The Ohio Department of Mental Health and Addiction Services (OhioMHAS) Addiction Clinical Roundtable has recommended that Ohio implement the National Practice Guidelines for the use of Medications in the treatment of Addiction Involving Opioid Use developed by the American Society of Addiction Medicine (ASAM). These guidelines bring our state into alignment with the nationally recognized best practices for the treatment of opioid use disorder and with the service and billing practices for Medicaid Reimbursement. ASAM guidelines were developed for the evaluation and treatment of opioid use disorder and for the management of opioid overdose. They are primarily intended for clinicians involved in evaluating patients and providing authorization for pharmacological treatments. They will replace the Low Dose Protocol initially established for opioid treatment by the former Ohio Department of Alcohol and Drug Addiction Services.
Medication-assisted treatment (MAT) is treatment for addiction that includes the use of medication along with counseling and other support. Treatment that includes medication is often the best choice for opioid addiction. If a person is addicted, medication allows him or her to regain a normal state of mind, free of drug-induced highs and lows. It frees the person from thinking all the time about the drug, reduces problems of withdrawal and helps people manage their addiction so that the benefits of recovery can be maintained.
There are three main choices for medication to treat opioid addiction. The two most common are methadone and buprenorphine. Occasionally, another medication called naltrexone is used. All of these medications have the same positive effect: they reduce problem addiction behavior. People can safely take treatment medication as long as needed – for a few months, one or several years, or even for life. Plans to stop taking any medication should ALWAYS be discussed with a doctor.
Taking medication for opioid addiction is like taking medication to control heart disease or diabetes. Used properly, the medication does NOT create a new addiction.
Opioid treatment program (OTPs) provide medication assisted treatment (MAT) for patients diagnosed with opioid-use disorder. Typically, these facilities have the largest array of MAT options including methadone, buprenorphine products, and naltrexone (a.k.a., Vivitrol).
OTPs are different than more common office-based opioid treatment programs because they are licensed by various federal and state authorities and must adhere to a strict set of guidelines that cover patient care. For example, patients on methadone must report to the facility for highly supervised medication management early in their recovery, and they are granted take home doses as they progress in their recovery. OTPs also provide enhanced counseling services, physical health care services, and promote recovery-oriented systems of care to all patients.
As of January 2017, Ohio has 26 OTPs (including three at Veteran’s Administration facilities). However, the number is expected to expand due to changes with Senate Bill 319, which removes several legislative requirements that made it difficult for new facilities to open in the state. Application must be submitted to the OhioMHAS Bureau of Licensure and Certification by organizations that are looking to establish new facilities for MAT across the state.