Medication Assisted Treatment: Ready, Set, Implement
In July, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) that — among other things — mandates our health care system to use state-of-the-science medications to treat addiction, in combination with other proven treatments.
Last year, I attended the official roll-out of the Surgeon General’s Report on Alcohol, Drugs and Health. The report joined the rally cry for greater use of medications as a part of addiction treatment.
In December, another call came. Congress and President Obama signed the 21st Century Cures Act, again demanding more funding and greater use of medication assisted treatment (MAT).
Given the momentum and clear evidence of MAT’s effectiveness, why are providers reluctant to use these proven medications?
I asked an integrated health care provider recently and he reiterated what I hear all the time: “We would like to start using MAT, but we don’t know where to start. I don’t know what I don’t know.”
For most providers, implementing MAT is a significant change in organizational philosophy. And it feels daunting … without proper guidance. Planning for MAT implementation requires the same thoughtful planning as implementation of any other service or evidence-based practice.
Do your Homework
Most providers focus on getting physicians trained in MAT, but to implement MAT, you also have to focus on a number of key areas such as financing, workforce and community readiness.
Here are some questions to ask:
- Do you have data on the people you serve that would demonstrate the potential benefit of implementing MAT, including information on co-morbid conditions and medication use?
- What MAT services will you offer (e.g., opioid use disorder, alcohol use disorder, smoking cessation)?
- What do Medicaid and commercial insurers require for MAT use in your state?
- How will you provide ongoing training and supervision to your staff?
- Do you have access to recovery supports to assess a patient’s support network?
Consult Other Community Stakeholders
Health centers and other treatment providers treat individuals, but addiction is a community issue. Consulting with other community providers to address these questions will help you position your organization as a valuable community resource and create a supportive environment for your clients and your program as you move forward with MAT services.
Some key questions for consideration include:
- What are the substance abuse treatment/prevention needs?
- What other treatment programs in your region and state currently provide MAT?
- Do you have relationships with other organizations that can provide additional treatment supports and resources?
- Does the community need further information on the benefits of substance abuse treatment/MAT?
Start Low and Go Slow
Implementing MAT can typically mean a significant change in policy and service delivery for most organizations. Given the significance of this change, it is perfectly acceptable to develop a PDSA cycle (plan-do-study-act) to begin monitoring when you start providing services to a small number of clients and go slowly through the process with them, making changes and revisions along the way. It will take some time for you to develop the robust and thriving MAT program that your community may need, but don’t be afraid to stop and assess your progress and make changes in the early stages of implementation. It will save you from more complicated problems in the future.
While these are certainly not the only questions that need to be considered before you implement your MAT program, use the Center for Integrated Health Solutions’ (CIHS) MAT Implementation Checklist as you move forward.
How are you working with your community to bring MAT into your service?