The New Standard for Treatment
In a move that’s sure to raise more than a few eyebrows, SAMHSA has officially endorsed medication-assisted therapies (also known as opioid replacement therapies).
While they’ve long been supporters of buprenorphine (Suboxone and Subutex) and methadone, the Substance Abuse and Mental Health Services Administration recently added wording to their grant application that strongly encourages treatment centers to make use of these medicines – or else.
This new language can be found in SAMHSA’s 2016-2017 block grant application. If you’re wondering, like I was at first, just how much this comes out to – it’s a lot. They have awarded, or still will, just shy of $2 billion this year.
That astounding sum of money certainly ups the ante for SAMHSA’s recommendation. It also brings them up to speed with the rest of the federal government and the majority of the medical establishment.
White House drug czar Michael Botticelli – a man in long-term recovery himself – has pushed medication-assisted therapies for years. He even hinted earlier this year that SAMHSA would be updating their guidelines to reflect what federal drug courts have in place (an emphasis on using opioid replacement therapies).
Find out exactly what SAMHSA changed their grant language to below!
What SAMHSA is Saying
While it’s a bit long and wordy, the official language of the 2016-2017 block application grant follows. You can also view it directly on the grant portion of SAMHSA’s site.
There is a voluminous literature on the efficacy of [Food and Drug Administration]-approved medications for the treatment of substance use disorders. However, many treatment programs in the U.S. offer only abstinence-based treatment for these conditions. SAMHSA strongly encourages the states to require that treatment facilities providing clinical care to those with substance use disorders be required to either have the capacity and staff expertise to use MAT or have collaborative relationships with other providers such that these MATs can be accessed as clinically indicated for patient need. Individuals with substance use disorders who have a disorder for which there is an FDA-approved medication treatment should have access to those treatments based upon each individual patient’s needs.
It’s important to note a few things before going on to explore just what this means for the future of the addiction treatment industry.
First, as a senior SAMHSA official pointed out, these are recommendations and nothing more. When a state is awarded a federal grant, it’s still up to them to spend it how they want. If Florida, for example, received a 2016-2017 SAMHSA grant, they would be under no obligation to mandate individual treatment centers make use of buprenorphine.
Still, this change in wording makes it appear that SAMHSA’s going to give preference to states that use opioid replacement therapy.
Second, even if federal block grants aren’t directly tied to states using medication-assisted therapies, some discretionary grants are. According to Anne Herron, the senior SAMHSA official mentioned above, the agency has began to include language in their discretionary grants that makes it mandatory for states to use buprenorphine and methadone.
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Does This Mean Everyone in Rehab is Going to Be on Suboxone?
That’s the question that’s being asked by many in the treatment industry. If a national agency like SAMHSA is increasingly making their grants conditional upon opioid replacement therapies – are federal and state funded rehabs going to medicate all their patients?
That answer isn’t as easy as simply saying yes or no, but the short answer is no.
Just because a treatment center makes use of medication-assisted therapy doesn’t mean they’re going to be pumping all their patients full of Suboxone or methadone. While it’s easy to image that as a worst-case scenario, it just isn’t likely to happen.
Rather, the federal government’s shift towards embracing “science rather than ideology” signals a few things.
First, buprenorphine, methadone, and the like will largely be used during detox. Second, certain patients will likely remain on them throughout treatment and into their long-term recovery. Still, this is probably only going to happen if the patient meets a number of criteria.
In other words – the government isn’t saying that everyone in recovery should be taking buprenorphine. Far from it. They’re encouraging states and treatment centers to embrace what science has shown for some time – that, in certain cases, medication can have a positive impact on an individual’s recovery.
Sounds good to me. What do you think? Let us know on social media!