National Drug Policy: Reducing Demand by Improving Treatment Access – October 2004

Remarks made by Mark W. Parrino during the Opening Plenary Session of the 2004 AATOD Conference
It is my great pleasure to welcome you to our Association’s 20th Anniversary National Conference on behalf of our Association’s Board of Directors. I want to extend my gratitude to our associates throughout the United States and overseas for taking the time and having the commitment to travel to the Conference.

I also want to thank our Florida colleagues for persevering through so many terrible storms in meeting al of the deadlines which were associated in making this Conference happen. I have heard many compelling stories of dedication, which our Florida colleagues have demonstrated in meeting the needs of their patients during terrible times of ordeal.

I also wish to thanks Dr. Thomas Payte for his willingness to take on the responsibility of Chairing this Conference in addition to the work of all of the Committee Chairs and their members. I am grateful to Ken DeCerchio and his agency for their support for this Conference and for all of the work they have done with AATOD from the inception. As Mr. DeCerchio just told you, the state took the initiative to work with our colleagues in 1987 to form the Florida statewide Association, which eventually became part of AATOD.

I too want to thank Gary Wenner and the members of the Florida Association for the Treatment of Opiod Dependence and Colonial Management for their support for this Conference as well. These Conferences are extremely complex events and we cannot work without the direct cooperation of our statewide hosts.

I am pleased to share the dais with Dr. Westley Clark and Stephenie Colston, underscoring the fact that our organization works so closely with all of the leading federal agencies, which have jurisdiction in our field. Both CSAT and ONDCP have been great partners to us throughout the years and I am grateful for their continued support in helping to improve the quality of our treatment system and to increase access to care.

Two Decades of Struggle and Accomplishment

As you know, this Conference marks AATOD’s 20th year of existence, which has spanned two decades of struggle and accomplishment. I would like to take the opportunity to thank past and present Board members for all that they have done to help me in making this national organization a powerful representative body of our treatment system. At present, AATOD is comprised of 21 state member chapters in addition to individual program members in fourteen other states. Collectively, our Association represents mote than 850 programs nationwide.

We have come to this place after confronting and surmounting enormous challenges. This challenge to work comes through a fundamental misunderstanding of what our treatment programs offer and the fact that we have never had a sustained national educational program to explain the work that we do each day and how the health of our patients is improved.

The first major challenge was to move from a statewide association in New York in 1983 to form a Northeast Regional Coalition, which originally consisted of eight founding states and the District of Columbia. We remained as a regional entity until the 1991 Inaugural Conference, when we included other states within our national structure. We have also worked with our associates in Europe, which has been led by Dr. Icro Maremanni of Italy and members of 20 nations in forging alliances for the future. During this very Conference, we continue to engage in discussions with our international colleagues about developing a worldwide federation. This will take years to build but it is a cause worthy of our efforts.

We are also pleased to have worked with CSAT to develop the first Treatment Improvement Protocol, “State Methadone Treatment Guidelines” which were published in 1993. We developed these guidelines in cooperation with the American Society of Addiction Medicine, and especially Dr. Thomas Payte, who was enormously helpful in the execution of the project with all of the medical chapters. At present, Dr. Clark and his staff are reviewing the new encyclopedic TIP, which will replace the four previously published methadone publications.

It is fair to say that our Association’s most important work has been behind the scenes in trying to change public perception about methadone treatment. At times, this work has managed to get onto the front pages of newspapers throughout the country, especially when these challenges come from well known political personalities. Such a challenge came from New York in 1998 and it took considerable effort to defeat the challenge of closing New York’s methadone treatment programs. We were grateful to have had the unwavering support of the White House Office of National Drug Control Policy and I continue to appreciate their support for our initiatives.

We have also worked closely with other federal organizations including the National Institute on Drug Abuse in producing our Clinicians Courses. One of those courses convened just yesterday under the sponsorship of Dr. Payte and his associates.

We have also worked with the Drug Enforcement Administration to produce the Best Practice Guidelines for our programs, which were originally distributed during April 2000. We have been working with the DEA to revise these guidelines and they should be ready for distribution within the coming year.

We have also worked with CSAT/SAMHSA to produce the Community Education Kit “Medication Assisted Treatment for the 21st Century”, which has proven to be an effective community education resource.

These Community Education Kits were developed in conjunction with the “Joy of Being Normal” which is a brief video, telling the story of three methadone patients and their families. This was developed with Danya International and it is on display at AATOD’s Exhibit Booth during this Conference.

We have been working to educate Drug Court Judges about the value of methadone treatment in writing the Drug Court Practitioner Fact Sheet “Methadone Maintenance and other Pharmatherapeutic Interventions in the Treatment of Opioid Dependence”, which was published during April 2002. This fact sheet was distributed to more than 10,000 drug court judges and their staff throughout the United States and has served as a vehicle of educating such drug courts in the country.

We have also worked with all federal agencies as the prescription of opioids has increased markedly in different parts of the United States. AATOD firmly understands and supports the responsible use of prescription opioids in treating chronic pain and believe that physicians continually need to be educated about the safe use of such medications, including methadone, as an effective method of managing chronic and severe pain.

We are pleased that CSAT/SAMHAS published its report in Methadone Associated Mortality during February of this year. I am grateful for Dr. Clark’s leadership on the project and for the perseverance of his staff, especially Robert Lubran. They achieved the impressive goal of coordinating the work of numerous federal agencies, state authorities, including Mr. DeCerchio and other national organizations in producing so critical a report in record time.

It is instructive to note that the report found that “the greatest incremental growth in methadone distribution in recent years is associated with the use of the drug as an analgesic and its distribution through pharmacies rather than OTP’s”.

The report tendered a number of recommendations and I suspect that Dr. Clark will share them with you this morning. We have also worked with ONDCP with regard to the President’s Access to Recovery Grants, which were recently announced during August 2004. Florida is one of the fourteen states, which has received this grant, and I suspect that Ms. Colston will discuss this as well.

Two Major AATOD Three-Year Initiatives

I am also pleased to report on the early success of two of our Association’s major initiatives, both of which were initiated during April 2004. AATOD has been working to increase access to methadone treatment and to buprenorphine through the criminal justice system. We are using a Robert Wood Johnson Foundation Innovators Award in addition to Mallinckrodt funding to accomplish five primary objectives.

  1.  The first objective is to increase access to methadone treatment in jails building on the Rikers Island model of New York. We are pleased at the recent expansion of such treatment access to methadone services in Florida, Rhode Island, New Mexico and the state of Washington.
  2. The second objective is to increase educational information to drug courts, jails and probation and parole officials.
  3. The third objective is to decrease the negative court rulings, which impede access to methadone treatment.
  4. The fourth objective is to evaluate laws and policies in the five targeted states, within the project. In this case, we will be working with our policy partner on the project (The Legal Action Center).
  5. The fifth objective will be to learn about the ideologic and funding impediments to increase access to methadone treatment through a national survey among three partners in the project, the National Drug Court Institute, the American Probation and Parole Association and the American Jail Association.

This project will continue for three years and will result in increased access to care through the criminal justice system and a series of policy documents which will help guide this growth in the future.

We are also at the beginning of a three-year study to determine the prevalence of prescription opioid abuse and its impact on new admissions to methadone treatment programs. AATOD has executed an agreement with Purdue Pharma, which will extend for three years and include reporting from 75 methadone programs in thirty states. All of the data will be collected and analyzed by the National Development and Research Institute, which is an independent research based organization in New York.

The importance of this study cannot be underestimated. It will provide quarterly trends which will track the impact that prescription opioid use and abuse is having on admissions to methadone programs.

While the past twenty years have been filled with accomplishment, I look forward to the work that lies ahead, knowing that there will be more challenges and opportunities. Thank you once again for joining us at this Conference and for your work in our field. It is a privilege to work with our patients and to offer such lifesaving care. Thank you for coming and enjoy the Conference.

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