Medication-Assisted Treatment for Opioid Addiction: Challenges and Solutions Part 1- June 2011
The AATOD Board of Directors are of the judgment that it is important for our statewide and individual members in addition to our policy partners to understand some of the challenges and the solutions that have defined our Association for the past quarter century. As a point of reference for what follows, AATOD was founded as the Northeast Regional Methadone Treatment Coalition in 1984. The Regional Coalition evolved into the American Methadone Treatment Association (AMTA) following the inaugural national conference of 1991 in Boston as an increasing number of state chapters joined the Association. AMTA transformed into the American Association for the Treatment of Opioid Dependence (AATOD) in 2001 following our national conference in St. Louis, reflecting our Association’s broader mission and the use of newly developed medications to treat chronic opioid addiction.
As you read what follows, please keep in mind that there is a greater sense of community among treatment providers, federal and state officials, patient advocates, corporate partners, and other critical stakeholders in our field when compared to 1984. This community represents an intangible but valuable asset since it was not present three decades ago when providers and other stakeholders were working in far greater isolation.
We recognize that this is a detailed document which is why there will be a new section each week until the entire paper has been forwarded to all parties. Feel free to communicate with any questions, and I hope you enjoy reading through what we have done to preserve the integrity of our field for such a long period of time. Medication-Assisted Treatment for Opioid Addiction: Challenges and SolutionsJune 2011The Challenge: The Dark Period of the 1980s
There were increasingly negative views about the value of methadone treatment during the 1980s. The brilliance and promise of the research of the 1960s, and the rapid expansion of methadone treatment during the 1970s began to fade with negative community reactions against the presence of methadone treatment programs (The Washington Times, Methadone: A Failed Cure
, 1984). One of the most damaging media reports about methadone treatment was published during 1983 by the Fort Lauderdale News and Sun-Sentinel, “Methadone, the Deadly Cure”. The editor’s cover letter to the series was stark:
“The public doesn’t care very much about methadone patients. They don’t enjoy a very good reputation, nor do they get much sympathy.
Indeed, the nationwide program to treat heroin addicts with methadone was not set up with the idea of doing something to help addicts. It was touted as a way to protect society, to keep addicts from committing crimes.”
The report combined fact with fiction over a series of articles, which was sent to members of Congress, governors, and state legislators. It represented a major challenge to the future of the existing treatment system, and also preceded a decline in the number of treatment programs that were available, decreasing access to patient care. It was clear that no single state association could respond effectively to this kind of threat. Solution
The Northeast Regional Methadone Treatment Coalition was created in 1984, growing out of the early organizing efforts of the New York State Committee of Methadone Program Administrators. There were nine founding member states of the Northeast Coalition, representing some of the most methadone treatment-populous states in the country (Connecticut, Delaware, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Washington D.C.). It was also decided that it would be best to build on the format of the prior statewide methadone conferences in New York transitioning to the Northeast Regional conferences as a means of organizing the field, training treatment providers, and drawing on evidence-based practices as a means of moving the field forward. The Northeast Regional conferences began in 1984 in New York and ended in 1989 in Rhode Island.
These conferences were the precursors to the national conferences of the present era, and successfully organized the field of methadone treatment providers, researchers, corporate interest groups, policy makers, and patient advocacy groups.
The national conferences served as a launching pad for many of the Association’s critical training initiatives. The first initiative was the Clinicians Course, introduced at the Washington, DC conference of 1994. This course instructed medical and clinical personnel in the Opioid Treatment Program (OTP) environment, and has continued to the present day through the National Institute on Drug Abuse (NIDA) funding. Hundreds of treatment practitioners have been trained as a result of this opportunity. The Media Training event was launched at the Washington, DC conference of 2003, and has resulted in hundreds of practitioners and patient advocates being trained in how to communicate more effectively with media in presenting the value of what we do. The Risk Management course was launched in 2004 in Orlando, Florida after years of working with professional liability insurance companies and treatment providers to determine best methods of reducing the risk of litigation and claims made against OTPs. The Hepatitis C Training was also launched in 2006 at the AATOD conference in Atlanta with SAMHSA/CSAT support, in training OTP clinical staff in better understanding the risks for patients with hepatitis C, and methods of preventing and treating the illness through the clinic environment.
These conferences also led to the expanding organization of our field in different states and in working with our European associates, which began during the 1989 conference in Rhode Island, and continues through the present time. It also led to the development of a formal working relationship between the European Opiate Addiction Treatment Association (EUROPAD) and AATOD, and the formation of the World Federation for the Treatment of Opioid Dependence (WFTOD) during July of 2007.
The full-time AATOD national office was opened on January 1, 1995, and resulted in a more strategic organization of the field for individual membership and the expanded development of state associations within AATOD. The AATOD Board of Directors subsequently developed policy and clinical guidance statements for the field, which have been disseminated through the AATOD website and email blasts.
The organizing of the field has been successfully achieved, increasing from the nine original founding states in 1984 to 29 state associations in 2010, in addition to admitting Mexico to the AATOD Board of Directors. What May Have Happened If AATOD Had Not Acted
In the judgment of the AATOD Board of Directors, without the organizing initiatives of AATOD, the field of opioid addiction treatment would have diminished in importance and would have been subject to dissolution through various federal and statewide legislative challenges. Additionally, treatment personnel would not have been as well informed about new developments in effective therapeutic patient care.