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Medication-Assisted Treatment Works for Opioid Addiction, But Isn’t Used Enough

While medication-assisted treatment (MAT) has been found effective for opioid addiction, new research also shows that it continues to be underused.

Medication-Assisted Treatment Works for Opioid Misuse and Addiction
The FDA has approved the drugs naltrexone, buprenorphine, and methadone for use in MAT. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has been shown to:

Improve patient survival
Help individuals stay in addiction treatment
Help reduce criminal activity among people with substance use disorders
Increase a patient’s ability to get and keep a job
Improve birth outcomes in pregnant women with substance use disorders

Recent Findings on MAT Underutilization

In the October issue of Mayo Clinic Proceedings, researchers reported that MAT drugs are effective, but are not applied as frequently as they should be. Their findings were based on a review of data from the available medical literature about MAT.

The researchers, led by Tyler Oesterle, MD, medical director of Mayo Clinic Health System’s Fountain Centers drug and alcohol treatment programs, pointed out that each drug has strengths and weaknesses. Clinicians should weigh the risks and benefits of each drug for each patient suffering from an opioid use disorder.

Why MAT Is Underutilized
Despite its effectiveness, there are persistent barriers to widespread MAT use in the United States.

Misinformation
Critics of MAT often say that the technique simply substitutes one drug for another. However, MAT actually helps relieve withdrawal symptoms and psychological cravings associated with opioid misuse. With MAT medications, patients have a safe, managed way to overcome opioid abuse.

Research indicates that, at the appropriate dose, MAT does not adversely affect a patient’s mental or physical functioning. This can help patients lead fulfilling, productive lives without opioid dependence.

However, this misinformation leads to stigma that may prevent people from getting the help they need through MAT. For example, many drug courts do not allow patients to be referred to this type of treatment for substance abuse.

Limited Access

Patients struggling with opioid misuse may not have access to an MAT provider. The three drugs used in MAT can only be dispensed through an Opioid Treatment Program (OTP) certified by the SAMHSA and accredited by a SAMHSA-approved accrediting body.

Federal, state, and local regulations also limit the number of MAT providers. Practitioners must receive a waiver to practice opioid dependency treatment with approved medications, which requires an application and training process. Under the SUPPORT Act, non-physician practitioners have received greater flexibility in providing MAT, though this still requires them to receive a waiver and fulfill other requirements.

Treatment providers and behavioral health organizations also may lack the funding to begin prescribing MAT or launch an MAT program. One study from 2009-2010 found that many funding policies “are unsupportive of the implementation of MAT,” which limits availability.
The National Council offers a variety of resources for behavioral health and addiction treatment organizations and other healthcare providers that are considering incorporating MAT into their practices.

Serving Addiction Treatment and Behavioral Health Clients

Whether you offer MAT, talk therapy, or a combination of treatments for substance misuse, your EHR system should help, not hinder, your practice. Contact BestNotes today to get started with EHR and CRM solutions tailored to your specific needs.

date:  Nov 04, 2019
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News Roundup: Ohio’s Opioid Settlement

In response to the national opioid crisis, more than two thousand U.S. states, counties, and cities have filed lawsuits against companies that manufacture or distribute opioid medications.

This year has seen several rulings and settlements related to these lawsuits, with several major developments occurring in Ohio. Let’s take a look at a few of the particular stories centered around these lawsuits.

More Than $23 Billion Could Go Toward Addiction Treatment After Settlements
Ohio’s Cuyahoga and Summit counties have reached a settlement with pharmaceutical firm Teva and drug distributors AmerisourceBergen, Cardinal Health, and McKesson. These companies, along with pharmacy company Walgreens, had been accused of recklessly prescribing and distributing medications that contained oxycodone and fentanyl.

Originally, the lawsuit was expected to lead to an important trial in holding drugmakers responsible for allegedly contributing to the nation’s opioid epidemic. However, on October 21, the companies reached a $260 million settlement with the two counties.

The drug distributors have agreed to pay $215 million to the two counties. According to the distributors, they expect their portion of the settlement to fund addiction treatment, rehabilitation programs, and behavioral health services. Teva will pay $20 million in cash and supply $25 million worth of Suboxone, distributed over three years.

Statement From Drugmaker Teva Discloses Global Settlement Framework

In an October 21 statement, Israel-based pharmaceutical company Teva announced not only its settlement with the Ohio counties, but “an agreement in principle” with attorneys general from North Carolina, Pennsylvania, Tennessee, and Texas to reach “a global settlement framework.”

Under the agreement, which is not an admission of liability, Teva would donate up to 10 years’ worth of buprenorphine naloxone (sublingual tablets) with a total value of approximately $23 billion. This donation of medication used to treat opioid addiction would be used to help individuals and communities that have been significantly impacted by opioid addiction. The agreement would also include a cash payment from Teva of up to $250 million over 10 years.

Ohio Settlement Leaves Questions Unanswered
Within Ohio’s Cuyahoga and Summit counties, communities and families are celebrating the opioid settlement. Many hope that the resulting funding and Suboxone supply can provide vital treatment for individuals impacted by opioid addiction.

Some experts say, however, that reaching a settlement instead of going to trial has left some issues in the opioid crisis unresolved. Some specific concerns include:

Had there been a trial, the jury’s decision could have had a significant impact on future opioid lawsuits, potentially validating future trials.
Without the validation of an Ohio trial, some communities may reach settlements with drug companies, but other communities could miss out on the addiction treatment support they need.
A full trial, rather than a settlement, would have revealed additional information about the business practices of opioid manufacturers and distributors.
Reaching a nationwide or global settlement with drugmakers that are allegedly responsible for the opioid crisis remains uncertain.

Are you ready for increased demand?
With more individuals seeking help for opioid addiction, behavioral health and addiction treatment providers could easily be overwhelmed by the increased demand. BestNotes EHR solutions can help you manage more patients, track outcomes, and bill appropriately, so you can help more people and get paid faster. Contact us to find out more or schedule a free demo.

date:  Oct 28, 2019
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Four Things to Know About the ASAM Criteria Assessment

As a behavioral health provider, you know that addiction treatment is one of the most complex services in your field. Not only do different patients have different needs, but each type of substance can have varying effects. With so many factors involved, it can be hard to determine the best treatment approach for each patient.

Since the 1980s, the American Society of Addiction Medicine (ASAM) has been working to develop criteria for treating addiction. Here’s what you should know about the ASAM Criteria and how it can help your addiction treatment practice.

1. The ASAM Criteria uses a holistic approach.

ASAM’s assessment for addiction treatment looks at six dimensions that include biology, psychology, and socio-environmental factors. This creates a fuller, more accurate picture of the individual patient.

Dimension 1 examines the patient’s past and current substance use and/or withdrawal
Dimension 2 examines the patient’s current and past physical health status
Dimension 3 examines the patient’s current and past mental health status
Dimension 4 examines whether the patient is willing or ready to change their substance use
Dimension 5 examines the patient’s individual risks of relapse or other continued substance use issues
Dimension 6 examines the patient’s living situation and whether it will contribute to recovery

2. The ASAM Criteria has authority and staying power.

This ASAM Criteria has become the most widely used set of guidelines for placing, treating, and discharging patients with addiction and co-occurring conditions. In fact, ASAM’s criteria are required in over 30 states. Also, many insurers and other payers require some form of ASAM assessment for patients receiving addiction treatment.

ASAM Criteria is continually reviewed and revised through collaboration between ASAM leadership and the Steering Committee of the Coalition for National Clinical Criteria. This coalition has been meeting regularly since 1991 to ensure that the Criteria adequately serves and supports both public and private payers, providers, and patients.

3. ASAM provides several products based on its Criteria.

Using its Criteria, ASAM developed a family of products known as ASAM Continuum® to help clinicians assess patients with substance misuse and co-occurring conditions. Using ASAM Continuum, a treatment team can conduct computer-guided, standardized patient interviews.

These tools include all six dimensions of the ASAM Criteria, as well as research-quality questions and assessments to create a comprehensive patient report that includes a recommended level of care.

Within the Continuum family, ASAM also provides CO-Triage® for referring patients with alcohol and substance problems. Using questions in the CO-Triage tool, clinicians can recommended the ASAM Level of Care to which a patient should be referred.

4. BestNotes is adding ASAM-based assessment.

BestNotes has been working with ASAM to secure copyright permission to build and implement our own ASAM assessment. This new feature will be added to the Documentation section of the BestNotes EHR software by mid-2020.

If you’re a behavioral health or addiction treatment provider seeking a better way to assess and refer patients, BestNotes EHR is here for you. Created specifically for behavioral health and addiction treatment organizations, BestNotes helps you ask the right questions, take better notes, track outcomes, and provide better care so you can make your practice more efficient and improve revenue. Contact us today to learn more, and even schedule a free demo.

date:  Oct 24, 2019
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More Farmers Are Seeking Mental Health Help

As mental health awareness grows and organizations seek to reduce stigma, one historically overlooked group is getting more attention. Recent months have seen a growing number of farmers and other agricultural industry workers seeking help for mental and behavioral health issues.

Farming carries mental health risk factors

It’s no surprise that agriculture has long been a high-stress line of work. In fact, according to the Centers for Disease Control and Prevention, farming is among the top 10 occupations that are at risk of higher suicide rates.

Factors that contribute to farmers’ stress include:

Social isolation
Fluctuating market prices
Unreliable weather
Diseases that affect crops or herds
Tariffs and other regulations

Many rural, agricultural communities also lack the resources to address farmers’ needs, creating additional challenges. The Department of Health and Human Services reported that 53.34 percent of rural areas had a shortage of mental health professionals.

Agricultural work traditionally comes with an attitude of self-sufficiency and a more stoic approach to adversity. As a result, many farmers suffer from mental and behavioral health struggles in silence.

Despite this attitude, a new national poll of rural residents found that 82 percent of farm workers reported that mental health is important to them and/or their family. Among farmers, 66 percent said it was important to reduce stigma about mental health in the agriculture community.

Awareness is growing and stigma is falling

Many states and organizations are working to address the increased demand for mental health services among farmers. Growing awareness of mental health has been encouraging more farmers to seek help for anxiety, depression, and other concerns.

The North Carolina Agromedicine Institute has begun to offer training for dealing with extreme farm stress, as well as teaching people about warning signs of suicide or depression. The institute is also seeking mental health clinicians and other resources to address the unique nature of farming. For example, many medications for depression and anxiety may not be suitable for individuals who work with heavy machinery.

The South Dakota Farm and Ranch Stress Summit in September, held by the South Dakota State University Extension Rural Behavioral Health Team and the South Dakota Counselors Association, gathered farmers and health specialists to discuss stress in rural settings. Organizers noted that more agricultural producers are speaking up about their stress and other mental health needs.

Technology could improve farmers’ health access

Several technology-based resources can help serve agricultural communities that otherwise lack mental health resources. Avera Health launched a free, confidential, 24-hour Farm and Rural Stress Hotline in January. On Twitter, many farmers open up about their burdens and encourage each other under the #AgTwitter hashtag.

Telehealth resources and mobile apps could also help expand behavioral health access and close treatment gaps in rural communities. SilverCloud, a digital platform provided by OSF Healthcare, is becoming popular with farmers within the OSF network to help them cope with mental health challenges.

Serve patients better, wherever you are

BestNotes EHR solutions help you streamline your services and improve patient care. Measure and track outcomes, order prescriptions, and bill more easily. Contact us today to learn more, ask questions, or schedule a free demo!

date:  Oct 16, 2019
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What is Exposure Therapy and How is it Used in Behavioral Health?

Behavioral health and addiction treatment providers know that different therapies help different conditions and populations. The BestNotes blog has been looking at some common therapy approaches used in a behavioral health or addiction treatment practice.

What is exposure therapy?
Exposure therapy (ET) can be used to help people confront and even overcome their fears. Trying to avoid things a person is afraid of can actually make those fears worse over time.

A clinician may recommend ET to help a patient break this pattern. The therapist creates a safe environment in which the patient faces the things that they have come to fear and avoid. Over time, this exposure can reduce that fear and avoidance.

What should happen during exposure therapy?
According to the American Psychological Association, patients can experience ET in a variety of ways. The specific approach depends on the disorder, symptoms, and fears involved. The different strategies include:

In vivo exposure involves a person directly facing their fear in real life, such as a person with a fear of spiders being in the same room as a living tarantula. While this may be useful for tangible objects, it is less practical for situations like combat-related PTSD.
Imaginal exposure involves the patient vividly imagining their feared object or situation. A person with PTSD may be prompted to remember and describe a traumatic experience.
Virtual reality (VR) exposure uses VR technology to recreate feared sensations or situations, such as a person with a fear of flying using VR technology to simulate an airplane flight.
Interoceptive exposure deliberately creates physical sensations of fear. For example, a person with panic disorder may be afraid of feeling their heart rate increase. He or she might be instructed to exercise to increase their heart rate, and learn not to fear the sensation itself.

Individuals may also face their fears in different degrees.

With graded exposure, the patient may list their fears from easiest to most difficult to face, and then begin ET with the easier fears.
Flooding takes the opposite approach, and starts ET with the most difficult fear to face.
Systemic desensitization combines exposure to the fear with relaxation exercises to help the fears feel more manageable.

Does exposure therapy really work?

ET can be used for a variety of behavioral and mental health issues related to fear, anxiety, and trauma. These include:

Phobias
Panic disorder
Social anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder (PTSD)
Generalized anxiety disorder

Studies have repeatedly found that ET can effectively reduce symptoms of these disorders. In fact, exposure-based therapy is sometimes recommended as a first-line treatment for many anxiety disorders.

Studies have shown that ET, either alone or combined with cognitive behavioral therapy, is effective for all anxiety disorders, but especially for generalized anxiety disorder and PTSD.

Improve the way you deliver therapies to your patients
Treatment and management techniques for behavioral health conditions can be complicated. Whether your patients receive ET or other types of therapy, the right EHR solution can help you and your patients set and achieve goals.

BestNotes EHR software was designed with you, your practice, and your clients in mind. Track patient progress, coordinate care with other specialists, and create all the documents you need with one optimal solution. Contact us today to learn more or request a live demo.

date:  Oct 14, 2019
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