Expanding Access to MAT: The Maine Experience

Linda J. Frazier, RN, CHES, MATreatment Manager

Maine Office of Substance Abuse, DHHS2009 NIATx Summit & SAAS National Conference

Tucson, AZ

Maine MAT Partners

Acadia Hospital Addiction Resource Center at

MidCoast Hospital Aroostook Mental Health Center Maine General Medical Center The City of Portland Health Care for the

Homeless FQHC The Maine Alliance for Addiction Recovery The Maine Association of Substance Abuse

Programs The Maine Office of Substance Abuse

Context of Maine MAT Project

9 OTP Clinics serving 3,518 clients receiving Methadone, capacity is 4,810

5 Original MAT Pilots + 5 New Pilots (6/09) SOTA – State Opiate Treatment Authority History of using Medicaid Funding for

treatment; State Plan includes and supports key components

OSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community

Key Activities

Partnership & Shared Aims – Rapid Cycle PI Surveys, Chart Audit, Focus Groups –

Provider Staff & Consumers Implementation of Non Discrimination

Language in July 2007 Contracts Implementation of Pay for Performance

Contracts July 2007 Changes to TDS Data System July 2007 –

Added questions on Evidence Based Practices, MAT, Access/Retention

RIDER E: PROGRAM REQUIREMENTS(SUBSTANCE ABUSE SERVICES)

NON-DISCRIMINATION

13. Providers receiving grant funds from OSA will not discriminate against clients who are using legitimate medications to assist their recovery and will not have policies that allow them to refuse admission to treatment or to discharge clients from treatment based on the use of legitimate addiction medications.

Partnership With MAT Agency Pilot Sites

Four original AR MAT pilots, 2 added vivitrol sites, LC with these and five additional sites April 2009.

ASAM LOC written into licensing regulations 2006. Develop treatment processes & protocols – ID need

for medication and access to funds, patients right to have MAT, address internal barriers like staff attitudes.

OSA sponsored training to address staff education and identified barriers of prejudice and mis-information about MAT.

Site visits in July 2009.

Support for MAT Systems Change

Continued support for MAT – Coaching, Learning Session Participation

State General Funds for MAT Medicaid Reimbursement for Suboxone without Prior

Authorization for Addiction Treatment Co-sponsorship & Support for Development of ROSC Education & Training Evaluation of MAT in Addiction Treatment Consulting Medical Director

STOP Selling What You Have

START Selling What They Need

STOP Talking, START Doing

IBM.com/doing/uk

Heathrow Airport Billboard

October/December 2008

Primary Barrier

People don’t know what they don’t know

Challenges

Addiction is a Chronic Health Condition! Information & technology transfer Policy & Regulatory Changes – connecting the dots Preventing Prior Authorization and benefit limitations

specific to Medications for Addiction Treatment Funding, Policy, & Professional Silos Using data results to support the above and make the

business case for sustaining and expanding access to MAT

Results

Four original RWJF Advancing Recovery MAT Pilot Sites

Percent of Admissions with any MAT

Percent of admissions with any MAT

0%

5%

10%

15%

20%

25%

30%

35%

40%

Percent of admissions with any MAT - AR agencies

Percent of admissions with any MAT - Non AR agencies

Percent of non-methadone admissions with MAT other than methadone

Percent of non-methadone admissions with MAT other than methadone

0%

5%

10%

15%

20%

25%

30%

Percent of non-methadone admissions with MAT other than methadone - AR agencies

Percent of non-methadone admissions with MAT other than methadone - Non AR agencies

Percent of admissions with Buprenorphine

Percent of admissions with buprenorphine

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Percent of admissions with buprenorphine - AR agencies

Percent of admissions with buprenorphine - Non AR agencies

Reduced use at discharge: AR agencies

Reduced use at discharge: AR agencies

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Reduced use - non-methadone MAT Reduced use - no MAT

Percent Abstinent at Discharge

Percent abstinent at discharge: AR agencies

0

10

20

30

40

50

60

70

80

Percent abstinent at discharge - non-methadone MAT

Percent abstinent at discharge - no MAT

Successful Whole Systems Change Requires ART Trust & Respect Identified Common & Shared AIMS AND

Mutual Accountability & Transparency Common Shared Language – Between

professional fields and the recovery community

Cultural Competency Positive Role Models, Access to

Coaching/Recovery Support