A pilot program in New Jersey is demonstrating that medication-assisted treatment can make a significant difference in the lives of low-income individuals chronically addicted to opiates, and project administrators look with optimism toward wider implementation of the initiative across the state.
The project director for the state’s Medication-Assisted Treatment Initiative (MATI) and an evaluator of the project offered a compelling presentation of the project’s results so far at the Sept. 6-9 Cape Cod Symposium on Addictive Disorders. The pilot initiative was funded through dollars attached to a 2006 needle exchange law in the state, and needle exchange programs have represented the most prominent referral source to the medication-assisted treatment program.
Among the lessons learned from the pilot implementation has been that a low-income population that has averaged nearly six prior drug treatment experiences has generally responded well to treatment with the Suboxone formulation of buprenorphine, and that many have preferred receiving their medication dosages via a mobile clinic (van) over a traditional office-based setting.
“ New Jersey became the first state to offer both methadone and buprenorphine in a mobile unit,” Jude U. Iheoma, PhD, MATI’s project director and holder of assistant professor titles at Rider University and Mercer County Community College, said in the Sept. 8 conference presentation. Five of six New Jersey communities that were targeted in MATI have had access to the mobile unit; policy-makers in Newark prohibited its use in that city because of their concerns over the mechanics of medication distribution from a mobile facility.
MerriBeth Adams, PhD, director of research and program evaluation at the New Jersey chapter of the National Council on Alcoholism and Drug Dependence (NCADD-NJ), said that in an examination of 18-month outcomes based on patient interviews and an analysis of administrative records, 80% of participants remained in the program at the 18-month mark. A similar percentage preferred the van, which is staffed with a physician, nursing staff and addiction counselors, to an office setting. Also, about two-thirds of the patients were able to initiate treatment and receive their first medication dose on the same day.
The analysis, conducted in conjunction with the National Center on Addiction and Substance Abuse (CASA) at Columbia University, also found a 69% decline in the prevalence of heroin use in the treated population, a significant decline in use of needle exchange among this group, and a 19% decrease in these patients’ accessing emergency room facilities.
Adams said CASA will release a formal report on MATI’s impacts after the full research effort is completed in several months. Preliminary results also were released this year at the conference of the American Association for the Treatment of Opioid Dependence (AATOD).
Project leaders expect that expansion of the initiative will be made possible by an infusion of an additional $10 million in funding, with plans to tie the effort into the state’s Medicaid waiver program. The intent is for the initiative to generate as much in health and related system savings as it requires in costs.
Any New Jersey treatment agency that seeks to participate in MATI must agree to embrace harm reduction principles in working with opiate addicts, said Iheoma, who made an impassioned case for a public health approach to opiate addiction in his comments at the Cape Cod Symposium. “All of the agencies, including residential treatment programs, have to promise that they will not detox someone off the dosage of methadone or buprenorphine,” he said.