New flexible regulations, and threat from MOTAA – Addiction Treatment Forum

The theme of the 2024 American Association for the Treatment of Opioid Dependence, Inc. (AATOD) Conference, held May 18-May 22 in Las Vegas, was “Treating Opioid Use Disorder: So Much More Than Medication.” This is apt, considering the theoretical threat posed to opioid treatment programs (OTPs) by the MOTAA proposed legislation, which would allow private physicians to prescribe methadone for opioid use disorder (OUD) and for patients to pick up their methadone at pharmacies.

We call this a “theoretical” threat because it’s unlikely many patients would be served this way, just as when buprenorphine was expanded to allow more prescribers to prescribe to more people, there was no increase. But it is a threat to patient safety and the quality of treatment, if prescribing alone is viewed as treatment, something AATOD president Mark Parrino has said frequently. Indeed, MOTAA came up at many sessions.

The intent of the conference was “to educate and promote acceptance and integration of MAT [medication assisted treatment] options by patients, families, clinicians, the medical system, judicial systems, government, policymakers, social service administrations, and the general public,” according to AATOD. Conference objectives were to:

• Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions.
• Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities.
• Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices.
• Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them.
• Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.

“Many people commented that it was one of our best,” Mr. Parrino told AT Forum. “There were over 1,700 attendees from over 45 states and 15 countries.” All of the workshops sessions were packed (there was only overflow room for many) and the plenary sessions were content rich. On one day there was an all-day meeting between officials from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the State Opioid Treatment Authorities (SOTAs), which was, we hear, productive (it was not open to anyone but the SOTAs and SAMHSA officials).

Even more important than MOTAA, which has been languishing in Congress for a few years, was the reality of the new liberalized methadone guidelines issued by SAMHSA this year (see https://atforum.com/2024/02/new-methadone-rules-allow-telehealth-induction-eliminate-one-year-history-requirement-make-treatment-friendlier-to-patients-and-otps/)

Compliance is required by October 2024 for these guidelines. The problems are that some states, and even some programs, are not ready or willing or either to go along with the more flexible take-home schedules which are now mandatory. Yngvild Olsen, M.D., director of SAMHSA’s Center for Substance Abuse Treatment, which implements the methadone rules, explained to attendees that changes will be happening, and soon.

“Dr. Olsen was very clear that it’s a culture change, and that means that a lot of layers need to fall into place,” Mr. Parrino said in an interview last week. “The primary issues rest with the state in terms of their own regulations, in terms of third party reimbursement which has been lagging, and provider issues.”

OTPs have long been living under federal regulations, but the COVID flexibility in take-homes created a shift. Still, nothing happens overnight. “I suspect there will still be programs that will continue to be conservative in terms of take-home medication,” he said.

And he added that there are no rules indemnifying OTPs from liability if something goes wrong with the liberalized take-homes.

It’s also important to remember that counseling services must still be available, so OTPs have to make sure they have the staff, with the appropriate training, available so that the services can be provided. “The new issue is that you cannot make the patient getting their medication contingent upon receiving those services,” he said.

In other words, if patients want the medication only, and refuse counseling, you still have to give them the medication.

Awards

Congratulations to the award winners at AATOD:

The Nyswander/Dole award. Named for Vincent Dole and Marie Nyswander, who were the first recipients of the award in 1983, the honor has been bestowed on individuals who are nominated and selected by their peers for extraordinary service in the opioid treatment community.

Maurice Dematteis, MD, PhD (France)

Kenny House, LCAS, CCS (North Carolina)

Linda Hurley, MA, CAGS (Rhode Island)

G. Davy Kneessy, MS, MAC, MCAP (Florida)

Christine Martin, LMFT, LAC-S, CS (South Carolina)

Allegra Schorr, MS (New York)

Maiysha Ware, BSA, MBA (New Jersey)

The prestigious Friend of the Field Award, established by AATOD’s board of directors, recognizes extraordinary contributions to the field of opioid treatment by an individual whose work, although not directly related to opioid treatment, has had a significant impact on our field.

Kathryn Cates-Wessel of Rhode Island.

The 2024 Richard Lane/Robert Holden patient advocacy award went to Anita Kennedy, outreach coordinator at the Mt. Sinai opioid treatment program (OTP) in New York City. Richard Lane was a long-term heroin user who, upon release from prison in 1967, was instrumental in establishing one of the nation’s first methadone treatment programs. In 1974, he became the executive director of Man Alive and later served as vice president of the American Methadone Treatment Association and as vice chairman of the Governor’s Council on Alcohol and Drug Abuse in Maryland. Lane was a passionate advocate for methadone treatment and, by disclosing his own treatment experiences, provided inspiration to patients and colleagues alike. Robert Holden was also a recovering heroin user, who later became the director of Partners in Drug Abuse Rehabilitation and Counseling (PIDARC), an outpatient methadone treatment program in the District of Columbia. He later served as the vice president of AATOD, succeeding Richard Lane’s term of office. This award was established in 1995 and recognizes extraordinary achievements in patient advocacy. In her acceptance speech, in true patient-advocacy fashion, Kennedy chastised the OTP provider establishment for not being more flexible than it is.

AATOD is the best conference in the United States – in fact, the only one – for OTPs. See you in Philadelphia in October 2026 for the next meeting.