Improving Public Health Through Access to and Utilization of Medication Assisted Treatment

Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA.
International Journal of Environmental Research and Public Health (Impact Factor: 2.06). 10/2011; 8(10):4102-17. DOI: 10.3390/ijerph8104102
Source: PubMed


Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best "one stop shopping" approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

Download full-text


Available from: Robert Lubran,
  • Source
    • "Methadone maintenance therapy (MMT) is recognized by the U.S. Institute of Medicine as well as by the World Health Organization (WHO) to reduce cravings for illicit opioids, reduce crime linked to drug use, reduce deaths from overdose, reduce HIV risk behaviors, and help patients stabilize their lives and sustain productive activity [3,4]. Since 2002, buprenorphine has also been authorized for treatment of opioid dependence in the U.S. and is in wide use [5]. Methadone and buprenorphine are included for their therapeutic use on the WHO Model List of Essential Medicines [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Specialized drug treatment courts are a central part of drug-related policy and programs in the United States and increasingly outside the U.S. While in theory they offer treatment as a humane and pragmatic alternative to arrest and incarceration for certain categories of drug offenses, they may exclude some forms of treatment-notably methadone maintenance treatment (MMT). We sought to understand from the perspective of treatment providers whether this exclusion existed and was of public health importance in New York State as a case example of a state heavily committed to drug courts and with varying court-level policies on MMT. Drug courts have been extensively evaluated but not with respect to exclusion of MMT and not from the perspective of treatment providers. Qualitative structured interviews of 15 providers of MMT and 4 NGO advocates in counties with diverse court policies on MMT, with content analysis. Courts in some counties require MMT patients to "taper off" methadone in an arbitrary period or require that methadone be a "bridge to abstinence." Treatment providers repeatedly noted that methadone treatment is stigmatized and poorly understood by some drug court personnel. Some MMT providers feared court practices were fueling non-medical use of prescription opiates. Drug court practices in some jurisdictions are a barrier to access to MMT and may constitute discrimination against persons in need of MMT. These practices should be changed, and drug courts should give high priority to ensuring that treatment decisions are made by or in close consultation with qualified health professionals.
    Harm Reduction Journal 12/2013; 10(1):35. DOI:10.1186/1477-7517-10-35 · 1.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prescription drug overdose is the leading cause of injury death in Ohio, as well as in 16 other states. Responding to the prescription drug epidemic is particularly challenging given the fragmentation of the health care system and that the consequences of addiction span across systems that have not historically collaborated. This case study reports on how Ohio is responding to the prescription drug epidemic by developing cross-system collaboration from local public health nurses to the Governor's office. In summary, legal and regulatory policies can be implemented relatively quickly whereas changing the substance abuse treatment infrastructure requires significant financial investments.
    Public Health Nursing 11/2012; 29(6):553-62. DOI:10.1111/j.1525-1446.2012.01043.x · 0.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During July–August 2010, Pakistan experienced extreme flooding that affected approximately 18 million persons. In response to the emergency, Pakistan’s Ministry of Health and the World Health Organization (WHO) enhanced an existing disease early warning system (DEWS) for outbreak detection and response. This report summarizes surveillance results early after implementation, describes system usefulness, and identifies areas for strengthening. Daily disease counts were reported from health facilities in four provinces containing 98% of the flood-affected population. During July 29, 2010–September 15, 2010, approximately 5.6 million new patient visits were reported. The most frequent conditions reported were skin diseases (18.3%), acute respiratory infection (15.1%), and acute diarrhea (13.3%). A total of 130 outbreak alerts were documented, of which 115 (88.5%) were for acute watery diarrhea (AWD) (suspected cholera). Of these, 55 alerts (47.8%) had at least one microbiological sample with confirmed cholera. Overall, DEWS was useful in detecting outbreaks, but it was limited by problems with data quality. Improvements in DEWS have increased system usefulness in subsequent emergencies. This report highlights the need to follow updated WHO guidelines on early warning disease surveillance systems to improve their usefulness (1).
    MMWR. Morbidity and mortality weekly report 12/2012;
Show more