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
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ATTC Network's Efforts to Address Resistance to Medication-Assisted Treatment
This presentation will address efforts by the ATTC Network to decrease the gap between research and practice and to influence understanding of factors that enhance uptake of innovations. This presentation outlines how pairing research with innovative dissemination techniques can enhance the use of EBPs related to MAT. The presentation will provide an overview of the Buprenorphine Suite, a training product designed by the ATTC Network to provide the SUD treatment field with the tools to access and adopt NIDA treatment protocols. Additionally this presentation will identify research undertaken by the Network which identifies barriers to providing MAT to minority populations.
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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
• 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
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.
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).
If MAT is effective, why isn’t it more widely used?
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).
If MAT is effective, why isn’t it more widely used?
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?
If MAT is effective, why isn’t it more widely used?
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).
Strategies to Increase the Use of MAT
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?
Strategies to Increase the Use of MAT
What the ATTC Network is Doing … Examples of Product Development Strategies
• Collaborations with state officials to address varying state requirements, regulations and funding
Strategies to Increase the Use of MAT
• 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
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
• 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)
The ATTC Network has:
• 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.
The ATTC Network has:
• 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
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
Overview of the Project
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
Overview of the Project
Structure Utilized to Achieve Goals
Agenda
• Overview of the Project
• Data Collection
• Products Developed
• 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
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
2
4
6
8
10
12
14
Afr.
Am.
Asian
Am.
H/L Native
Am.
Female
Male
Transgender
0
5
10
15
20
25
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
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.
Provider Online Survey
Agenda
• Overview of the Project
• Data Collection
• Products Developed
• 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