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SAMHSA News - November/December 2005, Volume 13, Number 6


Methadone, Buprenorphine

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 Of?cer 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. Of?cials 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.

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