Friday, September 09, 2005
An email message from Robert Lubran of CSAT summarizes the many efforts of government,provider groups and individuals to respond to the crisis of those in the Gulf region dependent on opiates - either methadone or buprenorphine prescribed for the treatment of dependence or pain, or illegal drugs such as heroin.
FROM DR ROBERT LUBRAN, CSAT (8 SEPT 05)
I have since learned that the one methadone program in New Orleans that opened (Desire Narcotics Rehab) has since closed and is planning to relocate to Baton Rouge. We have been hard at work the past week coordinating disaster relief activities with the affected states and Opioid treatment programs (OTPs) in the region. Now that we know people from the region are being evacuated throughout the United States it is no longer a regional issue. Here are some of the specific things we’ve done.
OTPs. We are in touch with many OTPs in the Gulf states region. Nick Reuter and I were in Texas and Alabama very recently and know many of the providers in the region. The state methadone provider associations have been in contact with us and with the exception of the closed programs in the New Orleans area seem to be handling the added workload. We have spoken with methadone drug manufacturers on efforts to supply additional opioid medications to shelters in Baton Rouge and Houston. They are being very generous.
Here is a breakdown of activities in the Gulf States:
Alabama – I was told by the President of the Alabama providers association that a few patients were being treated in Huntsville, Muscle Shoals and elsewhere and that the Mobile programs are operational.
Florida – Gary Wenner of Operation PAR told us that “In most cases we are seeing folks in withdrawal, and rather than guest dosing them we are actually admitting them to our programs. We are giving them a months free treatment, and trying to get them established in jobs ASAP so if they need to stay longer they will be able to support their treatment and themselves.”
Louisiana – We were contacted by one OTP in downtown New Orleans (Vernon Short, Desire Rehabilitation Center) that is now open in a mobile unit adjacent to program on Gentilly Road. We are working with him to ensure he has a supply of methadone. CRC in Baton Rouge has brought in staff from other sites and is being provided additional methadone at no cost. One of our medical officers has been deployed to work with the state of Louisiana with a focus on methadone treatment.
Texas – We are working with the Texas Department of Health (TDH) regarding methadone treatment at the Houston Astrodome. The TDH SMA reports that methadone patients at the Astrodome are transported to publicly funded treatment programs in Houston on a daily basis for dosing.
Exceptions. We are expediting review and approval of exception requests. We are encouraging OTPs to use our new electronic exception reporting system to save time, costs. There are several patients who are getting extended take-homes to enable them to volunteer in the Gulf States. We held a briefing with the Gulf States last week and are coordinating activities with each SMA. In addition, we are meeting with all the SMA’s by teleconference on the 19th. AATOD. We are in daily contact with Mark Parrino.
In addition, I’m providing a point-by-point response to your specific concerns. Please feel free to share this with your membership and other patient advocacy organizations. This will be the basis for Friday’s briefing.
1. CSAT expand and make maximum use of procedures including those for Interim Treatment for rapid transfer and hardship Exceptions for take-home doses, including publicizing the availability of new procedures to SMAs and providers in the region.
Response. A notification was sent last week (see attached) to affected states and OTPs in the region providing guidance on how to proceed under the emergency. We are planning to make this guidance available nationwide to all States and OTPs shortly. When the guidance is sent out you will receive a copy.
2. Publicize the ability of licensed MDs to prescribe methadone for up to 28 days for addiction, through state medical societies and similar bodies who may be in contact with general physicians.
Response. Physicians are not permitted under DEA rules to prescribe methadone for addiction treatment. Section 1306.07 of the DEA’s rules provide that a physician not working in an OTP can administer methadone to a person “for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment. Not more than one day's medication may be administered to the person or for the person's use at one time. Such emergency treatment may be carried out for not more than three days and may not be renewed or extended.”
3. Commend the Louisiana SMA for their efforts so far.
Response. We agree that the Louisiana SMA has done an excellent job to date. Moreover, the other states in the Gulf region, including Texas, Mississippi, and Alabama have similarly performed admirably under the circumstances. Many other states have stepped up to the plate to ensure that patients get medicated with a minimum of disruption.
4. CSAT should create emergency guidelines for accepting patients from the affected areas. For example, instructions for medicating patients that may not have identification or be able to validate their dose. Many patients will be exhibiting classic withdrawal and professionals should be able to access this and provide adequate medication.
Response. We’ve done that for the affected state and will issue additional guidance for the nation. You will receive a copy as soon as it is available.
5. CSAT staff contact every clinic in the states that are affected and adjacent states that will see evacuated patients (especially Texas, but also Alabama,Florida, Tennessee, Georgia, the Carolinas, Mississippi, etc.), and notify these states of any emergency procedures adopted, to reassure them of the legality of procedures and encourage a pro-active response. AATOD can coordinate with provider associations.
Response. This has been done. The next step will be to notify every program in the United States. We’re coordinating with AATOD and providers in states that are not a part of AATOD to ensure they are fully informed.
6. CSAT expedite the creation of a few "emergency dosing" stations through existing emergency medical providers based in areas (especially the Houston Astrodome and other major reception shelters in Texas) where we might expect a relatively larger concentration of patients without any means of transport to other facilities.
Response. There does not appear to be a need for “emergency dosing stations” outside the existing OTP network. The State of Texas has arranged for patients to go from the Houston Astrodome to a publicly funded clinic. I understand the patients do not have to pay for methadone treatment under this arrangement. Patient exceptions are being expedited. If the need arises for additional treatment capacity we are prepared to work with the providers in Texas and elsewhere to ensure patient access to both methadone and buprenorphine.
7. CSAT set up a help line for providers and patients to ask questions.
Response. We are considering the best manner in which this might be done with SAMHSA officials in the overall of the overall Department of Health and Human Services response to the disaster. We’ll keep you informed as to what direction the Agency determines will be most effective.
8. Allow pain patients who may be taking methadone and cannot access their medication to receive assistance until they can be transferred to other medical services.
Response. CSAT’s accreditation guidelines provide: Patients who are diagnosed with physical dependence and a pain disorder are not prohibited from receiving methadone/buprenorphine therapy for either maintenance or withdrawal in an OTP if such setting provides expertise or is the only source of treatment.
9. Notify NAMA what measures are being taken, we will attempt to publicize them as much as we can.
Response. We are trying to set up a conference call for a briefing with patient advocacy organizations.