In Case You Haven't Heard…

Remember the MAT‐PDOA (Medication Assisted Treatment–Prescription Drug and Opioid Addiction) grant program from the Substance Abuse and Mental Health Services Administration? It ended last September. Robert Ashford, a recovery advocate who is managing editor of the new Journal of Recovery Science , came in after the first year and headed up technical assistance (TA) for it. There were so many challenges to getting people educated about treatment. Twenty‐eight single state authorities (SSAs) received the funding. Some SSAs opted to make opioid treatment programs (OTPs) subrecipients under statewide grants, and many office‐based opioid treatment (OBOT) programs received funding. Ashford recalled that 60 to 80 percent of the training was on enhancing psychosocial reports, with the additional training on best practices for prescribing and induction. In some states, patients were titrated off their buprenorphine or methadone if they took benzodiazepines, and in some, they were refused induction altogether. “This wasn't always coming from the SSA; it was coming from individual lower‐level providers,” he said. Punishing people for using drugs by reducing their take‐home doses of methadone or buprenorphine is bad, he said. “But kicking people out of treatment is worse,” he said. The worst culprits were not the OTPs — they were the OBOT programs, or the Federally Qualified Health Centers (FQHCs) who contracted with them, he said. “There was a lot more sense that clients could be removed from the FQHC programs for noncompliance,” he said. “Sometimes, they would be discharged to a higher level of care. It wasn't a regulation, but many providers were doing it.” This raises questions about the kind of TA that is going to STR and SOR grantees and subrecipients. MAT‐PDOA grants were minuscule by comparison — $25,000. Some states, like Missouri, spent down their STR money quickly, with medication‐first, mainly buprenorphine. Missouri got a lot of patients into treatment by not requiring counseling. “As soon as you require, say, nine hours of clinical engagement, and they want to get reimbursed for it…,” he said, trailing off. “We have a lot of people who aren't getting the medication they need.” This is the purpose of TA: educating providers. But it doesn't always work. “We can educate all day long, but some of these philosophies are too deeply rooted,” he said.