SC MAT ACCESS Medication Assisted Treatment Academic Community - - PowerPoint PPT Presentation

SC MAT ACCESS

Medication Assisted Treatment Academic Community Capacity Expansion for Sustainable Success Kathleen Brady, MD, PhD, VPR, MUSC

Overdose Death Rates from Opiates

Most important sign of a SUD Marked increase from 1999 to 2014 by county

1999 2014

 Opioid OD Deaths US, 2000-2015

2015 Overdose Deaths: 52,404 Any Drug 33,091 Any Opioid

266 260 253 242 234 222 250 300 200 150 100 50

201020112012201320142015

OPIOID MME IN BILLIONS Source: IMS Health, U.S. Outpatient Retail Setting

 Opioid morphine milligram equivalents (MME) dispense fell by over 15% from 2010-2015

Opioid Prescriptions have started to Decrease

but

Opioid Fatalities are still Increasing

Heroin Price Has Decreased in Recent Years

4 out of 5 new heroin users started with rx opioids

"Retail" Price Per PureGram

$3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $-

National Drug Control Strategy--Data Supplement 2014. https://www.whitehouse.gov/sites/default/files/ondcp/policy-and- research/ndcs_data_supplement_2014.pdf

Emerging Illicit Synthetic Opioids

 Increasing reports of fentanyl

laced - heroin and prescription pills.

Other synthetic opioids emerging

i.e., Carfentanil.

HOW DID WE GET HERE?

OPIOID DEPENDENCE IN South Carolina

› Since 1999, rate of opioid- related deaths has quadrupled › In SC, 600 opioid-related deaths in 2015 › In 2015, 1 RX for an opioid was written for every adult in SC › SC in top quartile for opioid prescriptions › SC in lowest quartile re: access to medication treatment for opioid dependence

Opioid Prescribing

JAMA, published online August 6, 2014

Opioid-Involved Overdose Deaths by County of Occurrence in 2015

SC DHEC, 2017

Medications Are Effective and Save Lives

Medication Assisted Treatment (MAT) DECREASES:

• Opioid use
• Opioid-related overdose
• Criminal activity
• Infectious disease

transmission And INCREASES

• Social functioning
• Retention in treatment

But MAT is highly underutilized Opioid Agonist Treatments Decreased Heroin OD Deaths

Baltimore, Maryland, 1995-2009

Schwartz RP et al., Am J Public Health 2013.

Medication Assisted Treatment (MAT) in Opioid Dependence: Lifesaving!!!!

+ + + + + + + + + + + + + + + + + + + Methadone

Agonist

Buprenorphine

Partial Agonist

Naltrexone

Antagonist

Narcan Administration Counts by County, 2015 & 2016

SC DHEC, 2017

Methadone Treatment Centers, 2017

Buprenorphine Waivered Physicians by County, 2017

4 12 1 11 5 50 2 1 2 1 4 3 2 3 5 1 46 4 14 2 2 10 9 7 50 13 5 1 7

* 4 physicians did not provide valid county identifier

1 SAMHSA, 2017

21st Century Cures Act

Enacted Dec 2016, included: › Landmark mental health reform bill › Monies for states to fight

• pioid epidemic

› PDMP › Primary care involvement › Train in best practices › Prevention

SC MAT ACCESS

South Carolina Medication Assisted Treatment Academic Community Capacity Expansion for Sustainable Success

 A Partnership between MUSC and

the Department of Alcohol and Other Drug Services

 Improve access to evidence-based

treatments for opioid dependence throughout SC

Reaching Rural Areas to Address the Opioid Epidemic

 Multiple rural counties

26 counties share 233 doctors

 Many counties only 1-2 physicians

per 10,000

 Can academic detailing spread

best practices?

 Can telehealth be used for

specialized service delivery, consultation and training?

The South Carolina Telehealth Alliance

 Statewide collaboration to expand

Telehealth services statewide

 Headquartered at MUSC Center for

Telehealth: Dr. Jimmy McElligot

 Provides guidance, assists with

strategic development, advises on technology and standards to develop an open-access net

 Will assist with equipment/consultation

for SC MAT ACCESS

SC MAT ACCESS An Overview of the Initiative

Jenna McCauley, PhD

Methadone Buprenorphine Pill, liquid, and wafer Buccal film, sublingual tablet, film Taken once a day Taken once a day (at home) Combined with counseling & social support Combined with counseling & social support Receive medication under supervision

• f physician

Receive mediation under supervision of physician, NP, or PA Length of treatment: Minimum 12 mos. Length of treatment: Minimum 6-12 mos. Only dispensed at SAMHSA certified Opioid Treatment Program (OTP) Can be dispensed in physician’s office, community hospitals, health departments, OTPs, & correctional facilities

Training & Support for MAT Delivery Academic Detailing Interactive Web Resource

Academic Detailing

• University or non-commercial based educational outreach to

physicians and their staff

• Face to face education
• Delivered by trained healthcare professionals
• Structured visits
• Topics
• Responsible opioid prescribing
• Risk mitigation strategies
• Screening, brief intervention, and referral to treatment (SBIRT)
• Becoming a MAT provider

Other Educational Trainings

• Neurobiology and Epidemiology of Addictive Disorders
• Overview of the Opioid Epidemic
• Neurobiology, Epidemiology, and Treatment of Opioid Use Disorders
• Medication Assisted Treatment
• SBIRT Implementation
• Motivational Interviewing
• Practice Support

Training & Support for MAT Delivery

Training & Support for MAT Delivery

Pre-Implementation Needs Assessment:

• Strengths and resources of organization
• Personnel
• Fiscal
• Space
• Technology
• Relative weaknesses and needs of organization
• Workflow integration
• Who?
• When?
• Where?
• How many?

Training & Support for MAT Delivery

Waiver Training

• Drug Addiction Treatment Act of 2000 (DATA 2000)
• 8-hour training (16 hours for NPs) to qualify for a waiver to

prescribe and dispense buprenorphine

• DATA 2000 Waiver options:
• Buprenorphine Waiver Training at the American Academy of

Addiction Psychiatry

• American Society of Addiction Medicine Buprenorphine Course

for Office-Based Treatment of Opioid Use Disorders

• Providers Clinical Support System for Medication Assisted

Treatment Self-Study at the American Academy of Addiction Medicine

Next Steps:

• Registration (with proof of training)
• Patient limits: 30  100  275 (at least one year in each category)
• Record keeping requirements (ongoing)
• Staff training
• Prior authorizations and funding?
• Referral options for higher level of care

SC MAT ACCESS Website

• Resource for healthcare providers interested in:
• Learning more about MAT
• Becoming MAT providers
• Receiving ongoing practice support for their delivery of MAT
• Online repository for:
• Academic Detailing educational materials
• Trainings and presentations offered by our group across South Carolina
• ECHO consultation didactic seminars
• Practice support resources
• Promotes ongoing, bi-directional communication between South

Carolina MAT-providers and the MUSC practice support team:

• Online discussion forum
• Colleague Connections directory
• Consultation request form
• Updates and News

Training & Support for MAT Delivery

SC MAT ACCESS Project ECHO for MAT Success

Louise Haynes, M.S.W.

Although the ECHO model makes use

• f telecommunications technology, it is

different from telemedicine.

ECHO

Extension for Community Healthcare Outcomes

• Founded by a professor of Internal

Medicine at the University of New Mexico, Project ECHO started as a clinic to treat underserved Hepatitis C patients.

• The success of the model is due to

its simplicity and cost effectiveness.

• ECHO decreases provider isolation

and increases confidence.

ECHO Model

Hub and spoke knowledge-sharing network Hub and spoke knowledge-sharing network Led by expert teams Led by expert teams Clinicians learn to provide excellent specialty care for patients in their own communities. Clinicians learn to provide excellent specialty care for patients in their own communities. Project Echo allows for the collaboration of: ✓specialists at academic medical centers ✓community-based primary care providers to co-manage patients with a broad range of conditions. Over time, primary care providers develop the competencies needed to effectively manage complex patients independently. Project Echo allows for the collaboration of: ✓specialists at academic medical centers ✓community-based primary care providers to co-manage patients with a broad range of conditions. Over time, primary care providers develop the competencies needed to effectively manage complex patients independently.

Since its launch in 2003, the ECHO model has continued to draw interest, first with partner sites, then with a nationwide pilot by the U.S. Department of Veterans Affairs, and more recently, with a global chronic pain management program with the Department of Defense. Numerous other federal agencies, academic medical centers, and even other countries are in various stages of exploring or implementing Project ECHO.

Currently ECHO model initiatives focus on multiple diseases and high need aspects of care throughout the country and internationally.

Hepatitis C Behavioral Health Autism Child Abuse Sickle Cell Disease TB HIV

 Pain  Transgender Health  Maternal and Child Health  Geriatrics  Epilepsy  Palliative Care  Cancer

“If we can leverage technology to spread best practices through case-based learning and mentoring of providers, we can move knowledge – instead of patients – to get better care to rural and underserved communities across the country.” “Medical knowledge is exploding, but it’s often not traveling the last mile to ensure that patients get the right care in the right place at the right time.”

Using telemedicine technology through the MUSC Center for Telemedicine, SC MAT ACCESS will identify medical providers in SC who are interested in joining a mentoring network for supporting medication assisted treatment in community practices. Providers and MUSC experts in opioid treatment will be connected through telemedicine technology.

South Carolina’s ECHO Network South Carolina’s ECHO Network

Now nearly 300 clinicians in New Mexico are certified to prescribe buprenorphine—the best-practice treatment medication for opiate addiction. Before Project ECHO, fewer than a dozen clinicians in New Mexico were certified to prescribe Buprenorphine.

ECHO Plan for SC MAT ACCESS TEAM

• Team to attend training in New Mexico later this month.
• Model proposes a one hour weekly conference.
• The first half of the conference will be a case-based presentation by one of the

practitioners followed by group discussion. The second half will include a brief presentation by the MUSC team on a relevant topic.

• Topics for the didactics will be chosen by participants and/or based on case

material presented. The MUSC ECHO Coordinator will provide the liaison between participating practices and the MUSC team to schedule case presentation and didactics.

• Additionally, individual consultation concerning practice or patient-specific issues

will be available. Practitioners can request a consultation through a link on the SC MAT ACCESS website, and there will be a response within 24 hours.

Sample Topics

Introduction to Addiction Brady Opioids Brady Opioid Use Disorder (OUD) Barth Medication Assisted Treatment for OUD Brady Overview of Chronic Pain Barth Non-Opioid Pain Medications Barth Integrated Pain Care McCauley Screening for Depression, Anxiety and SUD Barth Assessment of OUD Barth Opioids Co-Prescribed with Other Meds Guille Pain and Addiction in Pregnancy Guille Alternative Treatments for Pain Borchardt Fibromyalgia/Osteoarthritis TBD Headaches/Complex Regional Pain Syndrome TBD Motivational Interviewing Killeen SBIRT Haynes 12-step Facilitation Haynes Recovery Haynes Cognitive Behavioral Therapy McCauley

 People need access to specialty care for their complex health conditions.  There aren't enough specialists to treat everyone who needs care, especially in rural and underserved communities.  ECHO trains primary care clinicians to provide specialty care services. This means more people can get the care they need.  Patients get the right care, in the right place, at the right time. This improves

• utcomes and reduces costs.

 South Carolina MAT ACCESS will use ECHO Model to enhance the state’s capacity to provide care to citizens with opioid related

• problems. With a focus on primary care providers.

OUR TEAM IS EAGER TO HEAR FROM YOU!

 What challenges do you face in providing care to

people with problems related to opioid use?

 What barriers do you face in your community?  How could our project help to address those

barriers?

For Additional Information Contact: Rachel Grater Program Coordinator II SC MAT ACCESS grater@musc.edu (843) 792-5380