Brook Etherington, MA Vice President of The Opioid Treatment Providers of Georgia

Medication Assisted Treatment Medication Assisted Treatment (MAT) – 3 FDA approved medications used to treat opioid use disorder. Methadone Buprenorphine (Suboxone, Subutex) Naltrexone (Vivatrol) Opioid Treatment Program (OTP), Narcotic Treatment Program (NTP) – Both refer to a treatment program certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide medication-assisted treatment for patients who are opioid addicted. OTPs/NTPs have in house pharmacies and provide dosing on site. Both medical and counseling services are available in this type of facility. This does not refer to office based physicians providing MAT with buprenorphine.

Treatment Administration of medication – “Dosing” Counseling administered or dispensed only by a practitioner licensed under the appropriate State law and registered under the appropriate State and Federal laws to administer or dispense opioid drugs - 42 CFR 8.12 Counseling “OTPs must provide adequate substance abuse counseling to each patient as clinically necessary. This counseling shall be provided by a program counselor, qualified by education, training, or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient and to monitor patient progress.” - 42 CFR 8.12 There must be at least one full-time counselor for every 50 patients. - 111-8-53-.10

Treatment Treatment Planning Medical Monitoring A complete individual treatment plan for each patient must be developed within 30 days of admission. Patients must be involved in the development of their treatment plans. Treatment plans must document a consistent pattern of substance abuse treatment services and medical care appropriate to individual patient needs. – 111-8-53.13 Medical Monitoring Qualified medical staff will monitor the effectiveness of the medications and adjust as necessary – “Dose Adjustments” Regular Physical Exams - “All patients must receive a physical examination by the medical director, the program physician, or an appropriately licensed and qualified member of the medical staff at least annually.” - 111-8-53.13 Laboratory Tests and Screening - including HIV status (if the applicant consents to be tested), CBC and chemistry profile, and pregnancy, STD, and Mantoux TB tests. - 111-8-53.12

Regulatory Process SAMHSA/CSAT - Federal: Accreditation Mandate Requires the position of State Opioid Treatment Authority (SOTA) Drug Enforcement Administration – Federal Issues DEA # which allows programs to order medication Inspects every 2 years without fail Georgia Department of Community Health Designates the SOTA who works in DBHDD NTPs regulated by Healthcare Facility Regulation Division Georgia Board of Pharmacy Regulated by Georgia Drugs and Narcotics

Cost of Treatment All programs in Georgia are privately owned and operated. Almost exclusively private pay $10 - $15 per day ($300 - $450 per month) is the typical cost for methadone treatment $15 - $20 per day ($450 - $600 per month) is the typical cost for buprenorphine treatment $800 - $1500 per month is the range for Vivatrol treatment. Rarely used in NTPs due to high cost

Cost of Treatment 70 NTPs in Georgia 3 NTPs are Medicaid providers 2 NTPs are contracted through the state to provide subsidized treatment As of 2016, The state of Georgia has allowed NTPs to apply to become Medicaid specialty providers. Insurance companies will not work directly with NTPs. Most do not consider MAT at an NTP as a covered service.

Benefits of Treatment Illicit opioid drug use decreases IV drug use decreases Consumers report participating in illegal activities less Crime rates decrease in areas where NTPs open HIV infection rates decrease Overdose rates decrease Drug related emergency room visits decrease Mortality rates decrease

In Support of NTPs “Access to medication-assisted treatment can mean [the] difference between life or death.” “Studies have shown that treatment plus medication can help save lives by preventing overdose deaths. Medication-assisted treatment is the recognized standard of care for opioid use disorders. ” - Michael Botticelli Director, White House Office of National Drug Control Policy “Individuals with chronic relapsing diseases should have access to MAT. It’s just the standard of care. We cannot diminish the importance of that.” - Elinore McCance-Katz, MD, PhD Former Chief Medical Officer, SAMHSA