LA County, Medications for Addiction Treatment, and the Substance Use Care Continuum

Transcription

1 LA County, Medications for Addiction Treatment, and the Substance Use Care Continuum Brian Hurley, M.D., M.B.A., DFASAM Medical Director of Substance Use Related Care Integration Los Angeles County Health Agency - Department of Health Services - Department of Mental Health

2 Brian Hurley, M.D., M.B.A., DFASAM No disclosures

3 For Alcohol: Ornstein, S. M., Miller, P. M., Wessell, A. M., Jenkins, R. G., Nemeth, L. S., & Nietert, P. J. (2013). Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings. Journal of studies on alcohol and drugs, 74(4),

4 Margaret E. Mattson, Ph.D. and Sean Lynch, Ph.D., L.C.S.W. The CBHSQ Report: Medication Prescribing and Behavioral Treatment for Substance Use Disorders in Physician Office Settings. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville, MD.

5 Core Components of Addiction Treatment Counseling* Support* Medications* *When appropriate Source:

6 Medications for Addiction Treatment (MAT)

7 Opioids Methadone Buprenorphine Naltrexone Tobacco Nicotine Bupropion Varenicline Alcohol Disulfiram Naltrexone Acamprosate Others No FDAapproved medications (yet)

8 Opioids Methadone Buprenorphine Naltrexone Tobacco Nicotine Bupropion Varenicline Alcohol Disulfiram Naltrexone Acamprosate Others No FDAapproved medications (yet)

9 Shapiro, B., Coffa, D., & McCance-Katz, E. F. (2013). A primary care approach to substance misuse. American family physician, 88(2),

10 Bouchery, E., Harwood, R., Malsberger, R., Caffery, E., Nysenbaum, J., & Hourihan, K. (2012). Medicaid Substance Abuse Treatment Spending: Findings Report (No. 1fdd951d a4a b61c). Mathematica Policy Research.

11 In Opioid Use Disorder: Adding psychosocial support does not change the effectiveness of retention in treatment and opiate use during treatment. Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD DOI: / CD pub4

12 Barriers to MAT Implementation System Level Government and insurance policies, program characteristics (such as treatment philosophy), lack of pharmaceutical industry support, and logistical issues like lack of equipment or access to prescribing clinicians Provider Level Informational Deficits / Perceptions and Concerns (Attitudes) Patient Level Informational Deficits / Perceptions and Concerns (Attitudes) Oliva, E. M., Maisel, N. C., Gordon, A. J., & Harris, A. H. (2011). Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Current psychiatry reports, 13(5),

13 Strategic Considerations SYSTEMIC FACILITATORS ORGANIZATIONAL CAPACITY PROVIDER READINESS (SUPPLY) PATIENT ACCEPTABILITY (DEMAND) Weiner BJ, Amick H, Lee SY. Conceptualization and measurement of organizational readiness for change: a review of the literature in health services research and other fields. Med Care Res Rev. 2008;65(4): Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27(2):63 80.

14 Evidence Based Models for Medications for Addiction Treatment Hub and Spoke Model Collaborative Opioid Prescribing (Co-OP) Model Office-Based Opioid Treatment (OBOT) (Yale) Massachusetts Nurse Care Manager Model Buprenorphine HIV Evaluation and Support (BHIVES) Collaborative Model One Stop Shop Model Project Extension for Community Healthcare Outcomes (ECHO) Medicaid Home Model for Those With OUD Southern Oregon Model Emergency Department Initiation of OBOT Inpatient Initiation of MAT Integrated Prenatal Care and MAT Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I, Zakher B, Grusing S, Devine B, McCarty D. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Technical Brief No. 28. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No I.) AHRQ Publication No. 16(17)-EHC039-EF. Rockville, MD: Agency for Healthcare Research and Quality. December

15 Shared Components of MAT in Primary Care Pharmacological therapy Psychosocial services/interventions. Coordination/integration of substance use disorder treatment and other medical/psychological needs Provider and community education and outreach Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I, Zakher B, Grusing S, Devine B, McCarty D. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Technical Brief No. 28. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No I.) AHRQ Publication No. 16(17)-EHC039- EF. Rockville, MD: Agency for Healthcare Research and Quality. December Accessed 12/6/2016.

16 Safe Med LA

17 CHCF Treating Addiction in the Primary Care Safety Net Project ECHO for Buprenorphine Coaching by experts Monthly CSAM webinars In-Person Learning Sessions Bup Waiver Trainings Site Visits

18 DHS DMC-ODS Enrollment

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20 U.S. Department of Health and Human Services. Treatment Improvement Protocol (TIP) 49: incorporating alcohol pharmacotherapies into medical practice, HHS Publication No SMA Rockville, MD: Substance Abuse and Mental Health Services Administration; Incorporating-Alcohol- Pharmacotherapies-Into-Medical- Practice/SMA Accessed 5/1/2014

21 Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I, Zakher B, Grusing S, Devine B, McCarty D. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Technical Brief No. 28. (Prepared by the Pacific Northwest Evidencebased Practice Center under Contract No I.) AHRQ Publication No. 16(17)- EHC039- EF. Rockville, MD: Agency for Healthcare Research and Quality. December ports/final.cfm - Accessed 12/6/2016.

22 SUMMIT Study Ober, A. J., Watkins, K. E., Hunter, S. B., Lamp, K., Lind, M., & Setodji, C. M. (2015). An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol. Implementation Science, 10(1), 1.

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25 Los Angeles County LA County Health Agency DHS DMH DPH SAPC

26 Los Angeles County 12% of Medi-Cal patients have a SUD 13.6% newly covered Medi-Cal beneficiaries (since expansion) have a SUD. ~400,000 Medi-Cal patients in Los Angeles County with SUD Mark, T. L., Wier, L. M., Malone, K., Penne, M., & Cowell, A. J. (2015). National estimates of behavioral health conditions and their treatment among adults newly insured under the ACA. Psychiatric Services, 66(4),

27 Los Angeles County ~47,000 annually receive publicly funded specialty SUD treatment: 10,000 alcohol use disorder 22,000 with heroin use disorder 3,000 with Rx opioid use disorder (up from 1,000 in 2006)

28 Los Angeles County - SAPC Service & Bed Availability Tool (SBAT) and Substance Abuse Services Helpline (SASH)

29 Vision for Los Angeles County Expand addiction medicine capacity in primary care, mental health sites, and specialty SUD sites. Willing Patients Ready Prescribers Treatment Org Capacity

30 Questions / Feedback bhurley@dmh.lacounty.gov