2004 has been a year of considerable progress in meeting the objectives of AATOD’s October, 2001 Five-Year Plan. The progress of 2004 represents planning that took place in previous years in addition to laying the groundwork for our future initiatives.

Working with Federal Agencies
AATOD has worked with federal agencies since its inception in 1984. It has been a hallmark of our organization to be able to work consistently with federal agencies from one year to the next.

Methadone Associated Mortality Report
AATOD was instrumental in working with DHHS/SAMHSA/CSAT in developing the Methadone Associated Mortality Report, which was officially released during February 2004. The report was critical in “exonerating” the nation’s OTP’s from direct responsibility for causing the dramatic increase in methadone associated mortalities.

The report indicated that prescription opioid use, especially methadone, is being used to treat pain. While AATOD does not oppose the appropriate use of methadone to treat chronic and severe pain, we have expressed concerns about how patients are evaluated and educated about the use of such opioids, including methadone as an analgesic.

The report was critical in establishing a series of benchmark recommendations, including the training of physicians in private practice with regard to the use of methadone as an analgesic; the development of standardized criteria for determining methadone toxicity overdoses by medical examiners throughout the country and in correcting public perceptions about methadone treatment, whether used to treat chronic opioid addiction or chronic pain.

AATOD will continue to work with CSAT and the other participating federal agencies and national organizations to meet these objectives.

Clinicians Course
AATOD has also continued to work with NIDA in gaining support for its Clinicians Course, which was offered to colleagues in San Francisco, California during January, 2004 in addition to being offered during the October, 2004 National Conference in Orlando, Florida. NIDA also used our Conference to provide the most current information about the advances made through their Clinical Trials Network.

AATOD will continue to work with NIDA in these efforts in addition to renewing support for our international initiatives.

DEA Theft/Loss Report
AATOD was also instrumental in working with the Drug Enforcement Administration in releasing its report on Drug Theft and Loss with regard to Methadone Hydrochloride Products. This report was released by the DEA during October, 2004. This represents the very first time such a report has been made available outside of the structure of the Drug Enforcement Administration. It represents the most elaborate reporting of methadone hydrochloride product theft/loss for calendar years 2001/2002/2003.

AATOD has also been working with the Drug Enforcement Administration during 2004 to update the April, 2000 publication “Narcotic Treatment Programs/Best Practice Guidelines”. It is anticipated that these guidelines will be made available to treatment programs and state agencies throughout the United States during 2005.

Hepatitis Training
AATOD has also continued its work with CSAT to develop a second round of Hepatitis C training initiatives for OTP personnel. This follows on the success of AATOD’s training initiatives with Hepatitis C organizations during 2003.

AATOD has secured a subcontract under the aegis of McKing Consulting to update the previous curriculum so that we can continue to train OTP personnel in different parts of the country during 2005. It is expected that this training initiative will continue for the following several years.

HIV Rapid Testing
AATOD has also continued to work with CSAT on a new HIV testing initiative so that methadone treatment programs will get access to the newly approved HIV Rapid Test. The objective is to be sure that OTP personnel are trained in the latest techniques with regard to using this new rapid HIV test instrument. AATOD will serve as a coordinator in conjunction with federal agencies, which will be coordinated by CSAT. It is expected that this program will get underway during 2005.

Working with Foundations and Corporate Interest Groups

Criminal Justice Initiative
AATOD has continued to make great progress on its work with the Robert Wood Johnson Foundation Innovators Award Program with a matching grant from Mallinckrodt. The objectives of this program, which officially began during April, 2004 have been to increase access to methadone in the jail systems of the United States in addition to working with three major partners within the criminal justice system, including the American Probation and Parole Association, the American Jail Association and the National Drug Court Institute.

All contracts were executed during April, 2004 including our policymaking partners at the Legal Action Center.

Five target states were selected during 2004, including Arizona, Florida, Maryland, New York and Vermont.

We began our initial meetings in Florida during March, 2004 with the Orange County Corrections facility in conjunction with our associates at the Center for Drug-Free Living in Orlando. This facility has been providing access to its methadone maintained inmates, as long as they were enrolled in a methadone treatment program at time of incarceration. We encouraged the expansion of this program and will continue to do so through 2005.

The second major initiative occurred during August, 2004 at a meeting with representatives from Maryland’s Department of Public Safety and Correctional Services. This meeting laid the groundwork for future meetings with the Secretary of Public Safety in Maryland to increase access to methadone treatment and buprenorphine so that it can be offered to inmates in the Baltimore City Prison System. This will require a significant educational undertaking and we will work with state officials in addition to other provider-based and policy-based organizations.

We have also participated in drug court conferences in Arizona with the most recent presentation convening during September, 2004 with the Arizona Supreme Court. We will continue to work with our Arizona based colleagues and state officials during 2005 as we build upon this early opportunity.

A major and promising opportunity has opened in Vermont during October, 2004 with the possibility of having methadone provided to Vermont inmates in the Vermont Correctional System. AATOD will continue to work with its policymaking partner (Legal Action Center) and state officials in Vermont as we move forward in training all appropriate parties during 2005.

The Legal Action Center has taken the lead in engaging in a series of preliminary discussions in meeting with New York state officials as a means of better understanding the impediments to increasing access to a Rikers Island model in other jail systems in New York State in addition to educating representatives from the probation and parole system.

The above initiatives focus on the five targeted states within this program, however, we have also provided technical support to representatives from Washington state and New Mexico as these states increase access to methadone treatment services through the criminal justice setting.

We will work with our research partner (NDRI) as we develop a survey instrument in the three aforementioned partners in the criminal justice system for the first quarter of 2005. This will give us a clearer understanding of the impediments, which currently block providing access to methadone/buprenorphine treatment services throughout the criminal justice system.

This project will continue for a three-year period of time and is expected to lead to significant policy changes so that people, who cross through the criminal justice system, will gain access to methadone/buprenorphine treatment in responding to their opioid addiction.

Increasing Prescription Opioid Use/Abuse
AATOD has also made considerable progress with regard to better understanding the impact that prescription opioid use/abuse has had on increasing admissions to methadone treatment programs. We executed a Master Services Agreement with Purdue Pharma during April, 2004 in addition to developing a subcontract with our research partner of this three-year initiative with NDRI, a research-based organization in New York City. This project officially began in April, 2004 and will last for a three-year period of time.

This study will track changing trends as patients are admitted to OTP’s of the United States. Seventy-five methadone treatment programs will participate in this study, which will involve having new patient admissions complete one-page survey questionnaires, which will be faxed to NDRI for independent review and analysis.

Dr. Andrew Rosenblum, who serves as the Principal Investigator for this project, representing NDRI, developed the parameters of the survey questionnaire. This was evaluated by the Purdue RADARS External Advisory Board during September, 2004 and was finalized for field review during a meeting on November 18, 2004. The questionnaire has been tested on a focus group in one of the participating 75 programs at the end of November, 2004 and will be pilot tested with seven specific programs during December, 2004. It is expected that the 75 participating OTP’s will go online in submitting these surveys during January, 2005.

This study is significant in being able to develop quarterly trend analyses as the programs submit these data through the 75 reporting sites.

AATOD Organizational Initiatives
AATOD has continued to make progress on a number of fronts, which have been used to improve the integrity of our treatment system.

Risk Management Seminar
The results of the AATOD Professional Liability/Risk Management Survey were tended to the AATOD Board of Directors during March, 2004. This survey clearly identified the major professional liability insurance markets for the treatment system in the United States. It also led to the development of a groundbreaking risk management seminar, which premiered at the AATOD National Conference of October, 2004.

AATOD Training Statement
The AATOD Board of Directors also approved a statement on training OTP medical practitioners during March, 2004 with regard to the use of methadone and buprenorphine. The statement provided guidance to members with regard to evaluating the current qualifications of
its medical practitioners to be certain that all are properly trained and are subscribing to current therapeutic practices with regard to the use of methadone and buprenorphine.

Shelf Life of Methadone Hydrochloride Products
The AATOD Board also approved a statement during June, 2004 with regard to the shelf-life for methadone hydrochloride products following OTP compounding. This guidance statement is especially important since OTP’s have been providing greater amounts of take-home since the publication of the CSAT accreditation guidelines, which were formally promulgated during May, 2001.

Expanded Website
AATOD launched its substantially upgraded website during July, 2004 after many months of planning and hard work. The principal architect of this new website was Angelina Budija, who is to be credited with the sophistication of its organization and the breadth of its content. Thousands of people have been accessing information and our website has been a critical communication vehicle in support of our projects.

20th Anniversary Conference
AATOD continued its tradition of producing major national conferences, which involved federal and state agencies throughout the United States and representatives from more than fifteen other nations. This Conference convened in Orlando, Florida and represented one of the most successful Conferences to date. It also celebrated AATOD’s 20th year of operation since its founding in 1984. AATOD’s Project Director is primarily responsible for its success (Carleen Maxwell) in working with Talley Management and all of the Conference committee chairs.

Program Organizing Initiatives
Our statewide and individual program organizing initiatives have continued in 2004. AATOD representatives have met with provider representatives in Maine and in Virginia and hope that both states will continue to organize their providers and eventually join AATOD.

Individual program membership has also increased during 2004 as individual members represent fifteen states outside of the 21 statewide Board structure.

Finally, we have continued to work with our European and international colleagues to develop a federation of programs, which will establish a more effective communication network throughout the world.

This furthers the organizing initiatives over the past several years, which have counted our EUROPAD colleagues as a primary organizing partner in this ambitious initiative. The ultimate goal is to have different regions of the world get organized, maintaining their own independence but promoting best practice guidelines for patients in treatment; best training recommendations for clinicians within the program structure in addition to advising governments on best policies to support the use of approved pharmacotherapies to treat chronic opioid dependence.

Without any question, 2004 was successful in fulfilling the objectives of AATOD’s Five-Year Plan, which was initiated during October, 2001. This will lead to continued progress in 2005 as we gain more information from all of the aforementioned projects.