ATTC Network's Efforts to Address Resistance to Medication-Assisted Treatment

Addressing Resistance to Medication-Assisted Treatment

Closing the gap between research and practice: Successful technology transfer strategies in combating

resistance to medication-assisted treatment

An ATTC Network Panel Presentation American Association for the Treatment

of Opioid Dependence (AATOD) 2012 National Conference

• About the Addiction Technology Transfer Center (ATTC) Network

• Utilizing Medication-Assisted Treatment (MAT)

• NIDA/SAMHSA Blending Initiative Overview: A focus on medication-assisted treatment

• MAT in Special Populations

Panel Agenda

3

The ATTC Network 2007-2012

Southern

Coast

The ATTC Network’s Vision

All professionals who address the needs of individuals with, or

who are at risk of having, substance use disorders will utilize

effective, culturally responsive practices that lead to improved

healthcare and long-term health and wellness.

What is Technology Transfer?

Southern

Coast

What is Technology Transfer?

Copyright 2010 ATTC Network





Panel Agenda

Medication-Assisted Treatment (MAT) is the use

of medication, combined with counseling and

behavioral therapies, to provide a whole patient

approach to the treatment of substance use disorders.

(http://www.dpt.samhsa.gov )

http://www.dpt.samhsa.gov/

Medications for Alcohol Dependence

Naltrexone (ReVia®, Vivitrol®, Depade®)

Disulfiran (Antabuse®)

Acamprosate Calcium (Campral®)

Medications for Opioid Dependence Methadone Buprenorphine (Suboxone® and

Subutex®) Naltrexone

Research has Demonstrated that MAT is Effective

Clinical trials have demonstrated efficacy of MAT for opioid dependent patients (Bickel et al., 1988; Amass et al., 2004; Ling et al., 2010).

MAT is cost effective & provides more health benefits than providing treatment without medication (M. Connock et al., 2007)

Research to date confirms lower risk of abuse, overdose, and toxicity and diminished withdrawal symptoms when using medication assisted treatment (Burns et al., 2009).

Published by SAMHSA as Treatment Improvement Protocol (TIP) 43, MAT is a widely recognized evidence based practice.

MAT is Not Widely Utilized to Tx SUDs

According to SAMHSA, only 22.3% of patients seeking treatment for a SUD received medication-assisted treatment in the form of Methadone or Buprenorphine (SAMHSA, N-SSATS

Report, 2008).

The University of Georgia’s National Treatment Center Studies found that out of the programs responding to the study only: 14.3% used Buprenorphine,

10.7% used Methadone,

15.2% used Naltrexone, and

16.5% used Disulfiram

(Knudsen et al., 2010 – from a 2007 study)

If MAT is effective, why isn’t it more widely used?

Two-thirds of organizations' efforts to

implement change fail (Damschroder et al., 2009).


Treatment philosophy may influence MAT

adoption. For example, persons endorsing a 12-

step model perceive less interest in addiction

medication (McGovern et al., 2004).

Lack of knowledge from physicians

about medication assisted

treatment (Mark et al., 2003).


SAMHSA surveys of physicians who

have been certified to prescribe

buprenorphine indicate that

complexity of induction, medication

costs, and regulatory limits have posed

barriers to prescribing (Thomas et al., 2008).

What do you think?

What is your experience?


Strategies to Increase the Use of MAT

Address Attitudes

Providers' perceptions about the beliefs of their peers are likely to

influence use of medications to treat opiate dependence (Rieckmann et al.,

2007).

Offer Training

Training improves staff attitudes and beliefs (Johnson et al., 2005; Knudsen et

al., 2005; Rieckmann et al., 2011).

Increase Opportunities for Experience

Experience with medications (for counselors) leads to more positive

perspectives (Thomas et al., 2003; Knudsen et al., 2005).


Participate in Research Networks

Research network participation helps promote positive attitudes toward

EBPs (Campbell et al., 2003; Levant et al., 2008).

Integrate Appropriate Structural and Procedural Supports in

Physicians’ Office Settings

While physician knowledge of effectiveness and an organization’s

positive attitude toward medications are important, physicians are

dependent on structural and procedural supports in their office settings

to allow for MAT (Wallack et al., 2010).

What would

you suggest?


What the ATTC Network is Doing … Examples of Product Development Strategies

• Curricula

• Marketing/Outreach Materials

Examples of Educational Strategies

• Online Courses, Regional Presentations & Trainings

• Learning Collaboratives

Examples of Organizational Change Strategies

• Process Improvement

• Coaching

Examples of Systems Transformation Efforts

• Collaborations with state officials to address varying state requirements, regulations and funding






Panel Agenda

NIDA/SAMHSA Blending Initiative

Overview: A Focus on Medication-Assisted Treatment

Thomas E. Freese, Ph.D. University of California – Los Angeles Pacific Southwest ATTC [email protected]

NIDA/SAMHSA Blending Initiative

According to Webster’s Dictionary definition

To Blend means:

a. combine into an integrated whole; b. produce a harmonious effect

http://www.merriam-webster.com/dictionary/blend

What is the Blending Initiative?

• GOAL: To move important scientific findings into mainstream addiction treatment

• Developed in 2001, NIDA and SAMHSA’s Center for Substance Abuse Treatment came together to work on a common vision: – Improve substance use disorder treatment and

accelerate the dissemination of research-based findings into community-based practice.

The NIDA/SAMHSA Blending Initiative encompasses three

components:

• Regional Blending Conferences

• State Agency Partnerships

• Blending Teams

Regional Blending Conferences

• Enhance bi-directional communication among:

• researchers,

• practitioners,

• and policy-makers

• Share innovative scientific findings about drug abuse and addiction

• Convene in different regions of the country

State Agency Partnerships

• NIDA and SAMHSA work closely with federal and state policy-makers to help identify strategies to accelerate the adoption of science-based practices.

Blending Teams

• Use NIDA research findings to design user-friendly science-based tools for use in treatment settings soon after research results are published.

• Teams include members from:

– SAMHSA-CSAT Addiction Technology Transfer Center (ATTC) Network,

– NIDA researchers, and

– Community treatment providers participating in the NIDA Drug Abuse Treatment Clinical Trials Network (CTN).

Blending Process

Selected CTN protocols

or other NIDA

Research

Hand-Off Meeting

Create the charge for Blending Team

Blending Team

Develop dissemination strategies and products

Current Blending Initiative Packages

Blending Initiative Packages

Available in Spanish

BUPRENORPHINE/NALOXONE

A Focus on Medication-Assisted Treatment

Buprenorphine and Buprenorphine/Naloxone Help Patients Quit Opiate Abuse Goal: to disseminate

information and enhance awareness among multi-disciplinary addiction professionals about buprenorphine treatment

http://www.nida.nih.gov/NIDA_notes/NNvol19N3/Successful.html

Buprenorphine Treatment: A Training for Multidisciplinary

Addiction Professionals

Products in Package:

– 6-hour classroom training including a training manual, PowerPoint slides, and the short movie, “Put Your Smack Down! A Video About Buprenorphine”

– Annotated bibliography and research articles

Buprenorphine Treatment: A Training for Multidisciplinary

Addiction Professionals

Goal: to instruct treatment providers about the 13-day buprenorphine intervention.

Short-Term Opioid Withdrawal Using Buprenorphine

Product in Package:

– 4-hour classroom training program including PowerPoint slides and a CD

Buprenorphine/Naloxone

Buprenorphine

Results: Present and Opioid Negative 0001 (Inpatient)

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Clonidine Bup/Nx

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% of opioid free urines

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Day 3-4 Day 7-8 Day 10-11 Day 13-14

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Results: Present and Opioid Negative 0002 (Outpatient)

Goal: to present the results of a buprenorphine trial conducted with young adults.

Buprenorphine Treatment for Young Adults: Findings and Strategies from a

NIDA Clinical Trials Network Study

Product in Package: 3-hour classroom training program including PowerPoint slides and a CD

Results: Opioid Positive Urine Tests

OUTCOMES

Buprenorphine-Related Blending Initiative Products

The ATTC Network has:

• Completed 764 Blending Product Trainings from January 2005-September 2011 (with a total of 15,958 people)

–134 Buprenorphine Treatment (3,317 people)

–18 Short Term Opioid Withdrawal Using Buprenorphine (801 people)

–22 Buprenorphine for Young Adults (318 people)


• Printed and distributed 567,000 brochures introducing each of the Blending Initiatives materials to the field

• Recruited and prepared trainers in every ATTC Region to teach the Blending Initiative materials

• Developed and distributed ancillary products to enhance the reach of the official NIDA products, such as curriculum infusion packages for addiction studies educators at colleges and universities.


• Presented information on the Blending Initiative at State, Regional, and National conferences to:

– Increase awareness about the training materials

– Identify new opportunities to train using the blending products

Products Currently Under Development

1. POATS (Prescription Opioid Addiction Treatment Study)**

2. Onsite HIV Rapid Testing Blending Initiative

Product Dissemination

Download the Products for FREE! Find upcoming trainings offered through SAMHSA’s ATTC Network!

Go to http://www.attcnetwork.org/blendinginitiative

http://www.attcnetwork.org/blendinginitiative





Panel Agenda

MAT with Special Populations

Erin Hobbs, M.P.A. University of Missouri – Kansas City

ATTC National Office [email protected]

Agenda

• Overview of the Project

• Data Collection

• Products Developed

• Next Steps

Overview of the Project

Purpose of the Project SAMHSA grant (TI-10-014) to increase awareness, provide education, and promote access to medication-assisted treatment (MAT) in four specific racial and ethnic minority populations:

African Americans

Asian/Pacific Islanders

Hispanic/Latinos

Native Americans/ Alaska Natives


Purpose of the Project

Goals of the Grant:

1. Collect data and resources to inform the development of products

2. Develop outreach materials for each of the special populations

3. Create training programs for MAT providers designed to enhance professionals’ knowledge and skills related to reaching and educating the special populations about MAT

4. Plan for additional trainings and dissemination of materials


Structure Utilized to Achieve Goals

Agenda


• Data Collection


• Next Steps

Literature Review

• Four Annotated Bibliographies Completed March 2011 by SALIS

• Focused on marketing and persuasion strategies to promote access to and utilization of healthcare services in general, and BH treatment in particular for each of the four special populations

Environmental Scan

• Completed March 2011

• Overview of the relative use and growth in use of MAT among treatment facilities captured in the N-SSATS survey

0%

20%

40%

60%

2002 2003 2004 2005 2006 2007

Facilities Reporting Pharmacotherapy Use, 2002 - 2007

Any Pharmacotherapy Antabuse

Naltrexone Buprenorphine

Metadone

Focus Group Goals

1. To understand the perceived benefits and barriers of MAT

2. To identify attitudes, values and social norms surrounding substance use

3. To learn how experiences and perspectives with MAT differ among various cultural groups

4. To prepare the substance abuse treatment workforce to engage minority populations in MAT

Study Design- Overview

• 8 qualitative focus groups, 90 minutes each

• Four minority populations – African American

– American Indian

– Asian American/Pacific Islander

– Hispanic/Latino

• 10-12 participants per group using MAT for 6 months

• Outpatient behavioral health clinics & substance abuse treatment centers

• New York, Los Angeles (2), Honolulu, Chicago, Oklahoma City (2), Seattle

Participants

• 68 participants – 15 African American

– 18 Asian American

– 19 Hispanic Latino

– 16 Native American/ American Indian

0

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Afr.

Am.

Asian

Am.

H/L Native

Am.

Female

Male

Transgender

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20s 30s 40s 50s 60s 70s 80s

Age Distribution of Participants

Participants

• Primarily unemployed

• Mostly high school educated

Broad Themes

Benefits/Barriers related to MAT

Motivation to use MAT

Role of Family/Significant others

Access to treatment/Barriers

Self-Efficacy

Influence of provider/clinic

MAT as drug v. MAT as medication

Provider Online Survey


• Survey sent to 510 individuals in September 2011

• 42% response rate • Average age = 47 (26~76)

• Average years in field = 13.5 (1~41)

• Purpose: √ Assess provider opinions regarding the use of MAT in the treatment of

patients or clients with substance use disorders, and

√ Assess the extent to which counselors and clinicians are comfortable using different types of communication approaches to talk to their clients about using MAT as part of their treatment recovery plan.

Agenda


• Data Collection


• Next Steps

Products

Outreach Materials

• Brochures

• Pass-along Cards

• Posters

• Website

2 Online Courses

• SUD Tx Providers

• Primary Care Practitioners

Outreach Materials

Prototypes

Outreach Materials Pilots

Four 60-minute Pilot Focus Groups, 20 Participants

• Phoenix, AZ (2)

• Kansas City, MO

• Jefferson City, MO

Purpose of groups were to assess for: Intellectual capacity – was information presented in a way recipients could

easily understand?

Knowledge acquisition – were the materials effective in improving recipients’ knowledge of MAT?

Readiness to Change – were the materials effective in improving recipients willingness to utilize MAT?

General Appearance – were the materials visually appealing and formatted for ease of use?

Final Outreach Materials

Training Program

Online Courses A training program designed to enhance treatment and medical professionals’ general knowledge of medication-assisted treatment (MAT) and improve providers’ skills related to reaching and educating identified minority populations about MAT.

Two Courses: 1. MAT with Special Populations for

Treatment Professionals (NAADAC, NBCC and NASW)

2. MAT with Special Populations for Medical Professionals (CME)

Training Program

MAT with Special Populations (for Treatment Professionals) • 3 Required Core Modules

(2 hours each)

• 4 Special Population Modules (1.5 hours each)

• Narrated Presentations, Videos, Readings, Quizzes, Homework

Pilot Completed in March 2012

• 114 participants – Clinical Supervisors

– Clinicians

– Recovery Specialists

Now Open for Enrollment!

ATTCeLearn.org

Training Program

Poor Excellent

Participants were asked to rate

their knowledge of…

Training Program

MAT with Special Populations (for Medical Professionals) • 3 Required Core Modules

(2 hours each)

• 4 Special Population Modules (1.5 hours each)

• Narrated Presentations, Videos, Readings, Quizzes, Homework

Currently in Pilot (Concludes April 30, 2012)

• 140 participants – Physicians

– Medical Faculty

– Other Medical Professionals (PAs, Nurses..)

MAT Resource Website

ATTCnetwork.org/MAT

Agenda


• Data Collection


• Next Steps

Next Steps

• Data currently being developed into two academic papers, one based upon focus group methodology, one focused on client identity and recovery

• Poster at College on Problems of Drug Dependence (CPDD), June 2012 in Palm Springs, CA

• Marketing and distribution of outreach materials to providers

• eBlasts

• Postcards

• Web Banners

• Promotion of Online Training Program

Panel Agenda





Panel Questions?

Erin Hobbs

[email protected]

Thomas Freese

[email protected]

Laurie Krom

[email protected]

Closing the gap between research and practice:

Successful technology transfer strategies in combating

resistance to medication-assisted treatment

ATTC Network's Efforts to Address Resistance to Medication-Assisted Treatment

Health & Medicine

Transcript of ATTC Network's Efforts to Address Resistance to Medication-Assisted Treatment