Hope For Kansas Families In Substance Abuse Crisis — Locking In The GOLD STANDARD For OPIOID Treatment

1. Medication Assisted
Treatment (MAT)
Hope For Kansas Families In Substance Abuse Crisis
5/25/2023 — Keri Strahler

2. Kansas Is Behind The Ball In An Opioid Crisis —
“Three hundred and ninety-one pharmacies in Kansas had a naloxone protocol;
however, most were in Sedgwick, Shawnee, Johnson, Wyandotte, and Douglas
counties, which are the urban centers of the state. Rural counties such as
Graham, Barber, and Morton counties had a high opioid vulnerability but did not
have any pharmacies with a naloxone protocol.”
~ Shrestha S, Pustz J, Jacque E, Sawyer J, Feng W, Lingwall C, and Stopka TJ.
Kansas Opioid Vulnerability Assessment, June 2020

3. From KDHE, Vulnerable Kansas Counties 2022 —

4. Why Medication Assisted Treatment?
“Medication-assisted treatment (MAT) combined with psychosocial therapies and
community-based recovery supports is the gold standard for treating opioid addiction.”
~ Elinore F. McCance-Katz M.D., Ph.D., SAMHSA (2017-2021)

6. 3 Medications To Treat Substance Abuse
● Naltrexone: Alcoholism (an opioid antagonist)
● Methadone: Opioid Abuse (an opioid agonist)
● Buprenorphine: Opioid Abuse (an opioid agonist)

7. Naltrexone —
“The data lend support to the hypothesis that endogenous opioid activity is
involved in the regulation of alcohol intake, and that antagonists of endogenous
opioids decrease craving and drinking. Opiate antagonists [blockers] such as
naltrexone are a new strategy in the treatment of alcohol dependence. Naltrexone
can be safely given to female and male alcoholics, is acceptable to patients, and
plays a role in reducing alcohol consumption and preventing relapse to heavy
drinking.”
~ Romach MK, Sellers EM, Somer GR, Landry M, Cunningham GM, Jovey RD, McKay C,
Boislard J, Mercier C, Pépin JM, Perreault J, Lemire E, Baker RP, Campbell W, Ryan D.
Naltrexone in the treatment of alcohol dependence: a Canadian trial. Can J Clin Pharmacol.
2002 Fall;9(3):130-6. PMID: 12422250.

8. Methadone —
“Methadone is a synthetic opioid agonist that eliminates withdrawal symptoms and
relieves drug cravings by acting on opioid receptors in the brain—the same
receptors that other opioids such as heroin, morphine, and opioid pain
medications activate. Although it occupies and activates these opioid receptors, it
does so more slowly than other opioids and, in an opioid-dependent person,
treatment doses do not produce euphoria. It has been used successfully for more
than 40 years to treat opioid use disorder and must be dispensed through
specialized opioid treatment programs.”
~ “How do medications to treat opioid use disorder work" National Institute on Drug
Abuse, 13 Apr. 2021

9. Buprenorphine —
“Buprenorphine is a partial opioid agonist, meaning that it binds to those same
opioid receptors but activates them less strongly than full agonists do. Like
methadone, it can reduce cravings and withdrawal symptoms in a person with an
opioid use disorder without producing euphoria, and patients tend to tolerate it
well. Research has found buprenorphine to be similarly effective as methadone for
treating opioid use disorders, as long as it is given at a sufficient dose and for
sufficient duration.”
~ “How do medications to treat opioid use disorder work" National Institute on Drug
Abuse, 13 Apr. 2021
*Buprenorphine with Naloxone is SUBOXONE

10. Barriers To Medication Assisted Treatment —
“If treatment is needed, the court or Child Welfare Case Management Provider would
provide resources and direct the parent/child to seek out drug and alcohol treatment
through a local provider and follow the recommendations. The CCBHCs (Certified
Community Behavioral Health Clinics) are able to provide a sliding fee scale for MAT for
those uninsured. Additionally, through the CCBHC Case Management services, the
CCBHC could assist the parent in applying for Medicaid if desired.”
~Jennifer S. Thomas, LBSW, Interim Deputy Director of Permanency, Kansas DCF
● Resources Are Few
● The DEA Rolls Back COVID Telehealth Considerations
● KanCare MAT Coverage Lags

11. Resources Are Few —
“But Kansas providers prescribe MAT at a rate lower than almost any other state. A 2019 report
from the Urban Institute found that Kansas had the fourth-worst rate of prescribing buprenorphine
in the United States, ahead of only Florida, South Dakota, Texas and Arkansas.
Even figuring out how many MAT providers exist in Kansas is no small feat.
The Kansas Department of Aging and Disability Services maintains a directory of licensed MAT
providers in the state, as does the federal Substance Abuse and Mental Health Services
Administration.
While there is some overlap, the two lists don't fully align. And some practitioners on both
databases have left the state or retired, making an accurate count difficult to ascertain.
~ The Topeka Capital Journal, 5/08/2023

12. The DEA Rolls Back COVID Telehealth Considerations —
“For CKF Addiction Treatment in Salina, 175 patients participate in MAT and the majority
of them do so via telemedicine. Many are in more rural or frontier areas and pick up their
prescriptions from a local pharmacy, participate in therapy appointments via telemedicine
and have never set foot in Saline County.
Most patients eventually do see a partner provider in their area, though this isn't an
option for everyone, depending on where they live, CKF President and CEO Shane
Hudson added.
"For new patients coming on you have this 30-day window and then it's like, all right, you
better travel to Salina which is seven, six hours away or whatever it may be," he said.
"That's an issue that would be caused."
~ The Topeka Capital Journal, 5/08/2023

13. KanCare MAT Coverage Lags —
“Access to these treatments is particularly important in Medicaid, which covers a
disproportionately large share of people with Opioid Use Disorder. Despite strong
evidence supporting the effectiveness of pharmacotherapy for OUD (sometimes
called medication-assisted treatment), research indicates that most people with
OUD do not receive treatment.”
~ ”State Variation in Medicaid Prescriptions for Opioid Use Disorder from 2011 to
2018” Urban Institute, August 2019
*Kansas legislators do not want to expand Medicaid.

14. Hope for Kansas Families in Substance Abuse Crisis —
● 2018 Family First Prevention Services Act, Title IV-E Funding
● Methadone Maintenance Treatment Program Reviewed
● All 26 Kansas Community Mental Health Centers Will Offer MAT

15. 2018 Family First Prevention Services Act —
“Title IV-E can pay for Substance Use Disorder prevention and treatment services on behalf of
children and youth at risk of entering foster care. Services can be provided to:
● Parents
● Children/youth
● Kinship Caregivers
● Pregnant and parenting youth in foster care whose children are at risk of entering care.
Other eligible services include mental health prevention and treatment services and in-home
parent skill-based programs. Services can be provided for up to 12 months and can be extended
if it is documented in a child’s case plan that more time is needed. Title IV-E can pay as long as
Medicaid is not already funding these services.”
~ “Implementing The Substance Use Disorder Provisions Of The Family First Prevention
Services Act” Children And Family Futures, 2020

16. Methadone Maintenance Treatment Program Reviewed —
“Methadone Maintenance Therapy (MMT) is a medication-assisted treatment that aims to
reduce the use of heroin and other opioids for individuals who have an opioid use
disorder. MMT must be administered by clinicians in federally-certified and licensed
treatment programs and includes counseling and social support services. States
individually determine appropriate staff-to-patient ratios for delivery of this treatment. To
meet federal requirements, MMT programs must be certified through the Substance
Abuse and Mental Health Services Administration (SAMHSA) Division of Pharmacologic
Therapies (DPT). MMT is rated as a promising practice because at least one study
achieved a rating of moderate or high on study design and execution and demonstrated a
favorable effect on a target outcome. Date Research Evidence Last Reviewed: Sep 2019”
~Title IV-E Prevention Services Clearinghouse

17. All 26 Community Mental Health Centers Will Offer MAT —
“MAT is a requirement of the Certified Community Behavioral Health Clinic
(CCBHC) model, so once all the CMHCs have received their CCBHC certification,
they will be providing it. We anticipate that all will be CCBHCs by January 2024.”
~Michelle Ponce, Association of Community Mental Health Centers of Kansas

18. What Needs To Be Done NOW —
● Awareness Helps To Establish Naloxone Protocols (Pharmacists)
● Explore Program Options At Kansas DCF To Reimburse MAT Providers
● Lock In Title IV-E Funding For Substance Abuse Treatment