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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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