207471 Implementing medication assisted treatment: The Advancing Recovery program

Tuesday, November 10, 2009: 9:24 AM

Dennis McCarty, PhD , Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
Traci Rieckmann, PhD , Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR
Paul Roman, PhD , Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, Athens, GA
Laura A. Schmidt, PhD , Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, University of California, San Francisco, San Francisco, CA
Dace S. Svikis, PhD , Department of Psychology, Virginia Commonwealth University, Richmond, VA
Victor Capoccia, PhD , NIATx, University of Wisconsin, Watertown, MA
The Robert Wood Johnson Foundation's Advancing Recovery program is testing strategies to promote adoption of medication assisted treatment and behavioral therapies. State (or local) agencies partner with three or more community treatment programs to modify state (e.g., regulations, contracts) and provider (e.g., intake, physician linkages) systems and promote pharmacological or behavioral evidence-based practices for addiction treatment. Advancing Recovery combines systems thinking (analysis of barriers, financing, purchasing and inter-organizational linkages) with process improvement Plan-Do-Study-Act (PDSA) change strategies. Eight of twelve sites addressed medication assisted treatment Maine, Maryland (Baltimore), Texas (Dallas), and West Virginia increased access to buprenorphine; Missouri and Rhode Island promoted oral alcohol medications and Colorado and Florida worked with injectable long-acting naltrexone. A mixed method evaluation assessed change over time and identified implementation strategies and challenges.

Maine, Maryland and Missouri enhanced linkages with physicians, provided access to medications, and trained clinicians; they made substantial gains in the use of medications. Gains were more incremental in Colorado, Florida, Rhode Island, Texas and West Virginia. Common implementation barriers included a) mechanisms to purchase and pay for medication, b) contract language that constrained provider options, d) contracts and regulations that did not require systems for patient referral to prescribers, e) counselor and physician training, and f) patient education and choice. Initial changes were small to encourage action. State policy interventions evolved through trial and error. Successful states constructed linkages with prescribers and gained access to state pharmacy purchases. Provider and consumer education were essential facets of implementation.

Learning Objectives:
Describe the key features of the Advancing Recovery Program. Identify strategies to facilitate the implementation of medication assisted treatment.

Keywords: Alcoholism, Drug Addiction

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: the primary medication assisted treatment in one state is topiramate; use of topiramate for alcohol use disorders is unlabeled.

Qualified on the content I am responsible for because: I am the co-Principal Investigator (with Paul Roman) for the national evaluation of Advancing Recovery and will present for the evaluation team. I am an APHA member and have presented at prior meetings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.