Medication Assisted Treatment
“I just can’t believe how much better I feel every morning now that I’m getting Suboxone. I don’t have to worry about getting enough money or worry about my safety in getting what I need and most of all I’m no longer putting my family at risk if I get busted.”
There are lots of different expressions of relief and profound gratitude that patients express after they get into what is called Medication Assisted Treatment (MAT). There is no doubt in my mind that this is a viable form of treatment for what is now diagnosed as Opiate Use Disorder. I can understand the current bias that exists that all I am doing is replacing the illegal drug with a legal one, which on the surface is true. However, most people don’t realize that any clinician who wants to treat opiate addiction has to apply for a waiver from the DEA to be permitted to prescribe it. The waiver requires a minimum of 8 hours of education from an authorized educational source and requires an agreement that the prescribing provider will provide or require supportive treatment.
In my experience in treating patients with Suboxone or Subutex the most critical part of the MAT is the supportive treatment. The waiver doesn’t prescribe what kind of support treatment is to be provided so it is essential that the clinic team design a program that will include trained substance abuse counselors and therapists and a strong case management team to set and monitor treatment goals, to assess regular compliance with required counseling, drug testing, medication management, and a strong disciplinary system for non-compliance when it occurs.
Sitting in on case management meetings as a prescriber was a very enlightening experience for me. I could really see the importance of the support team. A good number of people are very compliant so it is gratifying to see people being compliant in the program. I also began observing people who were having difficulty in the program express the source of their trouble and how the team would help them find solutions and emphasize how we can help them with any problem if it’s possible. The number one problem for all human beings who seek any kind of assistance is their automatic thought that they can manage life’s difficulties by themselves. That thought is the number one cause of eventual non-compliance and relapse. It is the goal of the support team to not only help identify the problem but to offer education and training for the very common problems through our required monthly group meetings (two 2-hour meetings for Suboxone recipients and four 1-hour meetings for Subutex). Attendance and drug testing results are strictly monitored at every monthly case management meeting that is required prior to meeting with the prescriber. I’m really impressed with our program and the leadership team’s effort to continue to improve the program. The task at hand is huge and daunting but it won’t end until we can serve everyone with this problem.