Medication Assisted Treatment for Opioid Addiction: 2010 State Profiles

2011·3.4 MB·English

Medication-Assisted Treatment for Opioid Addiction
2010 State Profiles
Medication-Assisted Treatment for Opioid Addiction
2010 State Profiles
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Medication-Assisted Treatment for Opioid Addiction: 2010 State Profiles
Acknowledgements
This report was prepared by Leslie Ann Ba and Willie Tompkins, Jr., Ph.D., for the Substance Abuse
and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services
(HHS).
Contact Information
For further information contact the Center for Substance Abuse Treatment, Division of Pharmacologic
Therapies at [phone] ([email protected]); or Division of State and Community Assistance/
Performance Measurement Branch at [phone].
Disclaimer
The views, opinions, and content of this publication are those of the author and do not necessarily
reflect the views, opinions, or policies of SAMHSA or HHS.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without
permission from SAMHSA. Citation of the source is appreciated. However, this publication may
not be reproduced or distributed for a fee without the specific, written authorization of the Office of
Communications, SAMHSA, HHS.
Electronic Access and Copies of Publication
This publication may be downloaded or ordered at store.samhsa.gov.
Or call 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).
Recommended Citation
Substance Abuse and Mental Health Services Administration, Medication-Assisted Treatment for Opioid
Addiction: 2010 State Profiles, Substance Abuse and Mental Health Services Administration, 2011.
Originating Office
Division of Pharmacologic Therapies and Division of State and Community Assistance, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke
Cherry Road, Rockville, MD 20857.
HHS Publication No. (SMA)-11-4643
Printed 2011
Table of Contents
Acknowledgements ...........................................3 Montana ...........................................................88
Table of Contents ...............................................4 Nebraska .........................................................90
About Medication-Assisted Treatment (MAT) .....5 Nevada ............................................................93
United States .....................................................7 New Hampshire ...............................................96
Highlights .........................................................10 New Jersey ......................................................99
Alabama ............................................................11 New Mexico ...................................................102
Alaska ..............................................................14 New York .......................................................105
Arizona ............................................................17 North Carolina ...............................................108
Arkansas...........................................................20 North Dakota ..................................................111
California .........................................................23 Ohio ................................................................112
Colorado ...........................................................26 Oklahoma .......................................................115
Connecticut ......................................................29 Oregon ............................................................118
Delaware .........................................................32 Pennsylvania .................................................121
District of Columbia ..........................................35 Rhode Island .................................................124
Georgia ............................................................41 South Carolina ...............................................127
Hawaii ..............................................................44 South Dakota .................................................130
Idaho ................................................................47 Tennessee .....................................................131
Illinois ...............................................................49 Texas .............................................................134
Indiana .............................................................52 Utah ...............................................................137
Iowa .................................................................55 Vermont .........................................................140
Kansas .............................................................58 Virginia ...........................................................143
Kentucky ..........................................................61 Washington ....................................................146
Louisiana .........................................................64 West Virginia .................................................149
Maine ...............................................................67 Wisconsin ......................................................152
Maryland ..........................................................70 Wyoming ........................................................155
Massachusetts .................................................73 Guam .............................................................156
Michigan ..........................................................76 Puerto Rico ....................................................157
Minnesota ........................................................79 U.S. Virgin Islands .........................................160
Mississippi .......................................................82 Appendix A .....................................................162
Missouri ...........................................................85
About Medication-Assisted Treatment (MAT)
Medication-assisted treatment involves the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders. Research shows that when treating
certain substance use disorders, a combination of medication and behavioral therapies is regarded as
most successful when treating the disorders. Medication-assisted treatment is clinically driven with a
focus on individualized patient care.
The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department
of Health and Human Services certifies Opioid Treatment Programs (OTPs) that provide methadone
and buprenorphine to treat individuals addicted to opioids such as heroin, oxycodone, or hydrocodone.
Currently, methadone and buprenorphine are the only scheduled opioid medications approved for the
treatment of opioid addiction. SAMHSA’s Center for Substance Abuse Treatment (CSAT) manages the
day-to-day regulatory oversight activities necessary to implement SAMHSA regulations, 42 CFR Part
8, on the use of opioid agonist medications (methadone and buprenorphine) approved by the Food and
Drug Administration (FDA) for addiction treatment. These activities include supporting the certification
of over 1,200 OTPs that collectively treat over 270,000 patients daily.
CSAT manages the operational requirements of the Drug Addiction Treatment Act of 2000 (DATA 2000),
which expands the clinical context of medication-assisted opioid addiction treatment by allowing qualified
physicians to dispense or prescribe specifically approved Schedule III, IV, and V narcotic medications for
the treatment of opioid addiction in treatment settings other than the traditional opioid treatment program.
Currently, the only medications that meet the statutory provisions of DATA 2000 are buprenorphine and
buprenorphine in combination with naloxone. Additionally, CSAT supports the training of medical and
substance abuse professionals on a variety of treatment issues including the use of methadone and
buprenorphine. For additional information visit http://www.dpt.samhsa.gov/.
Methadone
Methadone is a synthetic opioid that blocks the effects of heroin and other prescription drugs containing
opioids. Used successfully for more than 40 years in treating opioid addiction, methadone has been
shown to eliminate withdrawal symptoms and relieve drug cravings from heroin and prescription opioid
medications. Methadone is a medication that prevents opioid withdrawal symptoms for up to 36 hours
and must be taken daily. Taken as directed, methadone:
• blocks the euphoric and sedating effects of opioids;
• relieves the craving for opioids that is a major factor in relapse;
• relieves symptoms associated with withdrawal from opioids;
• does not cause euphoria or intoxication itself (with stable dosing), thus allowing a person to work
and participate normally in society; and
• is excreted slowly so it can be taken only once a day.
The use of methadone for medication-assisted treatment was developed in the 1960s, and is a form of
pharmacotherapy for the treatment of addiction or dependence to opioids, which includes a pharmaco-
logic intervention as part of a comprehensive substance abuse treatment plan, with an ultimate goal of
patient recovery with full social function.
Methadone has been demonstrated to reduce mortality, decrease transmission of HIV and other
blood-borne illnesses, and improve maternal and fetal outcomes during pregnancy. In light of these
well-established benefits, it is important to recognize that there may be side effects of methadone,
some of which may be severe and in some cases fatal, including cardiac arrhythmia and the risk of
respiratory depression and overdose.
Buprenorphine
Buprenorphine is a medication used for detoxification and maintenance therapy in the treatment of
opioid addiction. It works by blocking withdrawal and craving without producing euphoric effects. It is
the only opioid addiction treatment medication that can be prescribed by a physician in an office setting.
The brand names Subutex® and Suboxone® are prescription medicines that both contain buprenor-
phine and treat opioid addiction by preventing symptoms of withdrawal from heroin and other opioids.
Subutex® contains only buprenorphine hydrochloride, while Suboxone® contains the additional ingredi-
ent naloxone to guard against misuse.
While the safety profile of buprenorphine--a partial opioid agonist--is generally better than full opioid
agonists, the risk of central nervous system (CNS) depression still exists and caution must be used,
particularly in cases where other CNS depressants are present.
The Drug Addiction Treatment Act of 2000 (DATA 2000)
This act enables qualifying physicians to receive a waiver from the special registration requirements
in the Controlled Substances Act for the provision of medication-assisted opioid therapy. This waiver
allows qualifying physicians to practice medication-assisted opioid addiction therapy with Schedule
III, IV, or V narcotic medications specifically approved by the FDA. On October 8, 2002, Subutex®
(buprenorphine hydrochloride) and Suboxone® tablets (buprenorphine hydrochloride and naloxone
hydrochloride) received FDA approval for the treatment of opioid addiction. Subsequently in 2009 and
2010, the FDA approved two generic versions of Subutex®.
To receive a waiver, a physician must notify SAMHSA of his or her intent to begin dispensing or pre-
scribing this treatment. The Notification of Intent must contain information on the physician’s qualifying
credentials and additional certifications including that the physician has the capacity to refer such
addiction therapy patients for appropriate counseling and other non-pharmacologic therapies, and that
the physician will not have more than 100 patients on such addiction therapy at any one time. When the
waiver is received, the physician may then begin using buprenorphine for the treatment of opioid addic-
tion. For additional information visit http://buprenorphine.samhsa.gov/.
State Opioid Addiction Treatment System Maps
Within this report, two maps are presented for each state: Certified OTPs and DATA Certified
Physicians. The maps are intended to provide an overview of locations and were produced using street
addresses. Location points on both types of individual state maps may overlap due to multiple sites in
close proximity to one another.
A searchable directory of more than 11,000 drug and alcohol treatment programs that shows the
location of facilities around the country that treat alcoholism and alcohol and drug abuse problems
is available at http://findtreatment.samhsa.gov. A physician locator that similarly identifies physicians
who are authorized to prescribe buprenorphine is available at http://buprenorphine.samhsa.gov/
bwns_locator.
United States
These two maps present an overview of medication-assisted therapy in the States and territories of
the United States. They focus particular attention on SAMHSA certified OTPs that provide medication-
assisted therapy to treat individuals addicted to opioids such as heroin, oxycodone, or hydrocodone.
The first map shows the States with OTPs, and the second shows the number of patients. New York,
California, and Texas have the largest number of OTPs at 152, 146 and 78 respectively.
Number of Opioid Treatment Programs (March 2010)
Total Number of OTPs: 1,216
Source: SAMHSA, CSAT. OTP Database. March 2010.
*No data were reported by Idaho and Montana for March 31, 2008.
Number of Patients (March 31, 2008) in the U.S.
Total Number of Patients in OTPs: 272,351
Source: SAMHSA, CBHSQ. National Survey of Substance Abuse Treatment Services (N-SSATS).
March 31, 2008.
The map below presents the number of physicians who have a waiver to prescribe or dispense
buprenorphine and the number of patients in OTPs by State. New York, California, and Pennsylvania
have the largest number of physicians who dispense buprenorphine at approximately 2,096, 2,087, and
1,165 respectively. However, New York, California, and Minnesota have the three largest numbers of
patients receiving buprenorphine via OTPs.
Number of DATA Waived Physicians by State (March 2010)
Total Number of Physicians: 18,842
Source: SAMHSA, CSAT. OTP Database. March 2010.
Total Number of Patients Receiving Buprenorphine via OTPs: 4,280
Source: SAMHSA, CBHSQ. National Survey of Substance Abuse Treatment Services (N-SSATS).
March 31, 2008.
Highlights
SAMHSA’s Center for Behavioral Health Statistics and Quality (CBHSQ) conducts the National Survey
of Substance Abuse Treatment Services (N-SSATS), an annual census survey of all known facilities
in the United States, both public and private, that provide substance abuse treatment. The overall
response rate for the 2008 survey was 94.1 percent, and N-SSATS provides point prevalence data.
Major highlights from the 2008 N-SSATS, conducted on March 31, 2008, are listed below.
• Of the 13,688 facilities responding to N-SSATS, OTPs certified by SAMHSA were available at 1,132
facilities or 8 percent of all substance abuse treatment facilities and patients receiving methadone or
buprenorphine accounted for 24 percent of all patients in treatment.
• Of the 272,351 clients receiving one of the two medications approved for the treatment of opioid
addiction, 98 percent received methadone. Of the 15,732 clients receiving buprenorphine, the
majority (73 percent) did not receive it from OTPs.
• Between 2004 and 2008, the proportion of clients in all facilities receiving methadone or buprenor-
phine ranged from 22 percent to 24 percent.
• Most facilities with OTPs offered outpatient treatment (92.2 percent). Outpatient methadone/
buprenorphine maintenance was offered in 88.7 percent, regular outpatient treatment in 62 percent,
detoxification in 47.4 percent, intensive outpatient treatment in 25.7 percent, and day treatment/
partial hospitalization in 8.1 percent of facilities with OTPs.
• Federal government-operated facilities (i.e., Veterans Administration, Tribal government) with OTPs
were more likely than facilities of other operational structures to offer more than one type of care.
One-hundred percent of the Federal government-operated facilities with OTPs offered outpatient
treatment, 50 percent offered hospital inpatient treatment, and 36.1 percent offered residential (non-
hospital) treatment. Ninety-four percent offered outpatient methadone/buprenorphine maintenance.
Private for-profit facilities with OTPs had the lowest proportions of facilities offering residential
(non-hospital) and hospital inpatient treatment at 3.8 percent and 3.2 percent respectively.
The requirement for SAMHSA’s approval of OTPs is that they be accredited by an approved accredi-
tation organization. Of the OTPs, 27 percent were accredited by The Joint Commission (formerly
known as Joint Commission on Accreditation of Health Care Organization-JCAHO), 66.4 percent by
the Commission on Accreditation of Rehabilitation Facilities (CARF), 4.3 percent by the Council on
Accreditation (COA), .9 percent by the National Commission on Correctional Health Care (NCCHC),
and 1.4 percent by the State Accreditation Authority.