Expand Access to Medication-Assisted Treatment (MAT) - Revision history

G.Lehrman at 20:14, 7 November 2021

2021-11-07T20:14:08Z

G.Lehrman at 20:12, 7 November 2021

2021-11-07T20:12:08Z

G.Lehrman at 19:48, 7 November 2021

2021-11-07T19:48:28Z

G.Lehrman at 03:42, 30 October 2021

2021-10-30T03:42:18Z

G.Lehrman at 03:38, 30 October 2021

2021-10-30T03:38:55Z

G.Lehrman at 03:34, 30 October 2021

2021-10-30T03:34:09Z

G.Lehrman at 03:31, 30 October 2021

2021-10-30T03:31:20Z

G.Lehrman at 03:30, 30 October 2021

2021-10-30T03:30:02Z

G.Lehrman at 03:28, 30 October 2021

2021-10-30T03:28:48Z

G.Lehrman at 03:28, 30 October 2021

2021-10-30T03:28:20Z

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 == Moving from Stigma to Science ==
 === Pennsylvania and New Jersey ===
-<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] https://dbhids.org/MAT/</ref>&nbsp;Underlying problems still exist in restrictive medication regimen&nbsp;practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]Page Not Found</ref></div>
+<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] https://dbhids.org/MAT/</ref>&nbsp;Underlying problems still exist in restrictive medication regimen&nbsp;practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]https://dbhids.org/MAT/</ref></div>
 === National Healthcare For Homeless Council ===

@@ Line 265: / Line 265: @@
 == Moving from Stigma to Science ==
 === Pennsylvania and New Jersey ===
-<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] Page Not Found</ref>&nbsp;Underlying problems still exist in restrictive medication regimen&nbsp;practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]Page Not Found</ref></div>
+<div class="_">The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] https://dbhids.org/MAT/</ref>&nbsp;Underlying problems still exist in restrictive medication regimen&nbsp;practices, insurance coverage, and Public-Private partnerships, which require support to overturn previous hard-lined policies. An evidence-based approach has shown that introduction of MAT, especially with Buprenorphine, has had an increased mitigation effect on relapse and a higher chance of long-term recovery.<ref> [42]Page Not Found</ref></div>
 === National Healthcare For Homeless Council ===

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 == Different Medications Used in MAT: ==
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 *Acceptance of Third Party Insurance
-It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it.&nbsp;<sup class="reference"><ref>[12]Page Not Found</ref></sup>&nbsp;As a result, there are cases where medication diversion does occur, and there is a black market for the drug for self-treatment purposes.<sup class="reference"><ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup><br/> <br/> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<sup class="reference"><ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
+It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it.&nbsp;<sup class="reference"><ref>[12]https://www.fiercehealthcare.com/practices/only-10-eligible-primary-care-providers-can-prescribe-buprenorphine-to-treat-patients-for</ref></sup>&nbsp;As a result, there are cases where medication diversion does occur, and there is a black market for the drug for self-treatment purposes.<sup class="reference"><ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup><br/> <br/> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<sup class="reference"><ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
 *Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine]

@@ Line 288: / Line 288: @@
 == Canadian Guidelines ==
 <div class="_">This [https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs document ]has details on the MAT Methadone&nbsp;guidelines from Canada</div>
 = Available Tools and&nbsp;Resources =
-[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals.&nbsp;<ref>https://pcssnow.org</ref><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine training sessions&nbsp;are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<sup class="reference"><span style="background-color:#f1c40f;">[45]</span></sup><br/> &nbsp;
+[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals.&nbsp;<ref>https://pcssnow.org</ref><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine training sessions&nbsp;are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<font size="1">&nbsp;<ref>https://nccc.ucsf.edu/about-the-center/</ref></font><br/> &nbsp;
 <br/> PAGE MANAGER: [insert name here]<br/> SUBJECT MATTER EXPERT: [fill out table below]

@@ Line 288: / Line 288: @@
 == Canadian Guidelines ==
 <div class="_">This [https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs document ]has details on the MAT Methadone&nbsp;guidelines from Canada</div>
 = Available Tools and&nbsp;Resources =
-[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <sup class="reference"><span style="background-color:#f1c40f;">[44]</span></sup><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine training sessions&nbsp;are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<sup class="reference"><span style="background-color:#f1c40f;">[45]</span></sup><br/> &nbsp;
+[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals.&nbsp;<ref>https://pcssnow.org</ref><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> This is a DATA 2000 accredited resource for providing either an 8-hour training for Physicians or a 24-hour training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. It also offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations, as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine training sessions&nbsp;are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA), American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<sup class="reference"><span style="background-color:#f1c40f;">[45]</span></sup><br/> &nbsp;
 <br/> PAGE MANAGER: [insert name here]<br/> SUBJECT MATTER EXPERT: [fill out table below]

@@ Line 279: / Line 279: @@
 More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].
 == Financial Incentives for MAT training ==
-'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<sup class="reference"><span style="background-color:#f1c40f;">[43]</span></sup> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture, and physical therapy.
+'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/article/policy/health-plan-offers-financial-incentives-mat-training</ref>&nbsp;Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture, and physical therapy.
 == Canadian Guidelines ==

@@ Line 221: / Line 221: @@
 == New & Expanded Treatment Options ==
 === Connecticut ===
-<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medication-&nbsp;assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713
+<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medication-assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713
 </ref></div>
 === Vermont ===
 <div class="_">Vermont's Health Home for Opioid Addiction has&nbsp;employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts<ref> [37] Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals

@@ Line 15: / Line 15: @@
 = Key Information =
 === The Value of MAT (or Opioid-Agonist Treatment) ===
@@ Line 24: / Line 25: @@
 **“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills."
 **"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
-**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness.
+**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness."
 Access the study here:<ref>What’s this agonist / antagonist stuff? (n.d.). Retrieved December 5, 2019, from https://www.naabt.org/faq_answers.cfm?ID=5
@@ Line 33: / Line 34: @@
 &nbsp;
 = Relevant Research =

@@ Line 121: / Line 121: @@
 *Patients must continue to see their doctor at least every month while on Probuphine therapy.
 *[https://probuphinerems.com For more information visit their website.]
 === Methadone ===
@@ Line 127: / Line 128: @@
 *Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<sup class="reference"><ref>[16]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
 *Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
-*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <sup class="reference">[<ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
+*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <sup class="reference"><ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
 *Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<sup class="reference"><ref>[18]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref></sup>
 *Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone]
 *[[More_Information_on_Methadone|More info on Methadone]]
 === Naltrexone ===