Why are Federal Agencies Officially Recommending Suboxone & Methadone?

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).

substance abuse and mental health servies adminstration

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!

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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.

these pills arent suboxone or methadone but they look like them

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!

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A Drastic Shift in Drug Abuse Prevention Spending

They Want HOW Much Money?!

With drug abuse exceeding epidemic proportions in the United States, it’s time for something drastic to be done. Think about it – opioid overdose fatalities are now the leading cause of injury related death. We’re no longer in a painkiller or heroin epidemic, we’re in an all-out guerrilla war.

2016 senate drug abuse prevention budget-min

It’s clear that the government hasn’t had much success with prohibitory measures. It looks like they’ve taken this idea to heart and, in their proposed budget at least, are ready to make some shifts in federal spending.

Fourteen US senators recently petitioned Congress for a large increase in the 2016 drug abuse prevention budget. Spending large amounts of federal dollars to fight substance abuse and addiction is nothing new. What is new are the programs these senators would like to see backed.

What programs and agencies will benefit the most from this proposed budget? Find out below!

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And the Winning Agencies are…

The three agencies set to directly receive money from the proposed 2016 budget are the Center for Disease Control (CDC), the Substance Abuse & Mental Health Services Administration (SAMHSA), and the National Institute of Health (NIH). There are a number of secondary agencies and programs which will no doubt benefit, but there three are the big winners.

So, how much money does Congress want for each agency? Well, let’s look at the CDC first. According to the senators,

“We request that you fund drug overdose prevention and monitoring activities at the CDC at a total of $68.0 million, which is equal to the President’s budget request and an increase of $53.6 million over FY 2015” (Senator Tammy Baldwin’s Site).

$68 million is a lot of money! As Senator Baldwin mentioned, however, it’s the same as Obama’s 2016 proposed drug abuse prevention budget. It looks like their budgets are aligned on CDC funding.

Of the proposed $68 million, $48 would be used to “strengthen and expand the Prescription Drug Overdose (PDO) Prevention for States program to all 50 states.” The money would be broken down into individual state bundles and used for improving prescription drug monitoring programs.

Portions of the proposed $68 million will also be put towards direct prescription drug overdose interventions, data gathering, data monitoring, mortality surveillance, and “developing safe opioid prescribing guidelines…”

It’s important to note that the CDC wouldn’t be receiving this money in a vacuum. Rather, they’d be working alongside other agencies that are also set to receive significant sums of money. That brings us to SAMHSA.

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Senator Baldwin and her fellow senators believe the Substance Abuse & Mental Health Services Administration should receive $25.1 million. As noted above, although this may be a large sum of money and a $13 million increase from our current fiscal year, it’s equal to President Obama’s proposed 2016 budget.

So what programs in SAMHSA would this cool 25 million dollars be funding? Well, first and foremost is the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction.

This program, according to Baldwin, will “expand treatment for opioid use disorders, with a focus on heroin and prescription opioids through a combination of medication and behavioral therapies services.” In layman’s terms, they’re talking about Suboxone, Subutex, and the like.

Another $12 million of SAMHSA’s proposed federal dollars would go towards allowing individual states to purchase, distribute, and implement naloxone programs.

Heroin overdose is changing dramatically…

The Final Verdict

But wait, we haven’t talked about the NIH yet! There’s good reason for that. The senator’s 2016 budget is rather vague about the NIH’s cut of drug abuse prevention funds.

Although Senator Baldwin and others would like the National Institute of Health to receive $54.7 million dollars, there aren’t detailed plans for how this money will be allocated. The bulk of it will be to conduct clinical research in collaboration with the VA, but details beyond that remain sketchy.

So, is the 2016 proposed budget good or bad? Unfortunately drug abuse prevention is too complicated an issue to simply label this budget as good or bad. I believe, though, that the majority of this money will be money well spent. That is to say, I believe the agencies and projects it’s funding are well worth the investment.

Or course, the ultimate acid test is to see how this budget works in action. After all, with overdose deaths and general substance abuse at an all-time high, it’ll be easy to see if this money, allocated to these agencies and programs, produces noticeable results. Let’s hope it does.

Federal Government in Favor of Suboxone

A New Approach to Drug Court

In a move that’s sure to ruffle some feathers, the federal government is throwing its weight around to make Suboxone mandatory in many drug courts.

According to Michael Botticelli, the Director of the White House’s Office of National Drug Control Policy, the government will begin to cut off federal funding to drug courts that ban Opioid Replacement Therapies. These are things like methadone and Suboxone maintenance.

government suboxone regulations

Botticelli is quoted as saying,

“Part of what we’ve been working on at the federal level is to strengthen our contractual language around those grants…if you are getting federal dollars that you need to make sure that people, one, have access to these medications [and two], that we’re not basically making people go off these medications, particularly as a participant of drug court” (Huffington Post).

Meanwhile, Pamela Hyde, a senior administrator from SAMHSA, is quoted as saying, “We’ve made that clear: If they want our federal dollars, they cannot do that [ban opioid therapy] … We are trying to make it clear that medication-assisted treatment is an appropriate approach to opioids” (Huffington Post).

The White House’s collaboration with SAMHSA is the first step in an expected widespread reform of US drug policy. Targeting drug courts that have banned Suboxone and the like is the beginning of a new chapter in how addiction is treated in America.

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The Current State of Suboxone

Suboxone, which goes by the chemical name buprenorphine, is a semisynthetic opioid that behaves in interesting ways. It’s both an opioid agonist and antagonist. This means it simultaneously activates and deactivates the brain’s opioid receptors.

In layman’s terms, buprenorphine eliminates cravings, while at the same time preventing withdrawal and the euphoric effects of opioids (if someone tries to relapse while on the drug).

It’s currently tough for addicts to get a prescription for Suboxone. This is based on federal regulation of the drug, which is classified as a Schedule III narcotic. In order to prescribe buprenorphine, doctors must have a special certification. They’re also limited to treating 100 medication assisted therapy patients at a time.

According to a prosecutor from Ohio, who spoke to the Huffington Post, changing Suboxone use in drug courts is more complicated than the federal government updating funding regulations. The prosecutor said,

“…whether we permit Suboxone use or not [by defendants] is irrelevant if no local doctor is willing or able to prescribe it. And our clinicians feel that Suboxone is unlikely to be effective in this community with the lack of integration in the health care system. Even if we were to allow participants [in drug court] to use Suboxone, there would have to be significant structural changes before it would be recommended” (Huffington Post).

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A Shifting Landscape

So, how are these “significant structural changes” going to be made? Well, in some cases, Washington is receiving help from state governments.

drug court

Minnesota State Senator Chris Eaton has picked up the torch of Suboxone reform on a state level. Senator Eaton’s daughter passed away from a drug overdose in 2007. Since then, Eaton has been campaigning to change regulations around Opioid Replacement Therapy, both in drug courts and on a statewide scale.

Further evidence that “significant structural changes” must be made comes from the very way drug courts are funded. In some instances, drug courts may not have to implement new government policies regarding buprenorphine due to the fact that many drug courts are state funded, rather than receiving federal dollars. These courts can choose to implement or ignore federal guidelines at their own discretion.

Will the federal government ever be able to impose new regulations around drug courts and the therapies they allow? That remains unclear. What is clear, though, is the change that does need to be implemented.

It’s no hyperbole to say America is in the midst of an opioid epidemic. The federal government is attempting to change that. They’re attempting to shift the tide in the fight against painkillers. And everyone, regardless of politics or personal beliefs, can appreciate that.

Learn more about Opioid Replacement Therapy

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