Methadone, Buprenorphine in a Crisis
By Jon Bowen
In the wake of Hurricane Katrina, patients in Opioid Treatment
Programs (OTPs) in the Gulf Coast region found themselves cut off
from access to their daily medications—specifically methadone
and buprenorphine.
All seven OTPs in the New Orleans area were shut down by the storms.
Prior to shutting down, all OTPs were able to implement their disaster
plans, which included providing all patients with a week's take-home
supply of medication.
Across Lousiana, six OTPs were still open. They prepared to receive
any opioid-dependent patient who might need services.
To make matters worse, more than 5,000 physicians had to evacuate
the New Orleans area.
Of these physicians, approximately 34 were registered with SAMHSA
to prescribe buprenorphine. In addition, an unknown number of medical
practices had been engaged in pain management treatment with opioid
therapy, leaving those patients without providers to continue their
treatments.
As a result, in the days that followed the hurricane evacuations,
patients were walking into clinics in Baton Rouge, Houston, and
other cities, desperate for their medication. In many cases, they
had no proper identification papers, no medical history in hand,
and no proof of participation in a methadone or buprenorphine program
in their home state.
Robert Lubran, M.P.H., Director of the Division of Pharmacologic
Therapies within SAMHSA's Center for Substance Abuse Treatment (CSAT),
continues to work with state officials to ensure continuity of care.
"The big challenge is when somebody shows up at your door and
says ‘Hi, I'm a methadone patient from New Orleans,' "
said Mr. Lubran. "Verifying that information is next to impossible,
as is verifying dosage."
Managing this dilemma falls to local service providers and deployed
SAMHSA volunteers like Kenneth Hoffman, M.D., M.P.H., a medical
officer in CSAT's Division of Pharmacologic Therapies. Onsite in
Baton Rouge for 2 weeks, Dr. Hoffman worked in consultation with
personnel from Louisiana's Department of Health and Hospitals' Office
of Addictive Disorders to establish protocols for administering
medications to people without documentation.
Dr. Hoffman and his colleagues faced many hurdles. "How do
you know if a person is really in a program?" he recalled thinking.
"How do you identify doctors who will be willing to prescribe
medication? How do you establish a registry so you can have continuity
of care? There was no easy way to figure it all out."
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To provide assistance, SAMHSA issued a guidance on emergency medications,
which outlined procedures for short- and long-term emergency methadone
and buprenorphine treatment services to local populations affected
by the disaster.
More often than not, the solution involved starting from scratch.
"You just take someone as a new patient," Dr. Hoffman
said. "You do a physical assessment and look at their mental
status. Then you can start them on protocol."
Anton Bizzell, M.D., another CSAT medical officer, deployed to
Baton Rouge to work with Louisiana's Assistant Secretary for Addictive
Disorders and Assistant Secretary for Mental Health. "We helped
develop plans to make sure we had substance abuse and mental health
professionals on the ground," Dr. Bizzell said.
In some cases, SAMHSA staff helped grantees adapt to specific
needs "post-Katrina." For example, Dr. Bizzell received
a request from a SAMHSA grantee to reorganize funding to sustain
services in the storm's wake. After the required assessment of the
request, Dr. Bizzell assisted the grantee with the funding adjustments.
In Houston, Mr. Lubran said, "A lot of outreach was done
by SAMHSA's Screening, Brief Intervention, Referral, and Treatment
(SBIRT) program. SBIRT staff went into the Astrodome and screened
people for substance abuse. And the state provided transportation
to get these people into treatment programs."
All four states—Louisiana, Mississippi, Alabama, and Texas—received
SAMHSA Emergency Response Grants. Those funds are exhausted now,
but the grant-funded work done after the hurricanes has paved the
way for systemic improvements in the region's OTPs.
According to Mr. Lubran, SAMHSA is piloting an innovative,
Internet-based system to ensure continuity of care in
future disasters. The pilot is operating on a limited
basis at this time, and it will be several years before
the system is fully operational.
This system would make information on buprenorphine
and methadone patients enrolled in an OTP in one part
of the country available to staff at other OTPs across
the Nation.
"Once the system is up," said Arlene Stanton, Ph.D.,
CSAT's Project Officer on the project, "if a patient from New
Orleans walked into a clinic in Houston, the Texas staff could meet
that person's critical treatment needs with minimal delay."
Planning and design for the new system began after the terrorist
attacks of September 11, 2001. Officials recognized the need for
transfer of data regionally and nationally in the wake of a disaster.
For more information on methadone, buprenorphine, and other related
topics (e.g., the Agency's emergency guidance to State Methadone
Authorities), visit SAMHSA's Web sites at http://buprenorphine.samhsa.gov
or http://dpt.samhsa.gov.
« See Part 1: Hurricane Recovery
« See Part 2: Hurricane Recovery
« See Administrator's Message
« See First-Person Accounts
« See Resources
« See Children's Trauma Network
See
Also-Estimates of Substance Use in Affected States »
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