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SAMHSA News - September/October 2006, Volume 14, Number 5

D-ATM Digital Access to Medication

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 disruption.

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” programs.

photo of New Orleans, Louisiana on September 8, 2005 ten days after hurricane Katrina, there are still areas that have not been addressed by clean up crews
For patients in treatment for opioid dependence, SAMHSA's D-ATM
program will use a Web-based system to ensure patients can receive
their medications from treatment centers safely outside a disaster
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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The Need

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 closed.

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 efforts.”

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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The Solution

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 work followed.

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 dosing.

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 included.

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 arlene.stanton@samhsa.hhs.govEnd of Article

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SAMHSA News - September/October 2006, Volume 14, Number 5