AATOD Update: What You Need To Know

I hope this newsletter finds everyone enjoying the new year. My dad used to tell me that the years go faster as you get older; if the speed at which this year flew by is any indicator, he was right! There has been so much that has happened this year in our state and industry, and I foresee 2016 having plenty of activity as well.

As many of you remember, the December AATOD meeting is a two day affair when the Board meets with Federal government officials. First up was Michael Botticelli, and we are fortunate to have this man as the Director of the Office of National Drug Control Policy. He has an understanding of our treatment modality that is unprecedented of a person in his position, and his own personal recovery is a benefit to his understanding of addiction, treatment, and the stigma our patients experience. ONDCP continues to work to expand medication assisted treatment (MAT) into all areas they have influence over including criminal justice, federal health plans, and inclusion in the 2017 budget. Mr. Botticelli encouraged us to get our patients and patients’ families involved in educating local, state, and federal government. He brought this message last year as well, but reminded us this year that there is still a lot of education needed for congressional staffers and representatives. With the opioid dependence crisis at such a visible level throughout the nation, it is up to all of us (patients, families, professionals) to provide this education and remind our representatives and senators that opioid dependence does not discriminate on class, color, age, or anything else and our patients are people who need to be represented in the best way possible. He also shared some 2014 mortality data that was not surprising, but still disturbing. Prescription drug overdose deaths rose 16% to over 18,000 and heroin deaths rose 23% to over 10,000 deaths. Hopefully the work people are doing to distribute naloxone overdose kits will help those numbers begin to decrease from here forward. Mr. Botticelli is also going to be doing a multi-state tour in 2016 to connect with different populations in various areas of the country to assess where we are and where we need to go. I don’t have the list of states yet, but I’ll update you if he’s coming anywhere in the Southeast so you can make plans to go if you can!

Also visiting us during our meeting was Dr. Richard Frank, the Assistant Secretary of Planning and Evaluation at Health and Human Services. Dr. Frank relayed information about HHS efforts to combat the opioid dependence crisis: increasing provider education and providing trainings to members of various medical professional organizations, encouraging the development of abuse deterrent medications, expanding the use and sophistication of existing PDMPs and encouraging states without a PDMP system to develop and implement, promoting the development of user friendly naloxone and expanding its use, and revising the DATA 2000 regulations. Since Dr. Frank is in the planning and evaluation department at HHS, he is obviously interested in data and impacts, and he relayed that one area the Department is looking at is data from insurers to evaluate if patients prescribed buprenorphine are also getting counseling and drug screens. There was an alarming recent article published in the Journal of Addiction Medicine that discussed data from Pennsylvania Medicaid patients, this article was sent to member clinic representatives. Since this is the first comprehensive look at data of this nature, it will be interesting to see what type of information HHS receives, analyzes, and reports on.

With Dr. Frank and Kana Enomoto, the Acting Director of SAMHSA, we discussed the proposed new DATA 2000 regulations. Neither was able to share the contents, but we learned that while no changes can be made to the existing requirements (without Statutory change) for doctors with 30 and 100 patients in OBOT practices, any new limits can come with additional requirements and expectations. We also learned the regulations should be published for public comment in the early part of 2016. I will continue to keep everyone updated on when they are published so you can make comments during the open comment period established.

On day two we met with folks from CSAT. We received information on the new SAMHSA Suicide Safe App. If you haven’t downloaded this yet, you should; it may be very valuable in your practice. Tom Hill, the Acting Director of CSAT, Dr. Melinda Campopiano, and Wilma Townsend provided a broad overview of their major initiatives of 2016. So far, there have been five exemptions in two different states allowing mid-level practioners to evaluate and admit patients to treatment. Since Georgia does not allow mid-level prescribing of schedule two drugs, these exemptions are not relevant to our states, but others throughout the nation are able to benefit from this practice. There is a strong push within HHS and SAMHSA to get MAT seeded throughout all the programs under their umbrellas and all funding now has some variation of requiring programs to allow participation in MAT and cannot exclude MAT. MAT has also been added to SBIRT medical profession core curriculum, and the criteria are included in certified community behavioral health clinics. We will soon have a pocket guide for MAT produced by SAMHSA, and an advisory on sublingual and transmucosal buprenorphine for opioid use disorder that discussed new prescribing recommendations and the use of maximum doses. There will also be a document published that discusses collaborative approaches to the treatment of pregnant women with opioid use disorder. All of these informational publications are not only a benefit to the professionals in our industry; it gives you valuable information to share with doctors and others during your community education efforts. SAMHSA will also soon have a patient oriented MAT decision support tool that will help patients decide if and what type of MAT may be appropriate for them.

We also learned that SAMHSA strongly prefers all providers to submit their patient exemptions online from this point onward. If you submit the form via fax, it may take significantly longer to get a response, so make sure you have the ability to submit these online. If you missed the AATODdeveloped extranet trainings, the archived version is available on AATOD’s website and the electronic manual will soon be on SAMHSA’s website.

In looking forward to the 2016 AATOD conference, SAMHSA shared some of the potential topics for pre-conference sessions and they look excellent. Some of them are: smoking cessation, treatment and recovery in the criminal justice system, update on medical and recreational marijuana and opioid treatment, pregnant and parenting opioid dependent women, peer recovery, and the suicide safe app. I think the conference in Baltimore October 29 – November 2, 2016 is already shaping up to be great! Don’t forget to register and get your room. Early bird registration ends January 31, 2016 and the room rate is only $199/night. If you want to be a presenter or know someone you think has valuable information to share at this conference, the presentation submission deadline is January 22, 2016. There will also be some new non-education, but certainly personally beneficial things added at this conference. I am beginning the process of trying to organize at least one day of different level walking and running groups to do some touring of the downtown Baltimore area, and hopefully we will have at least one free yoga class offered at some point during the conference.

By Stacey Pearce | GPA Treatment of Macon, Inc