Disasters—both natural and human-made—present
a special challenge for service providers and recipients
in treatment for opioid addiction: how to ensure the
continuous availability of critical services for patients
in a highly regulated environment.
To help, SAMHSA’s Center for Substance Abuse Treatment
(CSAT) recently launched the next phase of a multi-year
project. The goal is to develop a system to help patients
in treatment for opioid dependence obtain their medication
in the midst of an emergency or other serious service
The project, Digital Access to Medication (D-ATM), focuses
on the retrieval of patient dosage information during
or following emergencies—such as snowstorms, power
failures, hurricanes, tornadoes, or terrorist attacks—that
may cause a treatment program to close or make it difficult
for patients to access care at their “home”
|For patients in treatment for
opioid dependence, SAMHSA's D-ATM
program will use a Web-based system to ensure patients
their medications from treatment centers safely outside
zone and in other cities around the country. Photo
by Liz Roll, in New
Orleans, LA, after Hurricane Katrina. Courtesy of
Federal Emergency Management Agency.
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Service continuity is critical for patients in treatment
for opioid dependence. This type of treatment is highly
regulated, because medication (usually methadone) cannot
be obtained from a pharmacy. For this reason, most patients
must go daily to a SAMHSA-regulated treatment center
for their medication.
Providers at each center know that the accuracy of a
patient’s dose is critical. Too high a dose could
cause an adverse reaction; too low a dose could be ineffective
and potentially disrupt a patient’s recovery. In
an emergency situation, it is even more critical that
patients know their medication will be readily available
and dispensed in the correct dosage.
Following the September 11, 2001, terrorist attacks,
one Opioid Treatment Program (OTP) located near the World
Trade Center was destroyed. Several other OTPs in the
New York metropolitan area remained closed for days or
weeks. Approximately 1,000 patients were displaced.
Despite the chaos, patients continued to seek treatment,
and staff and administrators in the area kept other OTPs
open to serve their own patients and assist others without
access to the OTPs where they were normally enrolled.
In August 2005, OTP patients had a similar experience
when Hurricane Katrina devastated areas of Louisiana,
Mississippi, and Alabama. New Orleans residents, including
OTP patients, fled to temporary shelters across the United
States. The seven New Orleans-area OTPs shut down for
an extended period of time. A year later, three remain
To provide medication, staff members at OTPs often had
to make critical dosing decisions with little information
other than a patient’s recall.
“After these catastrophes, patients showed us
just how much maintaining their recovery mattered to
them,” said Arlene Stanton, Ph.D., SAMHSA project
officer for D-ATM in CSAT’s Division of Pharmacologic
Therapies. “The D-ATM program will support their
But even in non-disaster situations, patients encounter
challenges to their recovery. “For instance, a
patient who is traveling might find it impossible to
reach a specific destination in time—maybe a plane
flight was cancelled or delayed. With a system like D-ATM,
this patient would be assured that another program could
provide needed medication,” said Dr. Stanton.
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Immediately after September 11, 2001, CSAT began working
with key stakeholders from New York, Connecticut, and
New Jersey. In 2002, CSAT funded a feasibility/planning
study to explore how a Web-based, centralized database
could help ensure that OTP patients received their appropriate
medications safely and effectively. Other developmental
CSAT funded the current D-ATM pilot project in fall
2005. D-ATM’s purpose is to develop the infrastructure
for the system and then pilot test it on a limited basis.
Guided by four principles—simplicity, affordability,
acceptability, and confidentiality—the project
will use a Web-based system to ensure patients can access
medication as easily as accessing a neighborhood automatic-teller
machine to obtain cash.
Starting in the metropolitan New York area, the D-ATM
pilot project may ultimately involve up to 50 programs.
A steering committee will continue to provide critical
guidance for the project.
Completion of the D-ATM pilot is expected in September
2008. At that time, a review of the pilot system will
be conducted to determine its effectiveness and to identify
any modifications needed to expand the program nationwide.
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How D-ATM Would Work
In the event of a disaster, patients may need to seek
treatment somewhere other than their home programs. Therefore,
the D-ATM Project uses a biometric device—such
as a fingerprint scanner—to store patients’
recent dosage information to a centralized database.
Simply by scanning a patient’s fingerprint, service
providers at a “guest” OTP will be able to
verify the visitor-patient’s medication information
and retrieve a report on current prescriptions and dosages.
To ensure confidentiality, the system will hold limited
information on any patients—in other words, only
the defined set of data needed to ensure safe and accurate
A patient’s information will be accessible only
if the patient initiates the transaction by allowing
a fingerscan or by presenting another type of information
that will identify that person to the system.
To maintain privacy, the system will not include patients’
names or other identifying information such as a social
security number. Even in non-emergency settings, this
type of patient information is limited due to stringent
privacy regulations such as the Health Insurance Portability
and Accountability Act (HIPAA) of 1996 and other restrictions.
SAMHSA recently created a D-ATM Web site that provides
a place to share, post, and exchange project-related
information. As the project develops, the Web site will
post progress notes, current project status, upcoming
milestones, technical information, frequently asked questions,
and outstanding issues. Planned pilot test locations
and information about patient protections will also be
For more information about the Digital Access to Medication
project, visit the D-ATM Web site at www.datm.samhsa.gov.
Or send an email to Dr. Stanton at email@example.com.
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