Use of Pharmacotherapies by Substance Abuse Treatment Facilities Cathie E. Alderks, PhD Substance Abuse and Mental Health Services Administration Department of Health and Human Services November 2007 1
The National Survey of Substance Abuse Treatment Services Annual survey of all organized substance abuse treatment facilities known to SAMHSA Collects information on location, characteristics, and services offered one-day census of clients in treatment Mixed mode: mail, web, telephone 2
Number of Substance Abuse Treatment Facilities Responding to the Survey Pharmacotherapies/ Prescription Medication Number of Facilities (in thousands) 16 12 8 4 0 Specific Drugs Mentioned 2000 2002 2003 2004 2005 2006 Number of Substance Abuse Treatment Facilities Number Offering Any Queried Pharmacotherapy Number Dispensing Methadone/LAAM/Buprenorphine 3
Facilities Offering Antabuse, Naltrexone, or Campral 4
Specific Pharmacotherapies Antabuse: (disulfiram) The first pharmacotherapy approved for the treatment of alcohol abuse and alcohol dependence by the U.S. Food and Drug Administration. Causes unpleasant side effects if alcohol is consumed. Naltrexone: (naltrexone hydrochloride) An opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Reduces the craving and blocks the high for alcohol and blocks the high of opioids. Campral : (acamprosate calcium) FDA-approved for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. Reduces the physical distress and emotional discomfort (withdrawal symptoms) people usually experience when they quit drinking. 5
Percent of Facilities Offering Antabuse, Naltrexone, or Campral 25 20 percent 15 10 5 Any Antabuse Naltrexone Campral 0 2002 2003 2004 2005 2006 6
Percent of Facilities Offering Antabuse, Naltrexone, or Campral by Ownership of Facility 80 percent 60 40 59 53 36 20 0 15 17 19 13 10 11 12 13 14 8 12 Tribal Govt Private non Profit Private for Profit 15 Local Govt 27 21 21 State Govt Federal Govt Antabuse Naltrexone Campral 7
Antabuse, Naltrexone, or Campral by Type of Treatment Offered by the Facility: 2006 80 % total facilities 67.2% 16.8% 9.3% 1.9% 0.3% 3.0% 1.4% 80 percent 60 40 % Facilities Offering Any of Three Pharms 40 44 37 37 35 52 57 55 56 53 50 60 40 20 0 16 11 12 6 5 6 15 14 14 OP Only RC Only OP & RC HI Only RC & HI OP & HI OP & RC & HI 28 20 0 OP = Outpatient HI = Hos pital Inpatient RC = Residential % of facilities in type that offer : Antabuse Naltrexone Campral 8
Facilities Offering Methadone, LAAM, or Buprenorphine 9
Specific Pharmacotherapies LAAM: (Levo-Alpha Acetyl Methadol ) Blocks the effects of other opiates and prevents withdrawal, but does not produce a subjective high. Production discontinued in 2003 (severe cardiac-related adverse events). Methadone: A synethetic opioid used medically as an analgesic and in the treatment of narcotic addiction. Reduces withdrawal symptoms in people addicted narcotics without causing the "high" associated with the drug addiction. Buprenorphine: Subutex (buprenorphine hydrochloride) and Suboxone (buprenorphine hydrochloride and naloxone hydrochloride). Subutex and Suboxone treat opiate addiction/dependence by preventing symptoms of withdrawal from heroin and other opiates. Approved by FDA in October 2002 10
Opioid Treatment Program An Opioid Treatment Program (OTP) is a substance abuse treatment program that is certified by SAMHSA s Center for Substance Abuse Treatment (CSAT) to use opioid drugs such as methadone or buprenorphine in the treatment of opiate (narcotic) addiction. 11
Number of Opioid Treatment Programs (OTPs) 1,250 1,000 Number 750 500 250 SAMHSA Certification of OTPs 0 2000 2002 2003 2004 2005 2006 Number of OTPs 12
Opioid Treatment Programs by Ownership 60 SAMHSA Certification of OTPs percent 40 20 Private For Profit Private Non Profit Local Govt State Govt Federal Govt Tribal Govt 0 2000 2002 2003 2004 2005 2006 13
Opioid Treatment Programs by Type of Program (Maintenance, Detox, or Both) percent 100 80 60 40 20 10.6 11.6 9.9 8.0 8.2 32.7 33.7 34.9 37.8 38.1 56.7 54.7 55.2 54.2 53.7 0 2002 2003 2004 2005 2006 Both Maintenance and Detox Maintenance Detox 14
Types of Treatment Offered by Facilities that Offer OTPs : 2006 100 Percent of OTPs 80 60 40 20 81 92% of OTPs are in facilities that offer Outpatient Treatment 5 4 3 4 3 1 0 OP Only OP & RC OP & HI OP & RC & HI HI Only RC Only RC & HI OP = Outpatient HI = Hospital Inpatient RC = Residential 15
Pharmacotherapies Offered by OTPs percent 100 80 60 40 20 Methadone Buprenorphine (any) Psychiatric Pharm Antabuse Nicotine Replace Naltrexone Campral 0 2002 2003 2004 2005 2006 LAAM 16
Total Number of Clients in Treatment Who are Receiving Opioid Replacement Therapy at Opioid Treatment Programs (OTPs) on Point Prevalence Date Thousands 300 SAMHSA Certification of OTPs 225 227 241 236 258 Number 200 100 173 0 6 3 3 1 1 2 2000 2002 2003 2004 2005 2006 Methadone LAAM Buprenorphine 17
How can you find facilities that have Opioid Treatment Programs? 18
http://findtreatment.samhsa.gov 19
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