No time for petty conflict amid an opioid crisis

Pharmacology vs. psychosocial treatment. Detox vs. maintenance. General practitioners vs. specialty treatment centers. At a time when substance use treatment systems are being tested to capacity like never before, unproductive conflicts continue to weigh down the field.

Presenters on the opening day of the American Association for the Treatment of Opioid Dependence (AATOD) conference in New York City urged the audience to get beyond differences and realize that all components of treatment must work in concert to have an optimal impact on the opioid crisis.

The more than 2,000 conference attendees heard about signs of hope on the budgetary and clinical front—but unfortunately against a backdrop of continually escalating overdose and death rates in many communities. AATOD president Mark Parrino reported on the latest group of states that now offer Medicaid reimbursement for services in federally regulated opioid treatment programs (OTPs): Illinois, Indiana, Kentucky and West Virginia. He promised that strong advocacy efforts will continue in the dozen states that still lack Medicaid reimbursement for OTP services.

At the same time, Parrino expressed hope regarding newly introduced legislation in Congress that would bring about a range of covered OTP services as part of Medicare Part B coverage. “We're closer to the first Medicare Part B benefit ever,” he said.

Parrino also clarified AATOD's support for comprehensive treatment that goes beyond medication. “Medication alone is not sufficient to treat long-term substance use disorder with opioid addiction,” he said.

Host state's approach

The state substance abuse services director in the conference's host state emphasized a multi-pronged approach to combating the opioid crisis, featuring a significant emphasis on the role of peer support and on care delivery in non-traditional locations such as homeless shelters and police stations.

Arlene Gonzalez-Sanchez, commissioner of the New York Office of Alcoholism and Substance Abuse Services (OASAS), said that since 2011, New York has added around 4,000 new OTP treatment slots, between new programs and capacity expansions of existing OTPs. New York now has just over 100 OTP locations.

“We are all going to act forcefully to promote medication-assisted treatment because we know this is the way to go,” Gonzalez-Sanchez said.

She also highlighted legislative reforms in the state that have sought to improve access to treatment, including the elimination of prior authorization provisions for insurance coverage of medically necessary inpatient treatment and of medications to treat addictions.

Stigma across borders

Also at the March 12 morning plenary session, the president of the World Federation for the Treatment of Opioid Dependence outlined barriers to success that influence the course of treatment worldwide. Icro Maremmani, MD, told the audience that voices as prominent as that of Pope Francis have an impact here, as the Pope once referred to opioid agonist medications as “a hidden way to surrender.”

Maremmani urged attendees to embrace “neutral, precise and respectful” language toward their patients, where “tapering off” should replace “detox” and “opioid agonist treatment” should help retire the use of “substitution therapy.”