Methadone Treatment for Opioid Use Disorder Improving Access Through Regulatory and Legal Change: Proceedings of a Workshop (2022) / Chapter Skim
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7 Expanding Access to Methadone through Regulatory Innovation: Envisioning Approaches Outside the Opioid Treatment Program System
7 Expanding Access to Methadone through Regulatory Innovation: Envisioning Approaches Outside the Opioid Treatment Program System
Pages 73-88
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From page 73... ...
. • Provision of methadone to stable patients at physicians' offices or pharmacies has been shown to produce high rates of treat ment retention, a low percentage of positive drug tests, little diversion, and improved patient satisfaction (Schwartz)
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From page 74... ...
. • To address the needs of American Indian and Alaska Native peoples, treatment programs should embrace a non-Western world view rooted in spirituality and traditional healing and should work in partnership with tribal communities (Venner)
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From page 75... ...
The outcomes for these patients were excellent, with very high rates of treatment retention and a remarkably low percentage of positive drug tests, said Schwartz. To assess diversion, staff randomly called patients between visits and asked them to return unused methadone.
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From page 76... ...
Participants in both office-based conditions reported significantly higher rates of new employment or social and family activities than those in the standard OTP group, he said. Schwartz suggested several regulatory changes for new or unstable patients that could achieve the goals of increasing patient choice and increasing the number of people in treatment: • Select and implement the best international approach for metha done medical maintenance using offices and pharmacies based on evidence of safety, efficacy, and impact on overdose deaths.
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From page 77... ...
She added that if a large chain pharmacy decides to stop offering methadone because of its insufficient remuneration, this can have a major impact on access. Thus, she said, attention should be paid to reimbursement mechanisms and other types of financial support to encourage pharmacies to provide methadone programs.
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From page 78... ...
These types of training events, as well as improving professional networks, could, in the future, provide an opportunity to discuss issues around inequity and culturally appropriate responses to different groups of people, Sheridan added. In Australia, around 80 percent of patients receive community pharmacy dosing and about half of pharmacies provide these services, said Nielsen.
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From page 79... ...
has led to increased mortality or diversion," Nielsen said (Coroners Court of Victoria, 2021) , adding that unsupervised dosing requires targeting and flexibility.
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From page 80... ...
Direct Admission to an OTP from Detoxification Centers At medically managed withdrawal programs, more commonly called detoxification centers or detoxes, many people seek treatment to reduce both their use of opioids and their overdose risk, said Walley. Yet paradoxically, detox is often followed by low treatment, high relapse, and high overdose death.
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From page 81... ...
This exception allows a physician not specifically registered to conduct a narcotic treatment program to administer but not prescribe methadone or other narcotic drugs for the purpose of relieving acute withdrawal. Only 1 day's dose of medication at a time may be administered for no more than 3 days.4,5 This approach was used successfully at a low-barrier substance use disorder bridge clinic in Boston in March 2021, said Walley (Laks et al., 2021)
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From page 82... ...
Walley suggested five concrete actions that could facilitate better use of these venue-based methadone initiations: • Issue and promote guidance for OTP direct admission approaches that already exist under current regulations. • Incentivize partnerships between OTPs and detox centers, hospi tals, outpatient clinics, and emergency departments.
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From page 83... ...
assess whether there are changes in substance use over time for Imani plus church-based, telehealthprovided MAT compared to Imani plus traditional referral and linkage for MAT; and (3) evaluate potential mediators and moderators of improvements that affect primary substance use disorder outcomes; for example, how choice of MAT treatment location and social determinants of health affect whether people stay in recovery.
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From page 84... ...
. Health inequities among American Indian and Alaska Native peoples are largely attributable to social determinants of health, said Venner.
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From page 85... ...
If they are willing to engage in conversation, she may then have the opportunity to address misinformation about methadone treatment as well as the potential harmful outcomes when people are taken off methadone. Venner suggested that there are aspects of evidence-based treatment that require cultural adaptation for American Indian and Alaska Native communities.
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From page 86... ...
Venner suggested that to encourage engagement and overcome barriers of stigma within American Indian and Alaska Native communities, it may be helpful to frame methadone as a medicine and remember that they were some of the original pharmacists, using plants and herbs as medicine. She also advocated ensuring that providers, directors, and staff are themselves American Indian and Alaska Native or at the very least are knowledgeable and comfortable discussing culture; hiring American Indian and Alaska Native Elders as staff or cultural educators; and ensuring there is space for traditional services and cultural activities.
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From page 87... ...
. • Issuing and promoting guidance for OTP direct admission approaches that already exist under current regulations for detoxification centers, hospitals, and outpatient settings (Walley)
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From page 88... ...
. • Addressing social determinants of health (e.g., unemployment, discrimina tion, transportation, childcare, housing, and neighborhood safety)
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