Follow-up on seeking more, not less

A friend responded to my recent post on Bill White’s paper on MAT and noted that I did not distinguish between OTPs (Opioid Treatment Programs) and OBOT (Office-Based Opioid Treatment). He pointed to the oversight and more comprehensive nature of OTPs vs OBOTs, adding that there will be significant variation in retention and other outcomes based on the service elements and the way(s) the program delivers them.

I agree completely that those kinds of distinctions are critically important to good policy, informed patients/families, and good care. The should be discussed more. That was the point of my post, and I believe it was the point of Bill’s article.

We often hear that MAT is evidence-based, the gold standard, or simply that it works. This is a little like saying antibiotics, acetaminophen, or CBT are evidence-based, the gold standard, or that they work.

They work to treat particular conditions, in particular patients, achieving particular outcomes, in particular contexts.

MAT is no different. Discussions of MAT’s effectiveness should address which medications, which concurrent psycho-social-spiritual interventions, which contexts, which patients, to achieve which outcomes.


So . . . I agree with my friend that MAT should stop being discussed as one thing, speak to the nuances mentioned above, and distinguish good care from bad care.

Another friend just shared an AATOD advocacy document.

AATOD is a professional association for OTPs. The document challenges proposed legislation to make it easier to establish OBOTs by eliminating a requirement that prescribing physicians receive 8 hours of training on opioid use disorders (which can be completed online).

Of course, this document and its contents could be dismissed as a cynical industry effort to protect commercial turf.

Wouldn’t it be better to see advocates and providers respond to the points AATOD makes in the document? If these disagreements between providers saw the light of day?

We similarly see other criticism of advocates and providers dismissed as stigmatizing to patients.

Just as we need to separate the person from the disease of addiction, we need to be able to separate the treatment from the patient. If we can’t, (even with wholly good intentions) we risk patients functioning as human shields to protect providers and advocates from being challenged to better serve those patients.

There’s plenty of treatment of inadequate quality, duration and intensity–MAT and medication-free. All of it should be challenged.

I’m of the opinion that we should all seek for a day when all people with addiction are offered recovery-oriented treatment of an adequate quality, duration, and intensity to achieve full, sustained recovery. They should be provided accurate information about the evidence that exists (or doesn’t exist) for their treatment goals, and they should have immediate access to the care of their choosing. And, if they change their mind, providers should cooperate with a transfer to the care they prefer.

By all means, let’s explore disagreements about what constitutes “adequate quality, duration, and intensity to achieve full, sustained recovery.” And, lets discuss the best ways to engage patients into that kind of care. For example, there are a lot of strategies that some will reject as treatment because it doesn’t constitute treatment of “adequate quality, duration, and intensity to achieve full, sustained recovery.” However, that same strategy may be acceptable to those same people as an engagement strategy into treatment of “adequate quality, duration, and intensity to achieve full, sustained recovery.”