NJ governor approves medical cannabis for OUD

Last week, Gov. Phil Murphy announced that New Jersey would remove prior authorization for Medicaid for medication‐assisted treatment (MAT) and would approve opioid use disorder as an eligible indication for medical marijuana. The moves, among several announced Jan. 23 in the state's efforts to combat the opioid epidemic, would increase access to treatment. Last year, more than 3,000 individuals in the state died from overdoses. “The opioid epidemic continues to devastate families and communities across our state,” said Gov. Murphy. “As we combat this crisis, it is critical that we use data‐driven, evidence‐based strategies to support individuals suffering from addiction and help them get on the path to recovery.”     

States call on HHS to immediately change year‐1 bupe cap

A coalition of 22 states and territories is requesting that the federal Department of Health and Human Services (HHS) lift restrictions on providing buprenorphine, one of the only three federally approved medications to treat opioid use disorder (OUD). “Buprenorphine is an essential tool in the fight to end the opioid epidemic,” said Howard Zucker, M.D., commissioner of health for New York state, which is leading the initiative. “Removing federal restrictions on prescribing buprenorphine will ultimately save lives and eliminate unnecessary barriers that prevent people with opioid use disorder from having access to treatment,” he said.     

H.R. 6: SUPPORT for Patients and Communities Act: The Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act

Section 2005. Medicare coverage of certain services furnished by opioid treatment programs. This provision expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering Medication‐Assisted Treatment (MAT) to expand access to treatment options for Medicare beneficiaries. Currently, OTPs are not recognized as Medicare providers, meaning that beneficiaries receiving MAT at OTPs for their opioid use disorders must pay out‐of‐pocket. In 13 states, the highest rate of opioid‐related inpatient stays is among the over 65 population. Under the provision Medicare will pay the outpatient OTPs through bundled payments made for wholistic services, including necessary medications, counseling, and testing.     

Under 2% of Medicaid‐covered youths get MAT after OD: Study

Fewer than one‐third of youths receive addiction treatment after an opioid overdose, and only one in 54 receive pharmacotherapy (methadone, buprenorphine or naltrexone), a study published in JAMA Pediatrics reports. The researchers urge interventions to link these youths to treatment after an overdose, and call for improving access to medications: methadone, buprenorphine, and naltrexone.     

Briefly Noted

It's not every day that a nationally known “rehab” offers methadone. Recovery Centers of America (RCA) has opened its second medication‐assisted treatment (MAT) clinic — Bravo Medical — that does just this. “MAT is a vital tool in the battle against opioid addictions,” said Melissa Bishop, RCA national director of MAT, last week. “But many people are still afraid to learn more about it because of the stigma attached to this form of treatment.” The public is invited to tour the clinic on Oct. 16 from 12–2 p.m. At this event, families of loved ones from the southern New Jersey and Philadelphia area can tour the Somerdale, New Jersey, facility; see how medication is administered; and learn about the effectiveness of MAT. RCA offers MAT at its inpatient treatment centers and at stand‐alone MAT facilities such as Bravo Medical and the Trenton Healthcare Clinic. RCA offers methadone and buprenorphine. New Jersey State Medicaid is accepted at Bravo Medical and the Trenton Healthcare Clinic.     

Briefly Noted

The National Institutes of Health (NIH) will award 12 grants to form the Justice Community Opioid Innovation Network (JCOIN) to support research on quality addiction treatment for opioid use disorder (OUD) in criminal justice settings nationwide, with a total of $155 million from the National Institute on Drug Abuse. One focus will be on finding new medications. There will be 10 research institutions and two centers. JCOIN is part of the NIH HEAL (Helping to End Addiction Long‐term) initiative launched last year. Funded institutions and the site locations are: the New York State Psychiatric Institute (New York), Baystate Medical Center (Massachusetts), Friends Research Institute Inc. (Maryland), Texas Christian University (Illinois, New Mexico, Texas), the New York University School of Medicine (Connecticut, Delaware, New Hampshire, New York, Oregon), Brown University (North Carolina, Pennsylvania, Rhode Island), the University of Chicago (Illinois), Chestnut Health Systems Inc. (Illinois), the University of Kentucky (Kentucky), and Yale University (Connecticut, Minnesota, New York, North Carolina, Puerto Rico). George Mason University in Fairfax, Virginia, will serve as the JCOIN coordination and translation center. For more information, go to https://www.nih.gov/research‐training/medical‐research‐initiatives/heal‐initiative/justice‐community‐opioid‐innovation‐network .     

Caron in‐network with Aetna

Caron Treatment Centers is an in‐network provider for Aetna, effective Oct. 1, the Pennsylvania‐based program announced last week. “The COVID‐19 pandemic is taking a toll on the mental health of Americans,” said Doug Tieman, CEO and President of Caron Treatment Centers. “Unfortunately, isolation and anxiety make addiction worse, and we are already seeing a spike in substance use and substance use disorders. It's imperative that families have access to affordable, high‐quality, life‐saving treatment programs and support services.” The expansion of in‐network insurance relationships is among several recent moves by Caron to make treatment more accessible. Caron is also an in‐network provider with Highmark and the Blue Card program, which covers persons entitled to benefits as a member of any other Blue Cross and/or Blue Shield plan licensed by the Blue Cross Blue Shield Association, Independence Blue Cross, AmeriHealth Administrators, Independence Administrators, UPMC, Blue Cross Blue Shield, Employer Groups of Penn Medicine and Tower Health. “Accessing quality substance use disorder treatment has always been difficult for many families,” continued Tieman. “With more than 20 percent of the treatment sector reducing or closing services and programs as a result of the pandemic, it's even more difficult. This in‐network agreement with Aetna allows their members to access Caron at a time when they are needed the most.”     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

ADA settlement exposes liability when providers refuse MAT patients

Gov. Andrew Cuomo of New York has added opioid use disorders (OUDs) to the list of approved conditions for which medical marijuana could be prescribed in the state, following the lead last month of New Jersey Gov. Phil Murphy, who limited such use as an “adjunct” to medications like methadone and buprenorphine (see ADAW, Jan. 28).     

Briefly Noted

Last month, the American Society of Addiction Medicine (ASAM) released a plan for advocacy, focusing on strengthening the addiction treatment workforce and standardizing the delivery of treatment. “We need comprehensive solutions to address such a complex problem,” said Paul H. Earley, M.D., ASAM president, in releasing the plan. “With the Advocacy Roadmap as our guide, ASAM will continue to advocate for equitable access to and coverage for evidence‐based addiction treatment services, increased funding for addiction research, and better education among professionals and the public to challenge the stigma and discrimination surrounding individuals with addiction.” Noting that there are still challenges in the field of addiction treatment, Earley said progress has been made, adding that “ASAM remains dedicated to treating addiction compassionately and effectively and, by doing so, saving lives.” There are 6,000 physician members of ASAM. For the “roadmap,” go to https://www.asam.org/docs/default‐source/advocacy/asam_report_feb2020_final.pdf?sfvrsn=f73f51c2_2 .     

Philadelphia‐based harm‐reduction advocate joins CleanSlate

Brooke Feldman is well‐known to the Philadelphia world of drug users as a peer counselor active in harm‐reduction work. But starting this week, she will be Center Manager for two sites owned by CleanSlate Centers, a treatment program focused on opioid and alcohol addiction. Feldman has a master's in social work and is able to bridge the “street” world and that of the established treatment center—but acknowledges that there was a leap of faith involved in joining the treatment field.     

AATOD paper confronts methadone controversies

A policy paper released this month by the American Association for the Treatment of Opioid Dependence (AATOD) focuses on some of the challenges facing opioid treatment programs (OTPs) today. For example, it cites an article published in the New England Journal of Medicine (July 5, 2018) by Michael Botticelli that promotes the idea of methadone being available in primary practice settings for the treatment of opioid use disorder (OUD) (see ADAW, July 16, 2018). “AATOD recommends that this proposal should only be considered after careful, conservative, and thoughtful evaluation,” according to the policy paper. “As history and our policies have shown, we do not reject the public health model for increasing access to care for OUD, nor are we ignoring what has been learned about clinical standards of care to treat this illness. It is important to understand, however, the complexity of inducting a new patient into methadone maintenance treatment when developing policies for increasing access to medication assisted treatment.”     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Shatterproof launches ATLAS, ‘Yelp’‐like tool for treatment

When it comes to treatment that is evidence‐based, nonprofit Shatterproof, funded mainly by insurance companies, is keeping patients informed in a “Yelp”‐like tool. The New York City–based organization formally launched its ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) in six states last week.     

Views on medication's role in treatment begin to converge amid deadly epidemic

In “Intervention stigma: How medication‐assisted treatment marginalizes patients and providers,” a researcher writes about one of the biggest paradoxes facing those treating and being treated for opioid use disorders (OUDs): the fact that the “gold standard” for treatment — methadone and buprenorphine — subjects both providers and patients to stigma, both within and outside addiction treatment communities.     

More from Louis Baxter on doctors taking MAT

The question of whether or not doctors and other health care professionals on medication‐assisted treatment (MAT) are safe to practice medicine has been debated for the last few years since the advent of Food and Drug Administration (FDA)–approved MAT for opioid use disorder (OUD). The newly approved medications have been primarily buprenorphine formulations for OUD, naltrexone formulations for OUD and alcohol use disorder (AUD), and, most recently, an alpha 2‐adrenergic medication that specifically targets amelioration of opioid‐withdrawal symptoms from OUD (lofexidine). Quite frankly, the question of safety about medications to treat substance use disorder (SUD) has been asked since the development of methadone for OUD treatment more than 30 years ago.     

Briefly Noted

Last week, Scott Gottlieb, M.D., abruptly and surprisingly resigned as commissioner of the Food and Drug Administration (FDA). He has pushed to reduce teenage vaping, been a vociferous supporter of medications to treat opioid use disorder and is noted in the field for his recommendation that methadone and buprenorphine patients should not be terminated from care for use of benzodiazepines. After he announced his resignation on March 5, vaping stocks surged. He was viewed as critical to protecting youths against nicotine and e‐cigarettes. “He was remarkably successful at keeping the agency moving forward at a difficult time and really focused on public health challenges, including the opioid epidemic and drug prices,” said Joshua M. Sharfstein, M.D., a former principal deputy commissioner at the FDA during the Obama administration, who is now a professor of health policy at the Johns Hopkins Bloomberg School of Public Health, told The New York Times. “He surprised a lot of people in his willingness to take some risks for public health.”     

Table of Contents

Heroin Bills Will Help Remove Insurance Barriers to Treatment in New York Fast‐Growing Inpatient Company Sees More Opportunities Overseas Waiting Lists, Lack of MAT Targeted at Heroin Summit Pharmacogenetics to Be NIAAA Focus for Next Decade A Recovering Alcoholic's Views on Marijuana NASADAD Asks Obama to Nominate Botticelli to ONDCP Post Briefly Noted Coming up     

Supplemental SOR grants released to states

Last month, the federal Department of Health and Human Services (HHS) released an additional $487 million to states and territories in its State Opioid Response (SOR) grant program, bringing the 2019 total to $1.4 billion, including the $933 million in second‐year, continuation SOR grants to be provided later this year. The SOR grants increase access to medication‐assisted treatment (MAT), reduce unmet treatment need and reduce opioid‐related overdose deaths.