New Treatments for Addiction Behavioral, Ethical, Legal, and Social Questions (2004) / Chapter Skim
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Appendix D: Adoption of Drug Abuse Treatment Technology in Speciality and Primary Care Settings
Appendix D: Adoption of Drug Abuse Treatment Technology in Speciality and Primary Care Settings
Pages 140-172
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From page 140... ...
Naltrexone for alcoholism treatment, for example, reached only a fraction of its expected market. Differences in the structure of the substance abuse treatment environment (less often built around a physician delivery model and commonly in specialty treatment settings)
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From page 141... ...
Literature on the adoption of substance abuse treatment technologies is reviewed, and particular challenges and opportunities are outlined -- including the organization, financing, and delivery of specialty addiction treatments that may inhibit rapid adoption. Implications for primary care and other treatment settings are discussed relative to the availability of new pharmacology-based interventions.
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From page 142... ...
142 use Patients Yes/No technologies. attitudes and acceptance Prescribe Provider/patient Patient characteristics publisher.
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From page 143... ...
. In summary, immunotherapy and depot medications can present promising new strategies for treating drug dependence and abuse if they have potential relative advantage over existing treatments, compatibility with current drug treatment practices, and both providers and patients find them easy to use.
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From page 144... ...
292) -includes its competitors, state and federal regulators, parent organizations, managed care organizations, pharmaceutical companies, and potential clients.
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From page 145... ...
may improve an organization's appraisal of immunotherapy and depot medications through official endorsements and dissemination of information about treatments. Pharmaceutical companies may also encourage adoption through marketing campaigns, particularly direct and repeated marketing to the focal organization (Van den Bulte and Lilien, 2001)
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From page 146... ...
. However, in the case of new drug treatment pharmacotherapies, marketing efforts, which are known to be a powerful driver of adoption of new medications, may be limited by how manufacturers perceive the profitability of new treatments.
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From page 147... ...
While the historical pattern in the United States is that of relatively rapid adoption of new pharmacotherapies, there are reasons to believe that the adoption of medications to treat drug and alcohol dependence will be more reserved. The use of medications as complementary interventions with behavioral therapies represents a vast change in the nature of treatment of drug abuse challenging current practitioner and provider structures.
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From page 148... ...
A mail survey conducted in Massachusetts, Tennessee, and Washington state among physicians with a substance abuse specialization (135 responses, 63 percent response rate) and certified addiction counselors (1,116 responses, 65 percent response rate)
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From page 149... ...
Recovery status did not have a significant influence on counselor use of naltrexone. Overall, these results suggest that organizational support, financing mechanisms, and state policies may influence the adoption of medications to treat alcohol and drug abuse.
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From page 150... ...
The Addiction Technology Transfer Centers promote an organizational change model to support the adoption of evidence-based practices in alcohol and drug abuse treatment centers. The Change Book offers a 10-step structure to foster organizational change and support the adoption and use of new drug abuse treatment technologies (Addiction Technology Transfer Centers, 2000)
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From page 151... ...
Independent practitioners, mental health centers, and prescription drugs account for little of the expenditures in alcohol and drug abuse treatment but for substantially greater proportions of mental health and general health care: independent practitioners (health care = 26.5 percent; mental health = 28.5 percent; substance abuse = 11.1 percent) ; mental health centers (health care = less than 1 percent; mental health = 15 percent; substance abuse = 9 percent)
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From page 152... ...
The presence of a large and autonomous system of specialty chemical dependency treatment settings reflects a legacy of poor service for alcohol and drug disorders in health care and mental health care settings, limited coverage in insurance plans, and the resulting divergence in payer sources and regulatory mechanisms. Specialty Chemical Dependency Treatment Services The most current source of data on facilities that offer drug and alcohol treatment is the 2000 National Survey of Substance Abuse Treatment Services (N-SSATS; previously called the Uniform Facilities Data Set-UFDS; Substance Abuse and Mental Health Services Administration, 2002)
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From page 153... ...
Thus, the picture that emerges from the N-SSATS census is of a treatment system composed of small specialty outpatient clinics that provide limited medical services and have little overlap with the larger general medical system of care. Current financing systems, however, do not encourage greater integration of substance abuse and primary care services.
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From page 154... ...
A 1995 survey of outpatient drug abuse treatment programs, for example, reported that 48 percent provided onsite physical examinations, and 40 percent offered routine medical care on-site (Friedmann et al., 1999a)
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From page 155... ...
Studies of screening and brief intervention and the adoption of buprenorphine to treat opioid dependence suggest that there is great opportunity for higher levels of impact and adoption. Screening and Brief Interventions Research suggests that individuals with high-risk patterns of alcohol and drug use can be identified in health care settings.
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From page 156... ...
Office-based dispensing and prescribing of maintenance medications are expected to increase access to treatment, reduce the stigma associated with seeking drug treatment, and provide better patient care (Fiellin and O'Connor, 2002)
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From page 157... ...
. It is important to note that the primary care clinic was affiliated with a drug abuse treatment service and patients participated in a weekly group counseling session at the clinic -- drug abuse treatment services were integrated into the primary care clinic.
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From page 158... ...
INTEGRATION OF IMMUNOTHERAPIES AND DEPOT MEDICATIONS INTO TREATMENT SETTINGS The reviews of technology adoption in alcohol and drug services, specialty treatment programs, and treatment of alcohol and drug disorders in primary care settings suggest general implications for dissemination of immunotherapies and depot medications. There are also implications for specialty and primary care settings.
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From page 159... ...
· Lack of knowledge about technology transfer -- a lack of systematic research on technology adoption in drug abuse treatment settings slows the development of more effective dissemination strategies. · Policy -- local, state, and federal policies sometimes restrict the types of services available and the individuals who receive those services.
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From page 160... ...
The essay suggests that adoption of medications will be inhibited in many specialty alcohol and drug abuse treatment centers because of experience with recovery without the use of medications, concern about unanticipated side effects and addiction potential, discomfort with the research supporting the use of medications, and perceived incompatibilities with traditional treatment approaches. The potential value of medications is acknowledged, but there is a strong sense of resistance and skepticism.
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From page 161... ...
Finally, financing for medications is not usually included in the reimbursement provided for most specialty drug abuse treatments. New financing mechanisms must be developed before rapid adoption is likely in publicly funded treatment centers.
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From page 162... ...
The recent implementation of stricter confidentiality standards for medical records (Health Insurance Portability and Accountability Act) does not obviate the stricter standards applied to alcohol and drug abuse treatment records but may foster consistent strategies for releasing and sharing information, including treatment for alcohol and drug disorders in health care settings.
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From page 163... ...
Second, in cases in which care is fully or partially capitated (either all services or carved out to specialty substance abuse programs) , new medications and treatments may need to prove they are cost effective in order to be adopted onto formularies and incorporated into treatment.
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From page 164... ...
Studies suggest that many of the barriers to adoption of new substance abuse treatments may be amenable to policy interventions, including appropriate education, adequate financing, and improved linkages between primary care and specialty treatment. Specific approaches to technology transfer can promote new therapies for drug abuse treatment and may have particular significance for the successful diffusion of depot medications and immunotherapies.
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From page 165... ...
It is essential to understand the structure of the market for immunotherapies and depot medications, so that manufacturers' efforts to promote these medications can be balanced by objective information from other sources. It is important to note that financing for substance abuse treatments occurs through various avenues in the public and private sectors.
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From page 166... ...
Before the medications can be used most effectively, however, policy makers and practitioners must prepare the field. Strategies to improve linkages with primary care, to train primary care practitioners, and to educate drug abuse treatment programs are essential to the long-term adoption of these emerging technologies.
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From page 167... ...
. An institutional analysis of HIV preven tion efforts by the nation's outpatient drug abuse treatment units.
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From page 168... ...
. On-site primary care and mental health services in outpatient drug abuse treatment units.
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From page 169... ...
Committee for the Substance Abuse Coverage Study.
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From page 170... ...
. Benefits of linking primary medical care and substance abuse services.
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From page 171... ...
: 2000. Data on substance abuse treatment facili ties.
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From page 172... ...
: How do French healthcare providers manage the opiate-addicted patients? Journal of Substance Abuse Treatment, 21(3)
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