The Medication Access and Training Expansion (MATE) Act, a pivotal legislation in the realm of opioid crisis management, was recently the focal point of a presentation by Thomas Sullivan, Senior Vice President at Clinical Education Alliance, and Tim Atkinson, PharmD, a clinical pharmacist for a large health system to the Maryland State Medical Association (MedChi) House of Delegates Meeting. They provided insights and expounds upon the critical elements of the MATE Act, its implications for DEA certificate holders, and the evolving landscape of substance use disorder treatment.
Background of the MATE Act
The MATE Act, integral to the omnibus spending bill passed by Congress, became effective on June 27, 2023. Designed to fortify the infrastructure surrounding substance use disorder treatments, the Act represents a bipartisan commitment to tackling the opioid crisis. It mandates a one-time educational requirement for all DEA certificate holders, barring a few exceptions, focusing on enhancing the understanding and treatment of substance use disorders.
The Opioid Crisis: A Three-Wave Challenge
Sullivan and Atkinson highlighted the three distinct waves characterizing the opioid crisis: the initial surge in prescription opioid misuse, the deadly ascent of fentanyl, and the recent rise in concomitant fentanyl-cocaine-related fatalities. They pointed out the exacerbation of these trends during the pandemic, with individuals turning to substances like fentanyl amidst lockdown-induced boredom and stress.
DEA Certificate Holder Requirements Under the MATE Act
The Act stipulates that all DEA certificate holders must complete an eight-hour training on substance use disorders. This can be fulfilled through various avenues, including board certifications in addiction medicine, medical education incorporating opioid training, or completion of the MAT waiver training.
Addressing the Epidemic: Education and Compliance
The presenters emphasized the importance of comprehensive education for healthcare providers in identifying and treating these disorders. They also discussed the intricacies of complying with the MATE Act, including the nuances of the Maryland Prescription Drug Monitoring Program (PDMP) and the implications for multi-state practitioners.
Clinical and Administrative Aspects
Atkinson delved into the clinical side, discussing the treatment of substance use disorders and the role of clinicians in this battle. They also touched on the administrative aspect, such as DEA license renewals, multi-state licensure considerations, and the legal repercussions of non-compliance.
The aims to provide a comprehensive overview for healthcare professionals and stakeholders, offering insights into the MATE Act DEA requirements and the broader context of the opioid crisis.
They also covered the CEA DEA compliant course now available to meet the DEA 8 hours of education on substance use disorders requirement which can be taken on demand either as slides and text or slides and audio.
Deep Dive into Substance Use Disorders
As part of their presentation they also covered the first module of the CEA DEA Compliant 8 hour Course. In his comprehensive presentation, Tim Atkinson, PharmD, delves into the complexities of substance use disorders (SUDs), emphasizing the need for broader training among general practitioners and frontline providers. Acknowledging that specialty providers alone cannot shoulder the responsibility of addressing this crisis, Atkinson underscores the significant barriers in treatment referral and acceptance.
Global and National Drug Use Trends
Atkinson cites the United Nations Office of Drugs and Crime’s annual report, revealing cannabis as the most widely used substance globally, followed by opioids, amphetamines, cocaine, ecstasy, and methamphetamines. He also refers to the National Survey of Drug Use and Health in the U.S., highlighting the persistent misuse of prescription pain relievers alongside the rise of illicit substances.
Substance Use Disorder in the United States
Around 40 million Americans qualify for a substance use disorder based on diagnostic criteria, with alcohol being the most prevalent. However, drug use disorders, both illicit and prescription, affect about 16 million people, showcasing the severity of the crisis. Notably, there is a significant overlap of around 7 million people suffering from both alcohol and drug use disorders.
Rising Concerns Over Stimulant Use Disorders
Atkinson points out the alarming rise in stimulant use disorders, particularly cocaine and methamphetamine, which tend to manifest in more severe forms. The fast-growing nature of these disorders in overdose deaths and general use is a concerning national trend.
Barriers to Substance Use Disorder Treatment
Highlighting SAMHSA’s focus on social determinants of health, Atkinson discusses how 80% of health factors are non-clinical, with only about 30% being controllable behaviors. This insight shifts the approach to care towards a more compassionate and understanding perspective, taking into account the patient’s circumstances and background.
Ethnic and Racial Access to Treatment
Data reveals disparities in access to substance use disorder treatment among different ethnic groups, with non-Hispanic whites having significantly better access compared to minorities. This underscores the importance of addressing health equity and ensuring treatment is accessible to all who need it.
Addressing Personal Bias and Promoting Health Equity
Atkinson stresses the importance of recognizing personal and systemic biases and adopting cultural humility. Health equity, as opposed to equality, means providing tailored assistance based on individual needs and circumstances.
Substance Use Disorder Treatment: Terminology and Approach
The presentation touches upon the evolution of terminology in the field, shifting from “abuse” to “misuse” and the implications of terms like “dependence” in medical coding. Atkinson also discusses the current treatment philosophy, which has moved from chronic disease management to harm reduction, focusing on patient safety and mitigation of risks.
SBIRT Model: An Effective Engagement Tool
The Screening, Brief Intervention, and Referral to Treatment (SBIRT) model is highlighted as an evidence-based method for frontline providers to efficiently address substance use concerns. This model includes straightforward steps for screening, intervention, and referral, making it feasible for busy practitioners.
Conclusion
Tim Atkinson’s detailed overview of substance use disorders not only sheds light on the current trends and challenges but also provides practical approaches and philosophies for treatment. His emphasis on understanding the broader social context and addressing health disparities underlines the critical need for comprehensive training and awareness among healthcare professionals in tackling this epidemic.
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