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The expanded scope of the Medicaid program has accomplished a great deal in bolstering substance use treatment, but further progress will depend on correcting deficiencies in non‐expansion states and within Medicaid managed care entities, a newly published commentary suggests. [ABSTRACT FROM AUTHOR]

Last week, ADAW featured a published paper recommending that higher doses of buprenorphine be used in the era of fentanyl (see "ASAM recommends higher doses if needed for treatment with buprenorphine," ADAW, Jan. 7, 2024, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.33984). The American Society of Addiction Medicine (ASAM) did not have time to get back to us by deadline but did respond to our questions for this week's issue. Below are our questions, in italics, followed by their responses. [ABSTRACT FROM AUTHOR]

A policy paper released this month by the American Association for the Treatment of Opioid Dependence (AATOD) focuses on some of the challenges facing opioid treatment programs (OTPs) today. For example, it cites an article published in the New England Journal of Medicine (July 5, 2018) by Michael Botticelli that promotes the idea of methadone being available in primary practice settings for the treatment of opioid use disorder (OUD) (see ADAW, July 16, 2018). "AATOD recommends that this proposal should only be considered after careful, conservative, and thoughtful evaluation," according to the policy paper. "As history and our policies have shown, we do not reject the public health model for increasing access to care for OUD, nor are we ignoring what has been learned about clinical standards of care to treat this illness. It is important to understand, however, the complexity of inducting a new patient into methadone maintenance treatment when developing policies for increasing access to medication assisted treatment." [ABSTRACT FROM AUTHOR]

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17). [ABSTRACT FROM AUTHOR]

The primary manner by which states have been using Medicaid to expand access to substance use disorder (SUD) treatment may actually be making it more difficult for individuals to receive the services most appropriate to their needs, a newly released paper suggests. Moreover, this preferred strategy in many cases violates the law, authors with the National Health Law Program contend. [ABSTRACT FROM AUTHOR]

An over‐reliance on federal block grants and "one‐off" funding initiatives has left the addiction treatment system under‐resourced to respond to an addiction crisis that stands to be at least as deadly as COVID‐19 during the span of the Biden administration, a trio of prominent researchers argue in a newly released policy paper. The authors suggest that the new administration and Congress should prioritize efforts to build on what they consider the most impactful developments in improving access and quality in addiction treatment, such as Medicaid expansion and parity mandates. [ABSTRACT FROM AUTHOR]

Two recent research papers highlight ongoing deficiencies in the provision of addiction and mental health treatment services to veterans, though the report focusing on depression treatment for patients with substance use disorders (SUDs) suggests that shortcomings in treatment for co‐occurring disorders affect all populations. [ABSTRACT FROM AUTHOR]

A new research paper on the neurobiology of opioid addiction is replete with complex terms, such as the pivotal "hyperkatifeia" (coined about a decade ago to describe an increase in the intensity of the negative emotional signs of drug withdrawal). But the primary takeaway message from the report's author, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George Koob, M.D., is much more accessible and direct. [ABSTRACT FROM AUTHOR]

The article presents the white paper from American Association for the Treatment of Opioid Dependence (AATOD) which focuses on how opioid treatment programs can coordinate with office-based buprenorphine prescribers.

The article focuses on a report in an issue of the "Palm Beach Post" on the downfall of the sale of a portfolio of addiction recovery treatment centers by real estate investor Frank Cid due to alleged kickbacks, patient brokering and fraud. It cites the alleged unethical practices in patient urine testing and billing, move by Cid to sue Florida Association for Recovery Residences (FARR) president John Lehman for defamation and the impression of Lehman over the revenue source of the centers.

The article talks about the concept of civil commitment for substance use disorders (SUDs), discussing a research paper released by Hazelden Betty Ford Foundation. Topics discussed include the views of some people that addiction is a disease and its treatment should not be coerced; a paper by the U.S. National Institute on Drug Abuse (NIDA) on it; and the benefits of involuntary commitment laws for substance use disorders.

The article discusses the traditional six-month rule of demonstrated abstinence from alcohol use before liver transplant eligibility. Topics covered include the reference given to a paper which deals with inadequate referral to transplant for end-stage liver disease patients with an alcohol use history and the story related by surgeon Richard B. Freeman which sought to determine which patients with kidney disease should receive dialysis.

This article discusses findings of the study "A Systematic Review of the Relationship Between Staff Perceptions of Organizational Readiness to Change and the Process of Innovation Adoption in Substance Misuse Treatment Programs." Topics covered include the research papers on "organizational readiness to change" reviewed by researchers, a model for outlining the measures for organizational readiness for change, and how treatment programs can embrace innovations -- new evidence-based practices.

A deeply researched white paper shows how mutual support groups can assist — and have assisted — people trying to deal with their drug use. The paper summarizes research on the use of these support groups and details how Narcotics Anonymous (NA) helps drug users, in much the same way Alcoholics Anonymous helps alcohol users, but there are some important distinctions. [ABSTRACT FROM AUTHOR]

The article discusses a white paper issued by Beacon Health Options "Confronting the Crisis of Opioid Addication" calling for a focus on outpatient medication-assisted treatment by primary care. Topics discussed include its focus on the need to treat opioid addiction as chronic condition, its criticism of providers of detox who did not participate in the continuum of care needed for chronic conditions and its support for 10 levels of care of the American Society of Addiction Medicine (ASAM).

A new payment model for addiction and recovery services was released last week in the form of a white paper called “Incentivizing Recovery.” The model, which is based on bundling — multiple providers get paid from the same fee — and capitation — the fee is preset, as in managed care – was proposed by Leavitt Partners, Facing Addiction with NCADD and Remedy Partners. [ABSTRACT FROM AUTHOR]

The article discusses Recovery Brands and Elements' white paper on Internet marketing which was presented during the annual meeting of the National Association of Addiction Treatment Providers (NAATP). Topic discussed include claims that Recovery Brands' website does not allow advertisers to promise cures, its promise to fully disclose site ownership and sponsorships and examples of unethical digital marketing practices such as the use of only one phone number by a low-quality directory site.