Tag Archives: Medication Assisted Treatment

Medication Assisted Treatment Deemed Appropriate for Sober Living

Alison Knopf, the award-winning journalist and editor of Alcoholism & Drug Abuse Weekly (ADAW), recently published an article highlighting SAMHSA’s new guidelines for recovery housing, which includes MAT/Medication Assisted Treatment. In her story entitled “SAMHSA guidelines for recovery housing emphasize MAT,” she writes:

If there’s any question about the appropriateness of medication‐assisted treatment (MAT) using methadone and buprenorphine for recovery housing residents, it has been settled by the most recent report from the federal government: Don’t ban it, and, furthermore, do it.
 
Best practices for operating recovery housing are a key part of the Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, under Subtitle D, “Ensuring Access to Quality Sober Living (SEC. 7031).” The law mandates the Department of Health and Human Services to identify or facilitate the development of best practices, and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued this report last week.
 
The document is focused on MAT for opioid use disorders, because the SUPPORT Act is only for opioid use disorders.
 
“This document is intended to serve as a guidance tool for states, governing bodies, treatment providers, recovery house operators, and other interested stakeholders to improve the health of their citizens related to substance use issues,” according to the executive summary.
 
The document constitutes guidelines. There are no provisions for the federal government to enforce or monitor these—except for SAMHSA funding, which can be based on state evaluations and adherence to these guidelines.
 
This report identifies 10 principles to help define safe, effective and legal recovery housing.
 
What is recovery housing? It’s not just housing; it’s an intervention that is meant to help a recovering person access a safe and healthy living space “while supplying the requisite recovery and peer supports,” the report states. Under the SUPPORT legislation, it also has to be “free from alcohol and illicit drug use and centered upon peer supports and connection to services that promote sustained recovery from substance use disorders,” according to SAMHSA.

The SAMHSA report, “Recovery Housing: Best Practices and Suggested Guidelines” specifically adopts NARR’s (National Alliance of Recovery Residences) levels of housing and appears to incorporate NARR’s MAT guide, “Helping Recovery Residences Adapt to Support People with Medication-Assisted Recovery”.

It is our hope that one day soon, eventually, the inevitable obvious conclusion will be reached – the recovery “journey” may start with treatment, but sustained recovery and the ability to be free of dependency upon substances takes long-term community support, in a community of fellow peers. For some, this includes both short term and long term use of MAT, depending upon each individual’s chemistry and needs.

But is also begs the question – cities that are effectively banning sober living by creating mandatory spacing requirements are doing so under the guise of preventing a “de facto social service district.”  What is a “de facto social service district?” Who has determined with evidence and study that a concentration of NARR level approved/certified housing is BAD for people in recovery? What if it actually helps, and these spacing requirements (ex. 1,000 feet between each home) actually hinder recovery???

Using the same assumptive reasoning in treatment, the abstinence-only approach has worked in the past, and continues to work for many (though mostly people with Alcohol Use Disorders primarily). Using MAT has a stigma attached to it (rightfully and understandably so) because the thought is that we are merely substituting one drug for another, not forcing the patient to fully confront their inner demons and move to the next level of emotional independence.  But the science says otherwise.

While we also understand that Big Pharma clearly has played a role in having MAT become synonymous with “treatment,” causing many to be suspicious and cynical of these supposed positive outcome studies, the larger picture is the need for recovery residences to learn how to incorporate MAT into their housing policies and procedures because MAT is here to stay.

While some housing providers continue to insist they have the right to deny residency to a patient/client on MAT, legal observers in this niche space have suggested that denying a patient residency because they are on MAT may actually violate the Fair Housing Act (FHA) and the Americans with Disabilities Act (ADA) based upon discrimination of a protected class based upon their medical condition alone.

We have written on this topic for years, and the antagonism between the two sides (for and against) remains strong.  However, there is now more than sufficient evidence and science of the efficacy of using MAT as useful tool to jumpstart many people’s recovery, and to sustain in long into sober living.

DOJ: Denying Services to Persons on MAT Violates ADA

On Thursday, May 10,2018, the US Department of Justice announced that it had reached a settlement agreement with Charlwell House, a skilled nursing facility in Norwood, Massachusetts, to resolve allegations that the facility violated Title III of the Americans with Disabilities Act (ADA) by refusing to accept a patient because they were being treated for Opioid Use Disorder (OUD).

Charlwell House is a 124-bed health and rehabilitation center that provides skilled nursing services and rehabilitation programs. According to a complaint filed with the United States Attorney’s Office, an individual seeking admission for treatment at Charlwell House was denied because they were being treated with Suboxone, a medication used to treat OUD. Individuals receiving treatment for OUD are generally considered disabled under the ADA, which among other things prohibits private healthcare providers from discriminating on the basis of disability.

According to DOJ: “Our office is committed to protecting the rights of people with disabilities, which includes those in treatment for an Opioid Use Disorder,” said United States Attorney Andrew E. Lelling. “The number one enforcement priority of my office is addressing Massachusetts’ opioid crisis. Overdoses killed more than 2,000 individuals in Massachusetts last year alone. As Massachusetts faces this overdose epidemic, now more than ever, individuals in recovery must not face discriminatory barriers to treatment. We appreciate the cooperation that Charlwell House has offered throughout our investigation.”

Under the terms of the agreement, Charlwell House will, among other things, adopt a non-discrimination policy, provide training on the ADA and OUD to admissions personnel, and pay a civil penalty of $5,000 to the United States.

Sally Friedman, the Legal Director of the Legal Action Center (LAC), applauded the U.S. Attorney’s office for taking action against this widespread form of discrimination, noting that it is likely the first ADA settlement against a skilled nursing facility for excluding patients because they are taking medication to treat their substance use disorder.

“The case law is abundantly clear that the ADA protects individuals with substance use disorder. This settlement by the Department of Justice should send a resounding message to skilled nursing facilities – and other entities – that denying care to people because they are taking life-saving medication to treat addiction is a discriminatory practice that will not be tolerated.”

This settlement announcement comes on the heels of a letter by the U.S. Attorney’s Office that it is investigating whether the Massachusetts correctional system is violating the ADA by forcing people off addiction medication when they become incarcerated, and an article in STATNews documenting the common practice of nursing facilities refusing to accept patients taking addiction medication.
Information about what to do when forced off medication assisted treatment (MAT) by the criminal justice and child welfare systems or employers is available in LAC’s MAT Advocacy toolkit,www.lac.org/MAT-advocacy.

Negative Press Causing Referrals to Florida to Come Into Question

The Portland Press Herald reported on July 19, 2017 in the article “Operation Hope stops sending clients out of New England for opioid addiction treatment” about how the Scarborough (Maine) Police Department’s Operation Hope has stopped sending clients out of New England for treatment for opioid addiction, largely because of negative media about alleged unscrupulous programs, especially in Florida (a story published in May by STAT, a health journalism website that partners with The Boston Globe, detailed alleged insurance scams and referrals to Florida clinics where patients were receiving little or no treatment).

Launched in 2015, Operation Hope was conceived as a way for police to channel addicts who sought help into a treatment program as an alternative to criminal prosecution on drug-related charges.

In most cases, getting help from Operation Hope meant flying out of state – to Florida or one of eight other states – because Maine lacked treatment opportunities. In the program’s first six months, four out of five Operation Hope participants headed out of Maine, mostly to clinics in Florida, Arizona and Massachusetts.

“We always wanted to help people closer to home, but we really had no other choice. That was the only way to get people help,” said Steve Cotreau, program manager at Portland Community Recovery Center. The nonprofit social support center for people in recovery has helped with Operation Hope placements.

With the current black-and-white approach that many law enforcement agencies are taking with regard to “regulation” of treatment providers, many good providers are electing to close up shop due to lack of regulatory guidance. When the only guidance available is a knock at the door from a detective claiming you have violated the law, when the lawyers themselves may disagree whether the law was violated, but it is to be “left up to the judge and jury” to determine one’s fate, many good providers are simply walking away.

There is an absolute vacuum of publicly-funded beds in Florida, and nationally. Even when there is some modicum of availability, these facilities are generally not accessible to persons who do not qualify as being impoverished, and are often staffed by persons who lack the experience or education to be administering what is becoming an overwhelmingly medical modality.

The ignorance from the regulatory bodies about how the private sector must be allowed to work is impeding innovation as well as necessary investment in technologies for growth. A truly progressive society would stop complaining and fully support the treatment industry altogether.

The apparent restriction of prosecutorial discretion for purposes of achieving popular political gains is not only short-sighted, but also has a significant negative impact upon the substantial legitimate employment that the industry provides, along with choking off the ancillary revenue that local businesses experience from developing recovery communities.

We will simply go from one crisis, to another.