J Craig Allen MD

Medical Director

Rushford

Implementing Medication Assisted Treatment within a Community Mental Health Center

Implementing Medication Assisted Treatment

within a Community Mental Health Centerldquo

J Craig allen MD

91517

Name Commercial

Interests

Relevant Financial

Relationships

What Was

Received

Relevant Financial

Relationships For

What Role

No Relevant

Financial

Relationships with

Any Commercial

Interests

J Craig allen MD None None None None

Hassan Dinakar MD None None None Non

Glossary of Terms

Commercial Interest - The ACCME defines a ldquocommercial interestrdquo as any proprietary entity producing health care goods or services with the exemption of non-profit or government organizations and non-health care related companiesFinancial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary royalty intellectual property rights consulting fee honoraria ownership interest (eg stocks stock options or other ownership interest excluding diversified mutual funds) or other financial benefit Financial benefits are usually associated with roles such as employment management position independent contractor (including contracted research) consulting speaking and teaching membership on advisory committees or review panels board membership and other activities from which remuneration is received or expected ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partnerRelevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity ACCME has not set a minimal dollar amount for relationships to be significant Inherent in any amount is the incentive to maintain or increase the value of the relationship The ACCME defines ldquorsquorelevantrsquo financial relationshipsrdquo as financial relationships in any amount occurring within the past 12 months that create a conflict of interestConflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which heshe has a financial relationship

Scope of the problem ndash opioid epidemic

ndash Healthcare field with deficient knowledge

-of pain treatment

-of opioid medications

-of addictions

ndash Inexpensive plentiful and high potency heroin (and illicit synthetic opioids)

ndash Rising numbers of opioid addiction

ndash Leading cause of accidental death

ndash Lack of treatment capacity

Rationale for integration into community behavioral health

ndash High rates of substance use disorder in people with mental illnesses

ndash Higher rates of mental health problems in people with substance use disorders (gt50 of those with an opioid addiction have a mental health disorder)

ndash Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

ndash Community mental health centers

bull case management

bull multilevel provider treatment teams

bull recovery-oriented system

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementing Medication Assisted Treatment

within a Community Mental Health Centerldquo

J Craig allen MD

91517

Name Commercial

Interests

Relevant Financial

Relationships

What Was

Received

Relevant Financial

Relationships For

What Role

No Relevant

Financial

Relationships with

Any Commercial

Interests

J Craig allen MD None None None None

Hassan Dinakar MD None None None Non

Glossary of Terms

Commercial Interest - The ACCME defines a ldquocommercial interestrdquo as any proprietary entity producing health care goods or services with the exemption of non-profit or government organizations and non-health care related companiesFinancial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary royalty intellectual property rights consulting fee honoraria ownership interest (eg stocks stock options or other ownership interest excluding diversified mutual funds) or other financial benefit Financial benefits are usually associated with roles such as employment management position independent contractor (including contracted research) consulting speaking and teaching membership on advisory committees or review panels board membership and other activities from which remuneration is received or expected ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partnerRelevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity ACCME has not set a minimal dollar amount for relationships to be significant Inherent in any amount is the incentive to maintain or increase the value of the relationship The ACCME defines ldquorsquorelevantrsquo financial relationshipsrdquo as financial relationships in any amount occurring within the past 12 months that create a conflict of interestConflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which heshe has a financial relationship

Scope of the problem ndash opioid epidemic

ndash Healthcare field with deficient knowledge

-of pain treatment

-of opioid medications

-of addictions

ndash Inexpensive plentiful and high potency heroin (and illicit synthetic opioids)

ndash Rising numbers of opioid addiction

ndash Leading cause of accidental death

ndash Lack of treatment capacity

Rationale for integration into community behavioral health

ndash High rates of substance use disorder in people with mental illnesses

ndash Higher rates of mental health problems in people with substance use disorders (gt50 of those with an opioid addiction have a mental health disorder)

ndash Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

ndash Community mental health centers

bull case management

bull multilevel provider treatment teams

bull recovery-oriented system

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Glossary of Terms

Commercial Interest - The ACCME defines a ldquocommercial interestrdquo as any proprietary entity producing health care goods or services with the exemption of non-profit or government organizations and non-health care related companiesFinancial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary royalty intellectual property rights consulting fee honoraria ownership interest (eg stocks stock options or other ownership interest excluding diversified mutual funds) or other financial benefit Financial benefits are usually associated with roles such as employment management position independent contractor (including contracted research) consulting speaking and teaching membership on advisory committees or review panels board membership and other activities from which remuneration is received or expected ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partnerRelevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity ACCME has not set a minimal dollar amount for relationships to be significant Inherent in any amount is the incentive to maintain or increase the value of the relationship The ACCME defines ldquorsquorelevantrsquo financial relationshipsrdquo as financial relationships in any amount occurring within the past 12 months that create a conflict of interestConflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which heshe has a financial relationship

Scope of the problem ndash opioid epidemic

ndash Healthcare field with deficient knowledge

-of pain treatment

-of opioid medications

-of addictions

ndash Inexpensive plentiful and high potency heroin (and illicit synthetic opioids)

ndash Rising numbers of opioid addiction

ndash Leading cause of accidental death

ndash Lack of treatment capacity

Rationale for integration into community behavioral health

ndash High rates of substance use disorder in people with mental illnesses

ndash Higher rates of mental health problems in people with substance use disorders (gt50 of those with an opioid addiction have a mental health disorder)

ndash Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

ndash Community mental health centers

bull case management

bull multilevel provider treatment teams

bull recovery-oriented system

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Scope of the problem ndash opioid epidemic

ndash Healthcare field with deficient knowledge

-of pain treatment

-of opioid medications

-of addictions

ndash Inexpensive plentiful and high potency heroin (and illicit synthetic opioids)

ndash Rising numbers of opioid addiction

ndash Leading cause of accidental death

ndash Lack of treatment capacity

Rationale for integration into community behavioral health

ndash High rates of substance use disorder in people with mental illnesses

ndash Higher rates of mental health problems in people with substance use disorders (gt50 of those with an opioid addiction have a mental health disorder)

ndash Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

ndash Community mental health centers

bull case management

bull multilevel provider treatment teams

bull recovery-oriented system

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Rationale for integration into community behavioral health

ndash High rates of substance use disorder in people with mental illnesses

ndash Higher rates of mental health problems in people with substance use disorders (gt50 of those with an opioid addiction have a mental health disorder)

ndash Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

ndash Community mental health centers

bull case management

bull multilevel provider treatment teams

bull recovery-oriented system

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

MAT is evidence-based and is the recommended course of treatment for opioid addiction

MAT is first line treatment

ndash American Academy of Addiction Psychiatry

ndash American Medical Association

ndash The National Institute on Drug Abuse

ndash Substance Abuse and Mental Health Services Administration

ndash National Institute on Alcohol Abuse and Alcoholism

ndash Centers for Disease Control and Prevention and other agencies

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Historical barriers ndash stigma regulatory misconceptions difficulties and perceived difficulties of implementation

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation - overview

bull Make a plan ndash

ndash scope

ndash goals

ndash measures of success

ndash need for revision

bull Communicate the plan- incorporating rationale and material above

bull Start a treatment program

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation - overview

bull Workforce

bull Programmatic structure Design

bull Practice Issues

bull Financial

bull Linkages

bull Special Poplations

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation ndash workforce issues

bull Who are appropriate leaders clinicians

bull Special physician issues

bull Training

bull Challenges

ndash Scarcity of medical providers trained to administer

MAT services

ndash Attitudes and misunderstandings about MAT

ndash Lack of support staff for providers currently

administering MAT services

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation ndash programmatic structure design

bull Levels of care

bull Specialized trackpersonnel vs dispersed broadly into clinic

bull Psychosocial treatments

bull Space and patient flow

bull Requirements for patients ndash attendance at psychosocial treatment and medical visits UDS drug use opioids drug use non-opioids

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation ndash practice issues

bull Forms (Treatment Agreements policy consent ect)

bull Managing problems ndash non-adherence disruptive behaviors

bull Additional interventions for struggling patients

bull Managing relapse

bull Approach to discharge and discontinuation of Rx (for cause for transfer for request)

bull Policy restrictiveness Vs individual practitioner variation

bull Medication supply prescription duration

bull BZDs

bull Lab testing

bull Approach to acute pain and analgesia (injury surgery etc)

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation - UDS

bull Logistics ndash

ndash collection frequency managing problems (ldquoI canrsquot gohelliprdquo)

bull Supervised collection Universal vs for cause vs never

bull managing positive results

bull managing adulteration

bull interpretation

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation- financial

bull Business model

ndash Ambulatory Detox induction

ndash Residential IOPPHP OP

bull Reimbursement

ndash Commercial

ndash Cash

ndash Medicaid

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation ndash linkages to a full local continuum

bull Specialty SUD treatment including bed based services

bull Inpatient psychiatry

bull General medical ndash hospital and primary care

bull Emergency Department

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Implementation ndash special populations

bull Pregnancy

bull Youth

bull Criminal justice

bull Chronic pain

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Medication Assisted Treatment at a mental health center

Focusing on Dual diagnosed (opiate use and mood disorders) patients

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Why have Medication Assisted Treatment Programs at Mental health centers

bull Patients with Dual diagnosis (mental health and opiate use) have difficulty in getting accepted by traditional Suboxone program

bull Staff at Mental health centers have expertise in dealing with difficult to treat Dually diagnosed patients (mental health and substance use)

bull Patient with mood disorders frequently ldquoself medicaterdquo using opiates to stabilize their mood

bull Suboxone may help with stabilizing mood issues

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Structure

bull Integrate into current programs

bull Consider using MAT medications as part of comprehensive treatment for the patient

bull Educating all staff to accept MAT as an acceptable ldquoharm reductionrdquo modality

bull Medical staff (psychiatrists and APRNs) are certified in using Buprenorphine

bull Selected clinicians who will be working with MAT patients receive additional training

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Program for medication assisted treatment

bull To maximize patient engagement it is recommended that all patients start in IOP level of care

ndash IOP 30 day program completed in 6 to 8 weeks

bull IOP is 3 hours of programming daily 5 days a week

bull Programming is focused on dual issues (mental health and substance use)

bull Weekly UDS and random pill (strip) counting

bull weekly rounds with the MAT staff

bull Ability to access varying intensity of services as clinically appropriate ie refer patients to IOPPHP if they struggle and OP as they stabilize

bull Close coordination between the Mat IOP and outpatient clinic

bull using a single pharmacy located preferably within the mental health center

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Staffing (MAT program)

bull Medical staff (psychiatrists and APRNs) trained in using MAT medications ndash do evaluations to confirm diagnosis and eligibility for MAT

bull Medical assistant (MAT coordinator) ndash keeps track of MAT patients (monitors prescriber numbers for bupnaloxone) help in induction Urine tests help with pharmacy issues

bull IOP clinician comfortable with working with MAT patients

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Highlights from Rushfordrsquos MAT program

bull 117 patients inducted on bupnaloxone and admitted to IOP over a period of 13 months

bull 100 of the 117 were Dual diagnosed (opiate use disorder and mood disorders)

bull 73 males and 44 females (63 males and 37 females in the Dual diagnosed group)

bull Most common mental health diagnosis was bipolar disorder followed by PTSD and then by depression and other mood disorders Patients with Schizophrenia diagnosis did not enter the program

bull Patients with Dual diagnosis gave history of being excluded by ldquotypicalrdquo MAT programs in the past due to their psychiatric history

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Suboxone For Dual diagnosed patients at our center

bull Usual dose for bupnaloxone 8mg ndash 2mg twice daily

bull For Dual diagnosed patients

ndash we avoid using any mood stabilizers including Atypicals during the first two weeks of Suboxone treatment

ndash (non-narcotic anxiolytics such as Hydroxyzine Buspirone or occasionally Gabpentin are allowed)

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

bull Overdose is the 1 cause of death for Americans lt 50

bull High rates of substance use disorder in people with mental illnesses and mental health problems in people with substance use disorders

bull Treating either disease alone mdash instead of concurrently mdash leads to poorer outcomes

bull Community mental health centers are ideal locations for MAT for OUD

ndash case management

ndash multilevel provider treatment teams

ndash Familiar with complicated clinical presentations

ndash recovery-oriented system

Summary and conclusion

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

Guide to other resources

American Society of Addiction Medicine Opioid Addiction Treatment Guide for Patients Families and Friends httpeguidelineguidelinecentralcomi706017-asam-opioid-patient-piece

Family loved ones and friends support

Allies in Recovery alliesinrecoverynet

Naranon

Alanon

Providersrsquo Clinical Support System (PCSS) PCSSMATOrg

American Academy of Addiction Psychiatry (AAAP) httpwwwaaaporg

American Society of Addiction Medicine httpwwwasamorg

National Council MAT web page httpswwwthenationalcouncilorgmat

National Council MAT web page httpswwwthenationalcouncilorgmat

MAT for Opioid Use Disorders Video Interview Series

Webinars

Opioid Dependence 101 and MAT

Making the Case How MAT Improves Mental Health Care

MAT Roundtable Lessons Learned from CBHOs Implementing MAT for Opioid Use Dependence

Medication-Assisted Treatment Lessons Learned from the Field

Resources from The SAMHSA-HRSA Center for Integrated Health Solutions

Webinar Addressing SUDs in the Primary Care setting

MAT Implementation Checklist

Expanding the Use of Medications to treat individuals with Substance Use Disorder

An Understanding of Addiction That Helps You Understand MAT

Substance Use Terminology Pocket Guide to Medication-Assisted Treatment of Opioid Use Disorder

Signs and symptoms of Opioid Overdose Education and Naloxone administration

httpwwwctgovdmhascwpviewaspa=2902ampq=509650

Guide to other resources