HomeMy WebLinkAbout2004-05-10 04-140 ORDERItem No. 04-160
Mate: 05-10-M
Item/Subject Order, AUMoriziig a Grant Application to Me U.S. Department Or Worth and Human Services,
SubstanceAbuse M1ental Health SeMces Adminabatlon,for an lin enartation Granite Develop a SUMtirreAcne
Treatment Nedwgrk In Support of the Use OF Buprenorphine in our P.egion
Responsible Department City Manager
Commentary: RapresentaMes of Acadia Hospital have approached Me City with a request fist we consider
applying for a gram that world MI Mem W undertake a program designed W work with phywcons W expend
the avalWbllity of buprenorphine treatment W ind wls with opldd addktbn Mmughom our region.
Buprenorphine a an alternative oplold adtlldon tteaM4m Mat has been approved by the FDA or physician
administration. FDA regulations allow physicians who have been specifically trained W beat up W 30 opioid
addicts in Meir individual podia.
The December 26, 2000 report OrMe Special Committee on Ogate Addiction evaluated the use of buprenorphine
and made a series of recommendations regarding R Acedla's proposal numas many of the recommentlations
included In this report. They are imposing W Identify six primary care provides in Washington, Hancock and
Pan dsom counters, aaslrt Mem in baoning cemfied W presoibe buprenorphine, work W initiate and stabilize
treatment of potential dents at Acedia Hospital, and acid tach patients and Matas In proNding conlinuetl core
at Indwldual pradids. Acadia will also evaluate Me effectiveness and morass of buprenorphine teatmeM.
Acacia has requested Mat we apply far this grant since it requires that a state of local government be an
applicant. The State has declined W ad in this capacity because they are committed W apply far sudi a grant far
several over programs and they lack the capacity to handle any further ones. Should we apply far an remove
surd a grant, the City will ad as farad agent and responsible federal party and wal coned with Arcadia fa the
actual nark entailed within the grant.
Given Mat Me City has been deaply concerned regarding aided addiction in our region, Mat a major source Of
MIs concern has stemmed from the potential for opioid addicts relocating W Bangor due W a lack of treatment
options in Meir area, and that the proposed program conWmrs W Me recommendations Included in Me report d
Me Special CommttWe, I would recommend your approval far such a gram application. If successful, we would
then enteroWa comradw0h Acacia fa the servicesWMed trough ihegram. Pleaee see Me adached
description of these sevices prO wed by Procne.
Depaitmem Head
Manager's Comment: This has been reviewed and b recommended by Me Hnageg Committee_ � a/
City Manager
Budget Approval:
inane Director
regal Approval:
a Solclsor
Introducetl far
X Passage
FIM Reading
Refeml
Page _ of
Assfgaed t0 Councilor Gratv£ek May 10, 2006
CITY OF BANGOR
(TITLE.) Order, Authorizing a Grant Application M the U.S. Department of Health and Human Services,
Substance Abuse Mental Health Services Administa6on, for an Implementation Gent M Develop a
Substance Abuse Treatment Network in Support of the Use of Buprenorphine In our Region
WHEREAS, Food and Drug AdministaGon regulations allow physicians who have been specifically
trained to treat up to 30 opioid addicts in their individual machines; and
WHEREAS, the December 26, 2000 report of the City's Special Committee on Opiate Addiction
evaluated the potential use of buprenorphine and made a series of recommendations supporting its
use, particularly in rural areas of our region; and
WHEREAS, representatives a Acadla Hospital have requested that the City apply for a grant that would
permit them to undertake a program designed to work with physicians to expand the availability of
buprenorphine treatment to Individuals with opioid addiction throughout Our region; and
WHEREAS, under this grant, Acacia will work with a group of primary care providers In Washington,
Hancock, and Penobscot Counties W assist them W become certified to prescribe buprenorphine, work
M initiate and stabilte treatment a potential clients, and assi4 both patients and damns In providing
continued care at individual practices; and
WHEREAS, the City of Bangor has a deep concern regarding opioid addiction in our region and the
need to provide treatment programs in near by rural areas; and
WHEREAS, to be eligible for a grant, the applicant must be a state or local government.
NOW, THEREFORE, BE IT ORDERED BY THE CITY COUNCIL OF THE Clay OF BANGOR, that the City
Manager is hereby authorized to apply to Me U.S. Department of Hearth and Human Services,
Substance Abuse Mental Health Services Administration, for an implementation grant to develop a
substance abuse treatment network in support of the use of buprenorphine In our region ---
iE
0 RDBH
(TITLE)"thorlaivg fl Gran[ Application
a the J. S. Depa[tment o nen to role
Susan Services, Substance Atmore rental
n
Implementation Creat tc Develop a
S hsrI,.o ahuan Teon [mnnt netwrk in
Support of the Use of mp[eo "Urre 1n
our Region
Faclgnc!to/Councilor
I V
04-140
April 29, 2004
Ed Banett
City Manager
73 Harlow Street
Bangor ME 04401
Dear Ed:
Thinks to you and Mary Am for taking the time fo meet with Scott Fare= and
me on Monday to discuss a grant opportanity regarding substance abuse treatment
services. As we discussed, we are requesting that the City of Bangor apply for a
services Want through the Department of Health and Hunan Services Substance
Abuse and Mental Health Services Administration (SAMHSA).
The purpose of the Want is described in the enclosed summary. Briefly, we are
hoping that a SAMHSA Implementation Gran[ will help us implement a network
of physician providers in this region who are trained and willing to provide
buprenorphine treatment services throughout the region for persons addicted m
opioids. The network would allow Acadia Hospital to accept patients for initial
treatment but dvn rapidly return stabilized patients to their home communities for
ongoing treatment. It will also allow us to add critical morseling and clinical
services to the medication management of clients, thereby increasing the chances
ofsucceesful recovery.
We appreciate the City of Bangor's ongoing participation in the complicated
discussions and problem solving approaches regarding opioid addiction. We ate
happy to answer my questions and are grateful for your consideration of this
request.
Very Truly Yours,
Lynn M. Madden
Vice President, COO
04-140 1
Acadia Hospital
Substance Abuse Treatment Network
INTRODUCTION
Opioid dependence is a complicated medical disorder with significant rates of co- morbid physical and
psychiatric illness, social dysfimction, legal issues and communicable diseases such as HIV and
Hepatifis-C. It is conservetively estimated that there are 800,000 -1,000,000 opioid dependent people in
the United States. Of these individuals, fewer than 200,000 we currently receiving opioid replacement
therapy, though all available data suggests that replacement therapy is by far the most efficacious
beermemofopioicidepeadence.
Most people in opioid trealment programs RUIrs) receive methadone, though buprenorphine, a unique
opioid agonist -antagonist medication, was recently approved by the FDA (1(V2002) for Ne treatment of
opioid dependence. Until the approval of buprenorphine, opioid replacement therapy bas been done
almost exclusively in OTFs that am heavily regulated by both state and federal govemmrnts. The gap
between the number of dependent persons and the number of Nose receiving treatment is almost
cankinly the result of lack of available treatment, particularly in the coral areas of the country. Factors
related to the lack of available treatment include strict regulation of OTPs by slide and federal
awhorifies, stigma associated onto receiving methadone in the "clinic" settings created by these
regulations, community resistance to the establishment ofineNadone treatment clinics and provider
resistance to methadone a valid treatment modality. The regidations associated wida the approval of
in a
clinic setting by allowing any licensed physician N prescribe the medication; the regulations further
require that physicians who wish m prescribe the medication obtain specific education and that each
practice limit the number of patients receiving the medication in their practice to 30.
The State of Maine is currently experiencing what some have called an epidemic number of persons
addicted N opioids. Requests for treatment services have gone up fourfold over the last several years
while available treatment and geographic factors have prevented many persons from being able to access
treatment. Ina coral setting such as the state of Maine there is limited access to methadone treatment and
04-14¢
Acadia Hospital
buprenorphine has been proposed as a means of bringing much needed treatment to underserved
patients, many of whom live several hams drive firm any treatment center. Particularly hard bit by
opioid addiction has been the downeast region of Manor, encompassing Washington, Hancock and
Penobscot counties; there is oNy one OTP in this entire region, established at the Acadia Hospital in
2001. Many people in the area live more than two hours firm any (YTp. Access to treatment is
exacerbated by lack of personal resources and by geography.
Extensive research prior to the approval of buprenorphine demonstrated its promise as an effctive
treatment for opioid dependence; however the trials were primarily conducted in closed clinical seMngs,
not in "reap' world rural satrap. previous research conducted with methadone patients shows thaz
patients in early methadone treatment tend to have better outcomes with more intensive treatment (i.e.,
counseling, case management, etc) than they do with motbado ve alone. Despite this finding, regulations
regarding buprenorphine do not require any adjunct therapy be provided with the medication. Doctors in _
a recent survey conducted by loin Together of the Boston University School of public Health expressed
concems regarding their ability manage the complicated needs of these patients in their office settings
and cited this as a reason why they were not currently prescribing buprenorphine. Anecdotal evidence
also suggests that many physicians who have received the certification training come away from that
experience feeling insufficiently trained to use a medication that is pothrrudly difficult to induct and a
patient population that present significant challenges in the traditional office setting.
Despite the overwhelming need for treatment in rural Maine, primary care physicians hove not began
using buprenorphine in any large-scale way. To date seventeen physicians in Maine are qualified to
prescribe bupremaryhine, though many of them have not begun utilizing this medication.
We propose to identify interested primary care providers in the downs[ region of Maine who have not
chosen to adopt the practice of prescribing buprenorphine despite the fact that they practice in
communifies with many people who are in need of treatment. In partnership with this group of
physicians, Acadia Hospital staff will identify, assess, and provide initial induction and stabilization for
buprenorphine patients who can then be transferred to the care of primary care provider. The
06-[W 3
Acadia Hospital
stabilization phase will include treatment in an inter eive outpatient selling that features relapse
prevention, identification of natural psycho-social supports, education regarding the risks of various
drug use practices and behaviors, as well as psychiatric evaluation as indicated. In other words, we are
proposing to provide patients with an enhanced treatment intervention that has previously proven in be
successful in methadone treatment programs. It is estimated that most clients would be transferred to a
local primary care provider within 4 -S weeks of initial induction of buprenorphine. In addition, we
propose to act as an ongoing consultatiooreferral resource for primary care providers so that they can
access information regarding specific patients and their continuing treatment needs or so they can
readily refer patients back to us for more intensive treatment.
It is our premise that these clients are more likely to be successful in treatment using this
spedalistlprimary care partnersbip model and that physicians in rural Maine will be more likely to adopt
the use ofbumenmphine into their practices with support.
QUALIFICATIONS OF PROJECT TEAM
Leading the project team is Paul Tisber, MD the medical director Acadia Hospital. Dr. Tisher isjoined
by Scott I==, LCPC, LADQ, Administrator for Substance Abuse Services at Acadia and Lynn
Madden, CHE, MPA, Acadia vice president for operations. The dune principal team members have
extensive experience in the healthcare field, particularly in mental health and substance abuse treatment.
Each is a member of the management staff of The Acadia Hospital, a 100 bad, not-for-profit psychiatric
and substance abuse hospital in Bangor, Maine. Dr. Tishar is board certified in psychiatry and is
certified in addiction medicine by the American Society of Addictions. He has a subspecialty in
neurology and also serves as chief of psychiatry at Eastern Maine Medical Center. Scott I== is a
licensed clinician in both mental health and substance abuse who has served in a variety of clinical and
supervisory roles since 1996, including narcotic treatment programs. Lynn Madden has worked in
healthcare management since 1997, holds a Master's degree in Public Administration and is an
instructor of health Policy at thc University of Maine. This team is currently engaged as a member of the
RWIF Paths to Recovery Learning Collaborative.