Recently, the Substance Abuse and Mental Health Administration (SAMHSA), a division of the U.S. Department of Health and Human Services, made an important recommendation that will impact anyone who works in the field of opioid addiction. By extension, anyone who is treated for opioid addiction is also affected by this breakthrough information.
(Photo: CleanSlate board member Patrick J. Kennedy assists CleanSlate employees in a ribbon-cutting for its new center in E. Indianapolis. CleanSlate helps patients suffering from addiction through medication for addiction treatment.)
The new guidance, Treatment Improvement Protocol #63 (TIP 63), “Medications for Opioid Use Disorders, reaffirms that the model of office-based opioid treatment (OBOT) programs offers the evidence-based care recommended at the highest levels of science and medicine. The federal government’s addiction experts clearly agree that providing ongoing pharmacotherapy to support recovery is the standard of care for treating opioid addiction.
As the Chief Medical Officer of CleanSlate, a national leader in medication for addiction treatment, I’m encouraged by these developments because I know all too well the challenges around providing treatment based on the scientific facts. We at CleanSlate look forward to working closely with providers throughout the addiction field to help them meet SAMHSA’s recommendations.
Reframing the traditional addiction treatment model
SAMHSA’s guidance will initially be controversial and confusing for some people unfamiliar with evidence-based addiction medical care. Some historical treatment programs that don’t offer or allow access to medication for addiction treatment will react to a number of the TIP statements.
The old term, “Medication Assisted Treatment” is not used, because medications do not assist treatment. The TIP states: “Medication is an effective treatment for opioid addiction. People with opioid addiction should be referred for an assessment for pharmacotherapy unless they decline. Discussing medications that treat opioid addiction with those with this disorder is the clinical standard of care.”
Just as doctors wouldn’t deny people with diabetes the medication they need to help manage their illness, SAMHSA states, “it is also not sound medical practice to deny people with opioid addiction access to FDA-approved medications for their illness.”
SAMHSA’s guidelines include the following key messages:
- Approaching opioid use disorder (OUD) as a chronic illness can help providers deliver care that helps patients stabilize, achieve remission of symptoms, and establish and maintain recovery.
- Patients should receive information from their healthcare team that will help them understand OUD and the options for treating it, including treatment with FDA-approved medication.
- Ongoing outpatient medication treatment for OUD is linked to better retention and outcomes than treatment without medication.
- The science demonstrating the effectiveness of medication for OUD is strong.
- Medication for OUD should be successfully integrated with outpatient and residential treatment.
- Patients treated with medications for OUD can benefit from individualized psychosocial supports
- Expanding access to OUD medications is an important public health strategy.
- Improving access to treatment with OUD medications is crucial to closing the wide gap between treatment need and treatment availability, given the strong evidence of effectiveness for such treatments
- Data indicate that medications for OUD are cost beneficial
Working together throughout the continuum of care
This new national Treatment Improvement Protocol will take time for everyone in the field of addiction to digest. But the bottom line is that the national guidance places greater weight on the science of addiction than ever before.
SAMHSA states that patients with opioid addiction should also have access to mental health services as needed, medical care, and addiction counseling, as well as recovery support services, to supplement treatment with medication. This is logical and consistent with the care coordination that many OBOT programs like CleanSlate offer. After all, we know that “medicines don’t take themselves;” if patients’ basic needs aren’t addressed, they cannot manage their chronic disease of addiction.
As SAMHSA has now stated, addiction programs that provide treatment for opioid addiction should make medication treatment available to every patient who expresses interest in this form of care. CleanSlate stands ready to assist our colleagues throughout the care continuum in providing medical treatment to their patients. We hope that this breakthrough guidance will help dissolve the frustrating stigma around medication treatment and that more people will help patients get access to the care they deserve.
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