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

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

  1. 1. Closing the gap between research and practice: Successful technology transfer strategies in combating resistance to medication-assisted treatment Addressing Resistance toMedication-Assisted Treatment An ATTC Network Panel PresentationAmerican Association for the Treatment of Opioid Dependence (AATOD) 2012 National Conference
  2. 2. Panel Agenda • 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
  3. 3. The ATTC Network 2007-2012 Southern Coast 3
  4. 4. The ATTC Network’s VisionAll professionals who address the needs of individuals with, orwho are at risk of having, substance use disorders will utilizeeffective, culturally responsive practices that lead to improvedhealthcare and long-term health and wellness.
  5. 5. What is Technology Transfer? Southern Coast
  6. 6. What is Technology Transfer? Copyright 2010 ATTC Network
  7. 7. Panel Agenda • 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
  8. 8. Medication-AssistedTreatment (MAT) is the use of medication, combined with counseling and behavioral therapies, to provide a whole patientapproach to the treatmentof substance use disorders. (http://www.dpt.samhsa.gov )
  9. 9. Medications for Alcohol Dependence  Naltrexone (ReVia®, Vivitrol®, Depade®)  Disulfiran (Antabuse®)  Acamprosate Calcium (Campral®) Medications for Opioid Dependence Methadone Buprenorphine (Suboxone® and Subutex®) Naltrexone
  10. 10. 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.
  11. 11. 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)
  12. 12. If MAT is effective, why isn’t it more widely used?Two-thirds of organizations efforts to implement change fail (Damschroder et al., 2009).
  13. 13. 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).
  14. 14. 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).
  15. 15. If MAT is effective, why isn’t it more widely used? What do you think? What is your experience?
  16. 16. 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).
  17. 17. 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).
  18. 18. Strategies to Increase the Use of MAT What would you suggest?
  19. 19. Strategies to Increase the Use of MAT 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
  20. 20. Panel Agenda • 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
  21. 21. NIDA/SAMHSA Blending Initiative Overview: A Focus on Medication- Assisted TreatmentThomas E. Freese, Ph.D.University of California – Los AngelesPacific Southwest ATTCtfreese@mednet.ucla.edu
  22. 22. NIDA/SAMHSA Blending InitiativeAccording to Webster’s DictionarydefinitionTo Blend means: a. combine into an integrated whole; b. produce a harmonious effecthttp://www.merriam-webster.com/dictionary/blend
  23. 23. 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.
  24. 24. The NIDA/SAMHSA BlendingInitiative encompasses three components:• Regional Blending Conferences• State Agency Partnerships• Blending Teams
  25. 25. 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
  26. 26. 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.
  27. 27. 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).
  28. 28. Blending ProcessSelected CTN protocols or other NIDA Research Hand-Off Meeting Create the charge for Blending Team Blending Team Develop dissemination strategies and products
  29. 29. Current Blending Initiative Packages
  30. 30. Blending Initiative Packages Available in Spanish
  31. 31. A Focus on Medication-AssistedTreatmentBUPRENORPHINE/NALOXONE
  32. 32. Buprenorphine Treatment: A Training for Multidisciplinary Addiction Professionals Buprenorphine and Buprenorphine/Naloxone Help Patients Quit Opiate Abuse Goal: to disseminate information and enhance awareness among multi- disciplinary addiction professionals about buprenorphine treatmenthttp://www.nida.nih.gov/NIDA_notes/NNvol19N3/Successful.html
  33. 33. Buprenorphine Treatment: A Training for Multidisciplinary Addiction ProfessionalsProducts 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
  34. 34. Short-Term Opioid Withdrawal Using BuprenorphineGoal: to instruct treatment providers aboutthe 13-day buprenorphine intervention. Buprenorphine/NaloxoneProduct in Package: – 4-hour classroom training program including PowerPoint slides and a CD Buprenorphine
  35. 35. Results: Present and Opioid Negative 0001 (Inpatient) Clonidine Bup/Nx% of Individuals present at end of taper 90 80 70 60 50 40 30 20 10 0 Day 3-4 Day 7-8 Day 10-11 Day 13-14 % of opioid free urines
  36. 36. Results: Present and Opioid Negative 0002 (Outpatient) Clonidine Bup/Nx% of Individuals present at end of taper 90 80 70 60 50 40 30 20 10 0 Day 3-4 Day 7-8 Day 10-11 Day 13-14 % of opioid free urines
  37. 37. Buprenorphine Treatment for Young Adults: Findings and Strategies from a NIDA Clinical Trials Network StudyGoal: to present the results of abuprenorphine trial conducted with youngadults. Product in Package: 3-hour classroom training program including PowerPoint slides and a CD
  38. 38. Results: Opioid Positive Urine Tests
  39. 39. Buprenorphine-Related BlendingInitiative ProductsOUTCOMES
  40. 40. 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)
  41. 41. 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.
  42. 42. 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
  43. 43. Products Currently Under Development1. POATS (Prescription Opioid Addiction Treatment Study)**2. Onsite HIV Rapid Testing Blending Initiative
  44. 44. Product DisseminationDownload the Products for FREE! Find upcoming trainings offered through SAMHSA’s ATTC Network! Go to http://www.attcnetwork.org/blendinginitiative
  45. 45. Panel Agenda • 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
  46. 46. MAT with Special Populations Erin Hobbs, M.P.A. University of Missouri – Kansas City ATTC National Office hobbse@umkc.edu
  47. 47. Agenda• Overview of the Project• Data Collection• Products Developed• Next Steps
  48. 48. Overview of the ProjectPurpose of the ProjectSAMHSA grant (TI-10-014) to increase awareness, provideeducation, and promote access to medication-assisted treatment(MAT) in four specific racial and ethnic minority populations: African Americans Hispanic/Latinos Asian/Pacific Native Americans/ Islanders Alaska Natives
  49. 49. Overview of the ProjectPurpose 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
  50. 50. Overview of the ProjectStructure Utilized to Achieve Goals
  51. 51. Agenda• Overview of the Project• Data Collection• Products Developed• Next Steps
  52. 52. 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
  53. 53. Environmental Scan• Completed March 2011 Facilities Reporting Pharmacotherapy Use, 2002 - 2007• Overview of the relative 60% use and growth in use of 40% MAT among treatment 20% facilities captured in the N-SSATS survey 0% 2002 2003 2004 2005 2006 2007 Any Pharmacotherapy Antabuse Naltrexone Buprenorphine Metadone
  54. 54. Focus Group Goals1. To understand the perceived benefits and barriers of MAT2. To identify attitudes, values and social norms surrounding substance use3. To learn how experiences and perspectives with MAT differ among various cultural groups4. To prepare the substance abuse treatment workforce to engage minority populations in MAT
  55. 55. 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
  56. 56. Participants• 68 participants 14 12 – 15 African American 10 – 18 Asian American 8 Female – 19 Hispanic Latino 6 Male – 16 Native American/ 4 Transgender American Indian 2 0 Afr. Asian H/L Native Age Distribution of Participants Am. Am. Am.2520 • Primarily15 unemployed Participants10 • Mostly high school5 educated0 20s 30s 40s 50s 60s 70s 80s
  57. 57. Broad ThemesBenefits/Barriers related to MATMotivation to use MATRole of Family/Significant othersAccess to treatment/BarriersSelf-EfficacyInfluence of provider/clinicMAT as drug v. MAT as medication
  58. 58. Provider Online SurveyProvider 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.
  59. 59. Provider Online Survey
  60. 60. Agenda• Overview of the Project• Data Collection• Products Developed• Next Steps
  61. 61. ProductsOutreach Materials• Brochures• Pass-along Cards• Posters• Website 2 Online Courses • SUD Tx Providers • Primary Care Practitioners
  62. 62. Outreach Materials Prototypes
  63. 63. Outreach Materials PilotsFour 60-minute Pilot Focus Groups, 20 Participants• Phoenix, AZ (2)• Kansas City, MO• Jefferson City, MOPurpose 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?
  64. 64. Final Outreach Materials
  65. 65. Training ProgramOnline CoursesA training program designed to enhance treatment and medical professionals’general knowledge of medication-assisted treatment (MAT) and improveproviders’ skills related to reaching and educating identified minoritypopulations 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)
  66. 66. Training ProgramMAT with Special Populations(for Treatment Professionals) ATTCeLearn.org• 3 Required Core Modules (2 hours each)• 4 Special Population Modules (1.5 hours each)• Narrated Presentations, Videos, Readings, Quizzes, HomeworkPilot Completed in March 2012• 114 participants – Clinical Supervisors – Clinicians Now Open for Enrollment! – Recovery Specialists
  67. 67. Training ProgramParticipants were asked to ratetheir knowledge of… Poor Excellent
  68. 68. 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, HomeworkCurrently in Pilot (Concludes April 30, 2012)• 140 participants – Physicians – Medical Faculty – Other Medical Professionals (PAs, Nurses..)
  69. 69. MAT Resource Website ATTCnetwork.org/MAT
  70. 70. Agenda• Overview of the Project• Data Collection• Products Developed• Next Steps
  71. 71. 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
  72. 72. Panel Questions?Closing the gap between research and practice:Successful technology transfer strategies in combatingresistance to medication-assisted treatmentPanel Agenda• 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 PopulationsErin Hobbs Thomas Freese Laurie Kromhobbse@umkc.edu tfreese@mednet.ucla.edu kroml@umkc.edu

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