Dayton agency uses NIATx principles to start a medication-assisted program

NIATx Principle 4, “Get ideas from outside the organization or field,” helped the change team from Addiction Services in Dayton, Ohio, think about how they’d like to set up a medication-assisted treatment (MAT) program with Suboxone®.

“We visited other agencies to see how they operate their MAT practices,” says William C. Roberts II, Bureau Chief for the agency. “That gave us the idea of adding a nurse practitioner to coordinate the program for the prescribing physician.”

Addiction Services is a division within Public Health-Dayton & Montgomery County. It was one of more than 50 Ohio treatment agencies that participated in the NIATx Ohio Buprenorphine Implementation Study.

The agency offers assessments, referrals, and intensive and non-intensive outpatient treatment, serving more than 800 adult clients each year. Most of the agency’s clients are Medicaid-eligible or uninsured. Opioid misuse is the most prevalent drug problem in the area.

The agency is currently preparing a location to house the MAT program, scheduled to open in fall 2016.

“We have a nurse on board as well as a case manager and other staff,” says Roberts. “Now, we’re actively seeking a physician prescriber.”

Initial resistance to MAT

As in a lot of treatment organizations, there was some initial resistance to offering MAT at Addiction Services.

Recognizing that MAT could ease patients’ withdrawal symptoms and get them engaged in treatment more easily helped convince staff of the benefits of offering medication, in combination with counseling.

“Our treatment philosophy has favored abstinence-based approaches, but over time we have come to see the benefits of MAT in combination with other therapeutic interventions,” says Roberts.

Securing a physician prescriber

Physicians must complete training to obtain a special waiver (the Drug Addiction Treatment Act of 2000 or DATA 2000 waiver) to prescribe buprenorphine. Until recently, waivered physicians could only treat 30 patients in the first year after receiving the waiver, and up to 100 in the following years. A new federal regulation approved in June 2016 increased the limit rule. Now, waivered physicians who have prescribed buprenorphine to 100 patients for at least one year can apply to treat as many as 275 patients.

In the Dayton area, existing physician prescribers are currently at their patient cap and unable to take on additional patients. Roberts is hopeful that the recent change in the patient cap will make a physician available for the Addiction Services MAT program.

Roberts says that the regular coaching calls he joined while participating in the NIATx Ohio Buprenorphine Implementation Study provided helpful encouragement and support for launching the MAT program.

“We’re looking forward to finding a physician for our program who uses best practices in working with a multi-disciplinary team to make sure that clients are receiving counseling and community support in combination with MAT,” says Roberts.

For more information, contact:

William C Roberts II
WRoberts@phdmc.org
Dayton & Montgomery County Public Health