Promoting Medication Assisted Treatment in Residential Treatment Facilities
According to the 2017 National Survey on Drug Use and Health, 19.7 million people in the United States have a substance use disorder (SUD) – including 2.1 million people with an opioid use disorder (OUD, i.e. addiction to heroin, illicit fentanyl, or prescription pain medications) and 14.5 million people with an alcohol use disorder (AUD). Medication assisted treatment (MAT) is an evidence-based treatment strategy that uses United States Food and Drug Administration (FDA)-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of SUDs. The use of MAT has been shown to significantly reduce the rate of relapse, compared to abstinence-based treatment. For OUD, MAT has also been shown to reduce overdose rates, as well as rates of HIV and hepatitis C transmission.Residential treatment programs play a key role in helping individuals with AUD and OUD achieve recovery. Individuals enter these programs in order to focus on their recovery in a safe, therapeutic, and supportive setting. However, some residential treatment programs have in the past denied admission to individuals who are receiving MAT. In 2018, the California Legislature passed SB 992, which, among other things, prohibits residential treatment facilities from denying admission to their program because the individual has a prescription for MAT.
MAT Toolkit for Residential Facilities
Harbage Consulting, with support from the California Health Care Foundation (CHCF), collaborated with the California Department of Health Care Services (DHCS) to develop a three-part toolkit for residential facilities to inform them about the evidence behind MAT, how it can help their patients, and how to get started with prescribing or allowing access to these medications within their facilities. Throughout the toolkit development process, Harbage Consulting solicited input from DHCS staff, residential facility directors, physician experts, and CHCF to ensure that the toolkit would be informative to providers in residential treatment facilities. The toolkit consists of three parts and an Appendix:
Part 1: Basic Overview of MAT – defines MAT, describes the most common FDA-approved medications used in MAT, discusses the benefits for the client, informs providers where clients may be referred to access MAT if it is not offered at their facility, and debunks common misconceptions about MAT.
Part 2: MAT in Residential Treatment Facilities – describes the benefits of offering MAT at residential treatment facilities, how residential treatment facilities can become approved for incidental medical services (IMS) to provide MAT onsite, and how residential facilities can provide access to MAT without becoming approved for IMS.
Part 3: Obtaining a Drug Addiction Treatment Act (DATA) 2000 Waiver – describes the benefits of obtaining a DATA 2000 Waiver to allow practitioners to prescribe buprenorphine in a residential treatment facility, primary care office, or other health care setting. Buprenorphine is an FDA-approved medication that is used to treat OUD, and can be administered by a dissolving tablet or film, monthly injection, or 6-month implant placed under the skin. This section outlines the steps physicians, nurse practitioners, and physician assistants need to take in order to obtain a DATA 2000 Waiver.
Appendix: Sample IMS Submission Documents – provides examples of IMS submission documents in Word document format for facilities that would like to become approved to offer MAT onsite.
The toolkit is available on the DHCS website and physical copies are being distributed to all licensed residential treatment facilities.
More to Come
As part of California’s State Opioid Response (SOR) Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), Harbage Consulting is working with DHCS to develop additional toolkits to inform various stakeholder groups about OUDs and the benefits of MAT, including toolkits for counselors, driving under the influence programs, criminal justice involved groups, and narcotic treatment programs.Harbage Consulting has also assisted DHCS on other initiatives to address the opioid epidemic including the design and implementation of the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver program. DMC-ODS aims to build an improved system of care for SUD treatment and recovery that offers a comprehensive continuum of SUD treatment and recovery services through a managed care system. In addition, Harbage worked with DHCS to design and implement the state’s $90 million STR grant, which included the development of a Hub and Spoke System. This system works to expand access to MAT in rural and underserved areas of the state as well as areas with the highest rates of opioid overdoses.