NC State Opioid Treatment Authority (NC SOTA) Practice Challenges and Opportunities

Transcription

1 NC State Opioid Treatment Authority (NC SOTA) Practice Challenges and Opportunities Addiction Medicine 203 Conference Asheville, NC Friday, April 2, 203 Spencer Clark, MSW, ACSW NC SOTA Administrator Dolly Van Wy, BA, RN NC SOTA Coordinator Smith Worth, LCSW, LCAS NC SOTA Program Consultant

2 Challenges and Opportunities Physician Leadership Use of CSRS Collaboration with Other Physicians Drug-to-Drug Interactions Involvement with Family and Collaterals Induction Monitoring Emergency Protocols 2

3 North Carolina State Opioid Treatment Authority (NC SOTA) 3 North Carolina State Opioid Treatment Authority (SOTA) established in rule Spencer Clark, MSW, ACSW, Administrator Dolly Van Wy, BA, RN, Coordinator Smith Worth, LCSW, LCAS, Program Consultant Brenda G. Davis, Administrative Assistant Community Policy Management Section (CPM), Flo Stein, Chief Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) Jim Jarrard, Acting Director NC Department of Health and Human Services (DHHS) Aldona Z. Wos, MD, Ambassador (Ret.), Secretary

4 Opioid Treatment Programs as of 4/9/2 and Proposed Local Management Entity - Managed Care Organizations (LME-MCOs) on //3 McLeod Addictive Disease Center Stepping Stone Wellness Center, Inc (Boone) / Smoky Mountain Center ATS of NC, Inc - CRC Health Gp, Crossroads Treatment Center Mountain Area Recovery Center Carolina Treatment Centers (Asheville) / Western Highlands Network McLeod Addictive Disease Center Metro Treatment Center of NC LP (Hickory) / Partners Behavioral Health Management McLeod Addictive Disease Center (Gastonia)/ Partners Behavioral Health Management Partnership For Drug-Free NC (Winston-Salem) /CenterPoint Addiction Recovery Medical Services McLeod Addictive Disease Center (Statesville) /Partners Behavioral Health Management ADS of Guilford, Crossroads Treatment Center, Metro Treatment Center of NC LP (Greensboro) / Sandhills Center Macy Hamm (Sanford) / Sandhills Center Scotland Robeson Macy Hamm (Lumberton) / Eastpointe ATS of NC, Inc - CRC Health Gp, Metro Treatment Center of NC (Fayetteville) / Cumberland LME 2 Bladen Columbus BAART Community Healthcare, Metro Treatment Center of NC (Durham)/ Alliance Behavioral Healthcare Sellati & Co, Southlight, Inc (Raleigh)/ Alliance Behavioral Healthcare Brunswick Pender New Hanover 2 Onslow Carteret Johnston Recovery Services (Clayton)/ Johnston LME Coastal Horizons Center, Inc, Metro Treatment Center of NC (Wilmington) / CoastalCare Macy Hamm (Rocky Mount) / Eastpointe Sellati & Co., PORT Human Services (Greenville)/ ECBH ATS of NC, Inc - CRC Health Gp, (N. Wilkesboro) / Smoky Mountain Center Alleghany Northampton Camden Ashe Gates Currituck Surry Stokes Rockingham Person Warren Caswell Vance Pasquotank McLeod Addictive Disease Center 2 Wilkes Hertford Watauga Granville Halifax Perquimans (Marion) / Smoky Mountain Center Yadkin Forsyth Guilford Orange Chowan Avery 2 Franklin Bertie Mitchell Alamance Mountain Area Recovery Center Caldwell Durham Yancey Alexander Nash 2 Davie 3 (Clyde) / Smoky Mountain Center Madison Burke Iredell Davidson 2 Edgecombe Martin Washington Catawba Rowan Chatham Wake Tyrrell Dare Randolph Wilson Buncombe McDowell 2 2 Haywood Beaufort Lincoln Lee Johnston Pitt Swain Greene Hyde 4 Rutherford Cabarrus Graham Henderson Montgomery Jackson Gaston Harnett Polk 3 Stanly Moore Wayne Lenoir Cleveland Craven Cherokee Transylvania Mecklenburg Macon PORT Human Services Cumberland Pamlico (New Bern)/ ECBH Clay Union Richmond Anson Duplin Jones Hoke Sampson Crossroads Treatment Center (Weaverville) / Western Highlands Center Treatment Centers LLC, McLeod Addictive Disease Center Metro Treatment Center of NC LP (Charlotte)/ Mecklenburg Treatment Centers LLC (Lexington) Treatment Centers LLC (Salisbury) McLeod Addictive Disease Center (Concord) McLeod Addictive Disease Center (Monroe) / PBH ADS of Guilford (High Point)/ Sandhills Center ATS of NC, Inc - CRC Health Gp, (Pinehurst) / Sandhills Center Macy Hamm (Jacksonville)/ CoastalCare ATS of NC, Inc - CRC Health Gp, (Goldsboro)/ Eastpointe Statewide: 45 Opioid Treatment Programs Across 30 Cities LME-MCO configurations reflect plans as of April 9,

5 OTP Facility Approval by SOTA 0A NCAC 27G.3604 (d) Compliance With State Authority Regulations. Each facility shall be approved by the North Carolina State Authority for Opioid Treatment, DMH/DD/SAS, which is the person designated by the Secretary of Health and Human Services to exercise the responsibility and authority within the state for governing the treatment of addiction with an opioid drug, including program approval, for monitoring compliance with the regulations related to scope, staff, and operations, and for monitoring compliance with Section 923 of P.L

6 Responsibilities of the NC SOTA Monitoring of current 47 local OTPs in 30 North Carolina communities against federal and state regulations, guidelines, and policies Review and approval of new OTPs in cooperation with CSAT-DPT, DHSR, DMHDDSAS Drug Control Unit, and DEA Development and implementation of State policies and practices regarding OTPs including best practices Review and approval of OTP Extranet Exception Requests Review of critical incidents and significant events Review of deaths of patients and collaterals Review of complaints of patients, collaterals, providers, and communities Provider clinical consultation, training and technical assistance Hosting of OTP statewide and regional meetings, trainings, and forums Represent NC in national organizations (NASADAD, AATOD) and forums Consultation with DMA regarding service definitions, DHSR regarding best practices and waiver requests, and CARF regarding accreditations 6

7 Examples of Statewide OTP Coordination, Networking, and Training Facilitation Hosting of OTP Monthly Physician/PA/NP Conference Calls (3 rd Thursday of Each Month, 9:00 am) Hosting of OTP Regional Physician Dinner Series (Raleigh Jan. 7, 203 & Hickory Feb. 07, 203) Hosting of OTP Quarterly Program Directors Meetings (3 rd Wednesday of st Month of Quarter, 9:30 :30 am at Variable Meeting Locations) Support of Annual Addiction Medicine Conference with OTP Medical Director/Physician/PA/NP Sessions (April 2-3, 203, Asheville, NC) 7

8 Highlights of Federal OTP Regulations 42 CFR, Part 8 42 CFR Part 8 Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Final Rule 8

9 CSAT OTP Accreditation Guidelines Guidelines for the Accreditation of Opioid Treatment Programs: Revised July 20, nes-2007.pdf 9

10 Highlights of 0A NCAC 27G Rules for MH/DD/SA Facilities Chapter 22C - Mental Health, Developmental Disabilities, and Substance Abuse Act of 985 RULES FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE FACILITIES AND SERVICES0A NORTH CAROLINA ADMINISTRATIVE CODE 27G 0A NCAC 27G Core Rules 0A NCAC 27G.3600 Outpatient Opioid Treatment anuals/apsm30-_-.pdf 0

11 OTP Medical Director Role The medical director shall assume responsibility for administering all medical services performed by the OTP. In addition, the medical director shall be responsible for ensuring that the OTP is in compliance with all applicable Federal, State, and local laws and regulations. 42 CFR, Part 8.2 b

12 NC Controlled Substances Reporting System (CSRS) This statewide reporting system was created in 2007 OTP Physician review of CSRS required by NC SOTA policy at patient admission, at time of OTP Extranet Exception Requests, and periodically during treatment episode e/index.htm Staff: Bill Bronson, Johnny Womble, & Devon Scott

13 The Burden of Unintentional Poisoning in North Carolina 3

14 Websites for Drug-Drug Interactions Multi-Drug Interaction Checker (Medscape Reference) Interactions Checker Results (Drugs.com: Drug Information Center) Methadone-Drug Interactions. PAIN TREATMENT TOPICS: January 2006, Addiction Treatment Forum Special Report, ATForum.com. 4

15 Mobile Applications for Online Drug-Drug Interaction Checkers Epocrates Micromedex: Thomson Reuters Medscape from WebMD WebMD PubMed 5

16 CSAT and NC SOTA OTP Extranet Exception Requests 6

17 NC SOTA Required Criteria for Review of Extranet Exception Requests Example: TX=5mo; CUR=2mo; MAX=2mo; L= Treatment = Patient s Time in Treatment since Admission; Current = Patient s Current Time of Treatment Compliance; Maximum = Patient s Maximum Time of Treatment Compliance since OTP Admission; Level = Patient s Current NC Level for Take-Homes; UA History of Recent Drug Screens = Urine Drug Screen Dates and Results of Last Three (3) Months; CSRS = Current CSRS Query Date, Results, and Analysis; Counselor = Date of Last In-Person Face to Face Session; Physician = Date of Last In-Person Face to Face Session; Stability and Compliance = Date and Results of Physician Evaluation of Patient Compliance and Stability; 7

18 CSAT Treatment Improvement Protocol Series (TIPS) Series-Treatment-Improvement-Protocols-TIPS- TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, df/tip43.pdf TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, Clinical-Guidelines-for-the-Use-of-Buprenorphine-inthe-Treatment-of-Opioid-Addiction/SMA

19 MD Faculty Consultation Resources Eric D. Morse, M.D., DFAPA Addiction & Sports Psychiatrist Cell Carolina Performance 8300 Health Park, Suite 20 Raleigh, NC 2765 Office Voic x Eric Morse 9

20 NC SOTA Contact Information Spencer Clark, SOTA Administrator, Dolly Van Wy, SOTA Coordinator, , Smith Worth, SOTA Program Consultant, , Brenda G. Davis, SOTA Administrative Assistant, , 20

21 Thank You! 2