AAC statement on NAATP lawsuit

As the National Association of Addiction Treatment Providers (NAATP) was beginning its annual leadership meeting May 6, American Addiction Centers sued the organization in federal court (see “AAC sues NAATP for defamation,” ADAW, May 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32362 ). We wanted to provide further information on the lawsuit (which we linked to in our story last week). Below is a statement provided exclusively to ADAW by AAC May 15.     

NAATP annual meeting: Measure what you're doing

Last week's annual leadership meeting of the National Association of Addiction Treatment Providers (NAATP) focused on the quality assurance guidebook coming out from the organization (see “NAATP releases draft guidebook for residential treatment providers,” ADAW, April 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32334 ). It culminated with a visit to Capitol Hill (see story, p. 3).     

‘Incentivizing Recovery’ follow‐up: White paper was a ‘first step’

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17).     

NAATP to court: AAC doesn't have a case

Citing “actions that it had every right to take, statements of opinion it had every right to make, and the actions and the conduct of third parties” for which it had no control or responsibility, the National Association of Addiction Treatment Providers (NAATP) filed a motion to dismiss the complaint against it by American Addiction Centers (AAC) filed in May (see ADAW, May 13, May 20).     

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.”     

CARF and ASAM award first 7 level‐of‐care certifications

Under the pilot for its new certification program for substance use disorder treatment, the American Society of Addiction Medicine (ASAM) has awarded the first seven certifcaitions. The ASAM level‐of‐care certification was created in partnership with CARF International and announced earlier this year (see “CARF adds OBOT accreditation and ASAM certification,” ADAW, Feb. 4, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32246 ).     

When pricing treatment,know your costs and set your profit margins

Billing, ethics and parity have been hot‐button issues for substance use disorder (SUD) treatment centers for years, but the National Association of Addiction Treatment Providers (NAATP) is getting closer to finding solutions. At its annual leadership meeting in Washington last month, members, not to be deterred by a surprise lawsuit on opening day from American Addiction Centers (see ADAW, May 20, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32368 ), gathered to hear from experts on how to properly conduct billing in a dynamic new environment.     

Fiellin: Keep the prescriber training for buprenorphine

It seems that almost everyone wants to deregulate buprenorphine for opioid use disorder (OUD) — with proposed legislation focused on getting rid of the Drug Addiction Treatment Act of 2000 (DATA 2000) waiver altogether (see ADAW, Oct. 11, “Bill to deregulate buprenorphine raises concerns among OTPs,” https://onlinelibrary.wiley.com/doi/10.1002/adaw.32510 ).     

Hill Day: The three big ‘asks’ from NAATP

At the “Hill Day” event that marked the end of the annual leadership conference of the National Association of Addiction Treatment Providers (NAATP), 120 association members went to the Senate and House of Representatives to make their case. “I felt it would be successful if we had 50 members who stayed the extra day and did the Hill visits,” Mark Dunn, NAATP policy representative, told ADAW of the May 8 visits. So he was thrilled that so many went.     

AMA and ASAM have different views on SAMHSA NPRM

The comment period for the notice of proposed rulemaking (NPRM) that would allow law enforcement to have access to all patient records if it is investigating an alleged serious crime by a patient (see ADAW, Sept. 9) closed Sept. 25. There was no extension, as some (including the American Medical Association [AMA]) had requested (see ADAW, Sept. 23). This proposal, by the Substance Abuse and Mental Health Services Administration (SAMHSA), would alter 42 CFR Part 2 by allowing this access, also changing the definition of serious crime to include anything related to drug trafficking.     

NAATP guidebook not only for residential care

The National Association of Addiction Treatment Providers (NAATP) has released its draft guidebook for minimum standards for members (see ADAW, April 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32334 ). NAATP is not only for residential treatment providers, however. “Our position at NAATP is that we are a membership association for providers along the entire continuum and that, while residential holds an important place in our work and is our historical foundation, our membership is in no way limited to residential,” NAATP Executive Director Marvin Ventrell told ADAW last week. “Even apart from our membership, we intend our resources, including ethics and the guidebook, to reach and guide the entire continuum. It is true that some of the guidelines have application more or less relative to type of care, but as a whole it should be viewed as a provider guide, not just a residential provider guide.” We regret any confusion. The field — and prominent organizations within it — is changing.     

Sublocade: Why a placebo arm?

In a time when people are dying from illicit fentanyl overdoses, why would a trial for a new medication to treat opioid use disorder — a formulation of buprenorphine, already proven to be safe and effective in oral form — include a placebo arm? This was the question asked by many when the results of Indivior's trial for Sublocade, a buprenorphine injection that lasts a month, were published last month in The Lancet (see ADAW, Feb. 25). The trial results were what led to Sublocade's approval by the Food and Drug Administration (FDA) for the treatment of opioid use disorder more than a year ago (see ADAW, Dec. 11, 2017).     

Names in the News

The American Association for the Treatment of Opioid Dependence (AATOD) will be presenting the 2019 Richard Lane/Robert Holden Patient Advocacy Award to Zachary Talbott at the organization's conference in October. Talbott was selected by his peers for the award. Nominations were announced last month (see ADAW, April 15, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32331 ). Talbott has opened and directed new opioid treatment programs, and had “compassionate advocacy of people with opioid use disorder,” as well as “fierce dedication to our patient population,” according to AATOD's May 1 letter to Talbott announcing the award offer, a copy of which was obtained by ADAW. Congratulations!     

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.     

AUD medications and postsurgery opioids: The latest

Topiramate's use as a treatment for alcohol use disorder (AUD) is not a new idea, Bankole Johnson, M.D. (now of ondansetron fame; see ADAW, March 25, April 1), reviewed it many times (see ADAW, Oct. 15, 2007; Feb. 11, 2008; June 16, 2008; Nov. 3, 2008; June 7, 2010; Jan. 31, 2011; Feb. 24, 2014). But a comprehensive review published recently in the Journal of Addiction Medicine is concise. While not approved by the Food and Drug Administration for AUD, topiramate can be prescribed off‐label, and should be considered as a treatment for the condition, according to Ajay Manhapra, M.D., and colleagues in the article, “Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review.” Like ondansetron and other possible AUD medications, including those that are approved (like acamprosate and naltrexone), topiramate doesn't work for everyone. But pharmacogenetic testing may help identify those who are likely to respond, according to the review. In addition, there are early studies indicating it could be used to treat cocaine and nicotine use disorder, as well as behavioral addictions.     

Shatterproof on its rating pilot for SUD treatment programs

Shatterproof launched its rating system for addiction treatment programs with a $5 million pilot, the company announced in December, with funding coming mainly from insurance companies and grants (see ADAW, Jan. 14). The project began a year ago (see ADAW, Jan. 15, 2018) but is now moving forward. ADAW caught up with Sam Arsenault, director of national treatment quality initiatives for Shatterproof, last week about the project.     

Study finds MAT combined with 12‐Step residential treatment is effective

To those who might assume a federal lawsuit seeking class status for treatment providers wronged by insurance company actions would be receiving immediate and universal acclaim in the provider community, a little caution may be in order. While the latest lawsuit against United Behavioral Health (UBH) certainly will be interpreted by some addiction treatment providers as an opportunity to recover payments that were inappropriately denied (see ADAW, Sept. 23), the case also could launch a broader discussion of how best to guarantee that insured patients receive the care to which they are entitled.     

Table of Contents

Addiction Treatment Provider Continues Expansion into Mental Health Seabrook Positions for Changes with Renewed Outpatient Emphasis NIH Responds to Nature Article on Duplicative Grants CSAT's Reuter Retires, Leaving a Legacy for OTPs Colo. Officials Worried about Child Welfare and Substance Abuse ADAW Editor Awarded CADCA ‘National Newsmaker’ Briefly Noted State News Correction Coming up     

NAATP keeps focus on parity

We need to move beyond the principle of parity into the practice of parity.” These words from Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), in an interview with ADAW last week are a sign of the frustration with how parity — the Mental Health Parity and Addiction Equity Act (MHPAEA), which guarantees that substance use disorders (SUDs) will be treated no differently from medical and surgical claims in the world of reimbursement — has been a real‐world disappointment to patients and providers alike.