SAMHSA urges treatment programs to test for HIV

Last month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) called on public health and substance use disorder (SUD) treatment providers to help make sure patients who are negative for human immunodeficiency virus (HIV) stay that way, and that those who are HIV‐positive are tested, receive antiretroviral treatment and stay “adherent” to the treatment. The directive came in the form of a “Dear Colleague Letter” from SAMHSA Director Elinore F. McCance‐Katz, M.D., Ph.D., assistant secretary for mental health and substance use for the Department of Health and Human Services.     

Opioid bills stalled after GOP clears them in Senate

Neither S. 2680 nor H.R. 6, the two big opioid bills that are being crafted into one package under the leadership of Sen. Lamar Alexander (R‐Tennessee), chair of the Senate Health, Education, Labor and Pensions (HELP) committee, have come before the full Senate yet. Despite the fact that Sen. Mitch McConnell (R‐Kentucky) called them a “priority” last month (see ADAW, Aug. 27), and got his party to clear Senator Alexander's package on Aug. 28, he has not yet scheduled a vote.     

Treatment center sues Tennessee town over zoning ordinance

Last week, ReVIDA Recovery Centers, which provides medication‐assisted treatment for opioid use disorder, announced that it would sue to keep its treatment program in Morristown, Tennessee, where the city has denied the company based on zoning. “Our patients are our first priority,” said CEO Lee Dilworth on September 25.     

Table of Contents

SAMHSA's Budget Request Again Seeks to Cut SA Prevention Set‐Aside Seattle OTP Emphasizes Safety Amid Policy Responses to Rx Abuse 3 States Use Rx Monitoring for Public Health, Not Enforcement OTPs and Tennessee Still at Loggerheads on Methadone ACA Requires Residential Treatment Coverage: Legal Opinion Briefly Noted Coming up     

‘Secret shopper’ study finds many barriers to OUD treatment

Treatment programs that don't accept insurance, but only cash, create a barrier for opioid use disorder (OUD) treatment, according to a study by Stephen Patrick, M.D., and colleagues, many of whom are from the Vanderbilt Center for Child Health Policy at Vanderbilt University Medical Center in Nashville. And despite the fact that pregnant women with OUD are a priority population for treatment due to the risks to the fetus of continued opioid abuse, nonpregnant women are more likely than pregnant women to be given an appointment for treatment with a buprenorphine‐waivered clinician.     

OTPs in NY to help study telemedicine to treat hepatitis C

Seven opioid treatment programs (OTPs) at 12 locations in New York state will participate in a study that uses telemedicine to integrate the treatment of opioid use disorder (OUD) and hepatitis C virus (HCV). The goal is to achieve better outcomes by delivering HCV treatment on‐site via telemedicine, instead of referring out. It makes sense that this would be more effective than sending patients elsewhere, but the study needs to be done.     

DEA,SAMHSA relax OTP/OBOT regulations due to COVID‐19

Opioid treatment programs (OTPs) that dispense methadone got a fast and clear reprieve from federal authorities last week in the face of COVID‐19. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued policies that give OTPs flexibility in take‐homes, limiting the frequency of face‐to‐face contact and opportunities for transmission of COVID‐19. There is also greater flexibility for office‐based opioid treatment (OBOT) with buprenorphine.     

Opioid withdrawal not lethal to fetus,if via medication taper

First of all, this story is not about Craig Towers, M.D., the charismatic Tennessee‐based OB‐GYN whose methods for detoxing pregnant women from opioids are not endorsed as standard of care by the American College of Obstetricians and Gynecologists. It is, however, about debunking the myth that pregnant women with opioid use disorder (OUD) must be maintained on agonist medication (methadone or buprenorphine). They don't need to be. They can be tapered instead.     

DEA allows buprenorphine inductions based on telephone only

Last week, the Drug Enforcement Administration (DEA) said opioid treatment programs (OTPs) and Drug Addiction Treatment Act (DATA)–waived prescribers can treat new patients with buprenorphine based on a telephone call only. The Controlled Substances Act (CSA), enforced by the DEA, requires all new patients being treated with controlled substances to have an in‐person — or, for now, telemedicine — physical exam. Now, however, because of the coexisting COVID‐19 pandemic and opioid overdose crisis, the DEA has dropped this requirement. This follows the decision of the Substance Abuse and Mental Health Services Administration (SAMHSA) to allow exemptions from the OTP take‐home regulations allowing stable patients to be given 14 or 28 days of methadone doses, instead of coming in more frequently (see DEA, SAMHSA relax OTP/OBOT regulations due to COVID‐19, ADAW March 23, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664 ).     

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.     

Proposed bill for HEROES Act would give $1.5 billion to SAPT block grant

With the House of Representatives planning to vote last Friday on the fourth COVID‐19 stimulus package, substance use treatment stands a chance of being included — if the Senate, which at press time was still opposing the measure, as was the White House, goes ahead to approve it as well. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, for about $2 trillion, would finally give some money to states, counties and health care. So far, more than $2 trillion has been spent on stimulus funding, with the field trying hard to be included in each bill (see “NASADAD requests $250 million for Phase 4 stimulus,” ADAW April 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32688 ).     

Starting a new OTP and leading clinical services for an OBOT: Talbott

Zachary Talbott, who founded Counseling Solutions Treatment Centers in 2015 and operated opioid treatment programs (OTPs) in Chatsworth, Georgia, and Murphy, North Carolina (see ADAW, August 17, 2015), which were then acquired by BayMark Health Services in August 2018 (see ADAW, Sept. 10, 2018), and who ultimately set his sights on returning home to Maryville, Tennessee, had a plan. Anyone who knows him knew he would. He recently joined ReVIDA Recovery Centers as their director of clinical services to develop, implement and oversee a comprehensive behavioral health program within the company's continuum of care.     

Briefly Noted

In 2020, 12 years after passage of the Mental Health Parity and Addiction Equity Act, treatment providers are still calling for parity for addiction treatment. The American Society of Addiction Medicine on April 24 issued a policy statement with specific recommendations for treatment coverage. Included in the recommendations: eliminating prior authorizations for medications, including addiction treatment as an essential health benefit, ensuring that provider networks are inclusive and more. For the recommendations, go to https://www.asam.org/Quality‐Science/publications/magazine/read/public‐policy‐statements/2020/04/24/third‐party‐payment‐for‐addiction‐treatment .     

STR grants: How one physician in rural Florida is trying to help

If the State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) grants are like an elephant — large, especially relative to funding for addiction treatment in general — they are also almost impossible to generalize about. But seeing one piece in context of the whole is essential in trying to find out where the money is actually going. The money goes to the single state authority (SSA) in charge of the Substance Abuse Prevention and Treatment (SAPT) block grant in each state, the person who knows most about what is needed in that state. The funding comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants added $2 billion‐plus to addiction treatment services for opioid use disorders for four years — and many expect this number to be doubled. For perspective, the entire SAPT block grant is under $2 billion and has been for decades.     

Long‐term use of methylphenidate continues to confer benefits

Patients continue to receive benefits from treatment for attention‐deficit/hyperactivity disorder (ADHD) with methylphenidate after long‐term use, researchers have found. Some patients may be withdrawn from the medication, however. Therefore, all patients should be assessed periodically to determine whether they continue to need the medication. The study, published in the American Journal of Psychiatry, was conducted because, while long‐term use of methylphenidate for children with ADHD is frequent clinical practice, its benefits are unclear. They looked at whether the medication remains beneficial after 2 years. Methylphenidate, a stimulant, has been controversial in some quarters because it is a controlled substance, However, the first‐line treatment for ADHD is psychostimulant medication, such as methylphenidate. How long children should take is is a question, but 60% of children receive stimulant treatment for ADHD for more than 2 years, and this is increasingly common, extending even into adolescence and adulthood. This is partly due to the awareness that ADHD is not a pediatric‐only condition. The study, “Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo‐controlled discontinuation study,” was published online May 21 by the American Journal of Psychiatry.     

Health promotional education: differences between school nurses' health counselling and teachers' health instruction in the finnish ENHPS

The purpose of the study was to describe school nurses' (N=24) and teachers' (N=25) opinions of how the health‐related goals in their counselling and instruction were attained and to find out the possible differences between the two groups in the Finnish European Network of Health Promoting Schools. The data were collected by a questionnaire and analysed statistically. Some significant differences existed. School nurses ranked non‐intoxicant use, human growth and development and life control highest in their health counselling, whereas teachers underlined health maintenance and well‐being, respect for other people and non‐intoxicant use. School nurses' health counselling covered disease prevention and treatment better compared to teachers' health instruction, whereas health maintenance and well‐being, environmental health, first aid and safety and respect for other people were covered better in teachers' health instruction. Teachers were more promotional and community‐oriented, while school nurses emphasised a more preventive and individually oriented approach.     

From starter OTP to acquisition by BayMark: A 3‐year journey

BayMark Health Services has acquired Counseling Solutions, a treatment provider focusing on methadone and buprenorphine treatment with locations in Chatsworth, Georgia, and Brasstown, North Carolina. When Zachary Talbott first started working to open his opioid treatment program (OTP) in Chatsworth more than three years ago, he had no plans to sell it (see ADAW, Aug. 17, 2015).     

NASADAD to NIDA: Connect research to practice

When the National Institute on Drug Abuse (NIDA) sought input on its five‐year plan, the people responsible for publicly funded prevention, treatment and recovery — state directors — called for returning to the days of communication between federal agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and between NIDA researchers and the service delivery system. In an Aug. 7 letter to NIDA's strategic planning team, Robert I.L. Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), noted that each state alcohol and drug agency has a critical role to play in NIDA initiatives. This role includes.     

Building Capacity for Local Governance: An Application of Interactional Theory to Developing a Community of Interest*

Abstract The Emory‐Obed Watershed in Tennessee, like many other rural areas throughout the United States, is experiencing changes in economic activities and social values associated with natural resources. Informed by the interactional approach to community development, this effort strove to build community capacity so community members could more fully govern their life according to their values and interests. We utilized key informant and focus group interviews to gain information about the watershed and to obtain different perspectives on resource‐related issues. Data from key informant interviews led to the selection of a geographic community in which a community of interest was nurtured throughout a year involving monthly meetings, a community assessment and submission of a development grant application. It was found that gaining entry into the community and building trust among participants, and between participants and researchers, were critical in this in‐place participatory community research. Lessons drawn from this experience applicable to similar efforts are discussed.