  addiction in conjunction with the appropriate
  social and medical services
• Efficacy in good treatment programs using
  adequate doses (80 to 150mg/d)
• Voluntary retention in treatment (1 year)
  50 80
• Continuing use of illicit heroin 5 20

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• OTP Oversight Regulation
• SAMHSA
• DEA
• OASAS
• NYS DOH
• LGUs

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What Services Can You Expect an OTP to
Provide?
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• Assessment Intake
• Determine if patient is appropriate for OTP
  treatment (possible referral)
• Intake Physical
• Individual Treatment Plan (based on patient
  goals, not cookie-cutter

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• Medication
• Methadone
• Suboxone (a.k.a. Buprenorphine)
• Vivitrol
• Also An important distinction between
  dispensing and prescribing.
• Provided by all OTPs
• Provided by some OTPs

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• Counseling
• Individual (brief longer)
• Group
• As called for by individual treatment plan

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• Harm Reduction Interventions
• HIV
• HEP C
• STDs

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• Services Provided by Some OTPs
• Primary Care
• Alternative to Inpatient Detox
• Directly Observed Therapy
• Social Service Criminal Justice Supports

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• Typical Benefits of OTP Treatment
• Retention in treatment
• Reduction or elimination of illicit opiate use
• Reduction or elimination of problematic secondary
  substance use
• Reduction in rates of contracting both HIV and
  Hepatitis C
• Reduction in rates of transmitting HIV, STDs, and
  Hepatitis C to others
• Reduction in the rates of criminal behavior
• Reduction in the rate of incarceration and
  re-incarceration
• Reduction in overdose deaths
• Reduction in both number and duration of hospital
  inpatient stays

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• Benefits of OTP Treatment (continued)
• Improvement in overall health (especially in
  pregnant women)
• Improved engagement in primary care
• Improvement in housing
• Improvement in employment / productive engagement

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• Even More Benefits
• Lowest cost per successful outcome
• Can most often be done in an outpatient setting
• Least disruptive to normal patient life family
  work responsibilities

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With the amazing success rate of medication
assisted treatment why isnt it being used more
widely?
Why does there continue to be resistance to this
treatment?
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Facing the Facts about Medication- Supported
Recovery

• Overcome Data Resistance (hiding from
  evidence).
• Urgent need for good science to triumph over
  SPAM Stigma, Prejudice, And
  MythUnderstandings.

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Myth

• Methadone was invented by the Nazis as a form of
  chemical handcuffs. As proof people say an
  early name for the drug Dolophine was a tribute
  to Adolf Hitler.

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Fact

• Methadone was invented in 1937 by the German
  pharmaceutical company IG Farben prior to World
  War II as a pain killer.
• Beyond initial laboratory testing it was never
  used in Nazi Germany.
• At the end of the war Eli Lilly obtained all the
  IG Farben facilities and patents and named the
  drug Dolophine as a combination of the Latin word
  dolor (pain) and the French word fin (end).

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Myth

• Patients on Methadone are getting high from the
  drug and its just substituting one drug for
  another.

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Fact

• When a patient is properly stabilized on
  Methadone there is no high.
• The drug is slow acting and it takes more than24
  hours for the drug to be fully metabolized.
• Virtually all drugs which produce a high are
  fast acting and achieve high levels in the blood
  stream quickly.
• Methadone is not just replacing one drug for
  another since Methadone treats an imbalance which
  has been created in the brain from the extended
  use of short acting drugs like heroin.

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Myth

• Methadone patients are sedated, behave like
  zombies and are said to be on the nod. Thus
  they are incapable of productive engagement like
  work or school, and they should not be allowed to
  drive a car.

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Fact

• Once a patient is stabilized on Methadone there
  is no sedation or cognitive imparement.
• There is no reason a Methadone patient should not
  be allowed to drive a car.

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Myth

• Methadone is harder to kick that heroin.

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Fact

• Once the brain has been altered by long term
  opiate addiction it is very difficult for many
  patients to achieve a drug free state without
  the use of addiction medicines.
• Transitioning from Methadone to a drug free
  state is no more problematic than transitioning
  from illicit opiate addiction to a drug free
  state.

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Myth

• Methadone rots your bones, and produces a number
  of other negative Physical health consequences.

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Fact

• Just the opposite is true. The drug itself does
  no harm when taken correctly.
• The patient in Methadone treatment pays more
  attention to their physical health and well being
  since they are no longer preoccupied by drug
  seeking behavior.
• The result is a dramatic improvement in overall
  health.

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Myth

• Methadone is unsafe. This is proven by the fact
  that there has been a dramatic increase in
  Methadone related deaths and Methadone overdoses.

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Fact

• Methadone (like all opiates) can suppress
  respiration. Until an opiate tolerance is
  established a sufficient dose of Methadone can
  cause serious illness and death.
• A GAO (General Accounting Office) report on
  Methadone deaths had two major finding
• Because of a lack of standardization in how
  deaths are reported, a death may be called
  Methadone related if there was any Methadone in
  the post-mortem toxicology report. This does not
  prove Methadone was the cause of death.

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Fact (Continued)

• The vast majority of true Methadone overdose
  deaths involved patients who were prescribed
  Methadone for home use for pain management.
• Patients were not properly informed of the
  dangers of the medication, or failed to use the
  drug as prescribed or to store it safely.
• In very few cases was death linked to the use of
  Methadone for the purposes of opiate addiction
  management.

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Myth

• Methadone is a crutch for people too weak to go
  drug free.

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Fact

• The physical changes in brain chemistry have
  nothing to do with strength of will.
• Once addiction has occurred and the brain
  chemistry and physiology has been altered the
  brain will constantly seek an opiate drug to
  address this craving.
• Addiction medication (Methadone, Buprenorphine,
  Vivitrol) resolves this physical craving and
  dramatically reduces the likelihood of relapse to
  illicit opiate use.

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Using Addiction Medicines is Against our
Philosophy
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Etymology of Philosophy
Philo - loving
Sophia - wisdom
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How is it possible to love wisdom and reject
science?
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Where can I find an OASAS licensed OTP near me?
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• Go to the OASAS Website
• www.oasas.ny.gov/providerdirectory
• Click on Treatment Providers, then
• Under Provider Type scroll down to Methadone
  Treatment
• Of course it should say Opioid Treatment
  Programs!

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For more information about Opioid Treatment
Opioid Treatment Programs, contact Allegra
Schorr President COMPA (Committee of Methadone
Program Administrators of New York State
Inc.) 911 Central Avenue, 322 Albany, NY
12206 allschorr_at_westmidtownmedical.com
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