AATOD’s Board of Directors initially approved a strategic organizational Five-Year Plan during 2001, and subsequently updated the plan in 2007 and 2012. AATOD implemented these plans in conjunction with Board members, treatment providers, federal and state agencies, partnering policy organizations, corporations and patient advocacy groups.
Increasing the Number of OTPs in the United States
As we cross into 2017, there are approximately 1,475 operating OTPs in 49 states, the District of Columbia, Puerto Rico and the Virgin Islands. The OTPs have expanded over the course of the past five years but the expansion has not been significant enough to meet the increasing needs of people with opioid use disorders, requiring access to comprehensive treatment services, which are provided through OTPs. Accordingly, AATOD will devote its resources in working with federal and state governments to increase access to OTPs wherever they are needed.
Supporting Integrated Service Delivery Models
AATOD will build upon the work of the three policy papers that were developed by the Association for the Substance Abuse and Mental Health Service Administration and released during the summer of 2016. The objective of these papers was to showcase integrated service delivery models connecting to OTPs as the essential hub treatment sites in providing specialized care for opioid use disorders.
Increasing Access to Third Party Reimbursement for OTPs
At the present time, 16 states still do not provide access to Medicaid reimbursement for OTP services. AATOD will build upon the work that we initiated during 2016 to provide guidance to state agencies and OTPs to implement such third-party reimbursement through Medicaid coverage. A recent success occurred when the state of Georgia decided to provide access to Medicaid reimbursement for OTPs in 2016. AATOD will continue to work with other state agencies in addition to federal agencies such as CMS Medicaid in order to continue to expand access to Medicaid reimbursement in support of patient care in OTPs.
We will continue to work with the appropriate federal agencies to provide access to Medicare reimbursement for OTPs. This has been historically challenging especially since CMS Medicare has determined during 2016 that their agency does not have the standing authority to make this change within its own jurisdiction. Accordingly, AATOD will work with the White House Office of National Drug Control Policy, CMS Medicare and Members of Congress in order to create this opportunity.
AATOD will also work with commercial insurers to develop model contracts for reimbursement between commercial insurers and OTPs. In addition, AATOD will work to develop cross training opportunities so that OTPs will learn how to engage such commercial insurers to better understand how to work with OTPs.
Developing Current OTP Evaluation Studies
Methadone maintenance represents one of the most studied medications used in a treatment system. Methadone was the first of the three federally approved medications to be used in treating opioid addiction based on the early research work of Drs. Vincent Dole, Marie Nyswander and Mary Jeanne Kreek at Rockefeller University. A great deal has been learned over the past 50 years in treating opioid use disorders with medications such as methadone, buprenorphine and Vivitrol Naltrexone.
A number of elected and appointed officials have expressed concern about the most important studies, demonstrating the efficacy of methadone maintenance treatment, as being outdated. Accordingly, such officials have asked for more recent studies, evaluating the benefits of methadone maintenance in treating opioid use disorders.
Developing Educational Initiatives for Members of Congress
AATOD will work with relevant policy partners, including the Board of Directors in order to develop a sustained educational initiative to educate Members of Congress. The importance of this initiative was clearly identified during 2016 since so many Members of Congress do not understand how opioid treatment programs function, the characteristics of the patients we treat and the comprehensive services that are provided. There is also a major misunderstanding about how medications are used to treat opioid use disorders, especially methadone maintenance treatment.
Working with Federal and State Agency Partners in Support of Strategic Planning Initiatives
It is understood that AATOD will continue its work with the federal agencies which have jurisdiction in working with OTPs throughout the United States. We will continue to build upon our successful working relationships with the Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration, the Drug Enforcement Administration, the Food and Drug Administration, the National Institute on Drug Abuse and all other federal agencies with a policy interest in this area.
Promulgating the Use of All Federally Approved Medications to Treat Opioid Addiction
AATOD will continue to promulgate the value of utilizing all federally approved medications to treat opioid use disorders through OTPs. This is the foundation of having OTPs as essential hub treatment sites for opioid use disorders and providing access to comprehensive services through more integrated models of care. This will include training for all relevant parties in how to properly use such medications throughout the course of patient care and as long as the individual patient benefits from such treatment.
AATOD will continue to use its conferences as a method of showcasing leading initiatives and training for OTP personnel. These conferences began in 1984 and continue to the present time. We will continue to promote evidence-based practices and patient centered care through such conferences in addition to supporting patient advocacy training and methods of improving programs’ operational capabilities.
Webinar Development, Enhanced Communication
We will continue to use webinar based training resources as a method of advocating for the goals of this strategic plan. We developed such training opportunities for Medicaid expansion in 2016 and we will continue this work in 2017. We will also use the concept of such webinar development to further promulgate new training opportunities based on what we have learned from recently completed surveys as indicated in a prior section of this plan.
We will continue to work with our partners in the World Federation for the Treatment of Opioid Dependence and EUROPAD in increasing access to treatment wherever it is needed in the world. We will build on our long-standing work with the United Nations Office on Drugs and Crime in addition to working with the U.S State Department as a method of increasing resources for developing programs in different parts of the world.
AATOD will continue to work with the Legal Action Center and other policy partners to increase integrated care with criminal justice partners, including drug courts and correctional facilities. This will build upon the work of many years and the models, which were promulgated in policy papers published in 2016.