Medication Assisted Treatment (MAT) for Substance Use

TOOLKIT

The CT Behavioral Health Partnership (CT BHP) is committed to the early identification and treatment of alcohol and other drug use disorders to promote optimal health for its members. The paramount task is to confront stigma and promote the understanding of addiction as a biologically based, relapsing chronic illness and to provide as much education and access to resources, as possible, to both provider and member communities.

The CT BHP Medication Assisted Treatment (MAT) Toolkit is a resource for both providers and members and contains the following:

Medication Assisted Treatment Brochure Frequently Asked Questions Resources for Members and Providers Recovery Principles

In addition to the following, feel free to visit the Medication Assisted Treatment (MAT) Resources page on the CT BHP website at www.ctbhp.com. The MAT web page offers a variety of resources and a MAT Provider Locator Map.

Thank you,

CT Behavioral Health Partnership

Medication Assisted Treatment (MAT) for Substance Use

TOOLKIT

FREQUENTLY ASKED QUESTIONS

What is Medication Assisted Treatment (MAT)? Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines talk therapy and medications to

treat substance use disorders. The FDA has approved several different medications to treat Opioid Use and Alcohol Use Disorders.

These medications relieve withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused substance. Research has shown that when provided at the proper dose, MAT medications used have no negative effects on a person’s intelligence, mental capability, physical functioning, or employability.

Some of the medications used in MAT are controlled substances due to their potential for misuse.

What Substance Use Disorders can be treated with medication-assisted treatment?Both Opioid Use Disorder (heroin and prescription painkillers) and Alcohol Use Disorder can be treated with medication-assisted treatment.

Are MAT services covered under Medicaid? There are four medications that are typically prescribed for opioid and or alcohol use disorders. These medications are covered by Connecticut Medicaid. They are described below. These medications have a name brand and a generic variation and can be found on the “preferred” drug list for Connecticut Medicaid. You can see the most up-to-date version of this list here: https://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/CT_PDL_medicaid.pdf

What are the different MAT Medications? Methadone – Methadone is an opiate that replaces the highs and lows of the abused drug with a steady dose of medication.

During Methadone treatment the person does not get high and feels normal, so withdrawal doesn’t occur. Pregnant or breastfeeding women must inform their treatment provider before taking Methadone. It is the preferred MAT medication for women who are pregnant or breastfeeding. Methadone is dispensed on a daily basis in a clinic setting.

Buprenorphine or Suboxone - Like Methadone, Buprenorphine is an opioid that suppresses and reduces cravings for the abused drug. It can come in a pill form or a tablet that is placed under the tongue. Buprenorphine is a prescription that a person takes independently in the community.

Naltrexone or Vivitrol - Naltrexone is not an opioid. It can be used for the treatment of both Opioid and Alcohol Use Disorders. This medication blocks cravings for these substances. If a person using Naltrexone relapses and uses the abused drug, Naltrexone blocks the effects of the drug and prevents the person from getting high. It comes in a pill form or as an injection. The pill form of Naltrexone should be taken daily. The injectable extended-release form of the drug is given once per month. This injection can cause withdrawal. As a result, patients are warned to be free of all opioids for a minimum of 7-10 days before their first injection.

Antabuse - Antabuse (disulfiram) blocks an enzyme that is involved in metabolizing alcohol intake. Antabuse is used in certain people with chronic alcoholism. This medicine can help keep you from drinking because of the unpleasant side effects that will occur if you consume alcohol while taking Antabuse. Antabuse is used together with behavior modification, psychotherapy, and counseling support to help you stop drinking. This medicine is not a cure for alcoholism.

What is Naloxone? Where can I get it? Naloxone or Narcan is a medication approved by the FDA to prevent opioid overdose. It blocks the drug, reversing the effects

of the overdose for a period of time. Naloxone is given when a person is showing signs of opioid overdose. The medication can be given by a spray in the nose, injection into a muscle, under the skin or into a vein. When this medication is given, 911 must be called as medical attention will be needed immediately.

For more information on preventing opioid overdose, see SAMSHA Overdose Prevention Toolkit.

Medication Assisted Treatment (MAT) for Substance Use

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FREQUENTLY ASKED QUESTIONS – FOR PROVIDERS

How can I provide Naltrexone/Vivitrol services for CT Medicaid Members? Must be a Connecticut licensed prescriber Must be enrolled in the Connecticut Medical Assistance Program (CMAP). Enrollment in CMAP can be completed online

through Hewlett Packard Enterprises website: www.ctdssmap.com Click Provider Enrollment under the Provider Tab. 1-(800) 842-8440

Pharmacy Authorization: Naltrexone tablets are currently on the CMAP Preferred Drug List and do not require prior authorization. Vivitrol (injectable) is currently on the Non-Preferred Drug List and requires prior authorization. The prescription is authorized by submitting a State of CT DSS Drug Prior Authorization Request Form. The form is available on the www.ctdssmap.com website. Completed request forms are faxed and processed within 2 hours.

Always complete a urine drug screen prior to Vivitrol injection. A Clinical Laboratory Improvement Amendments of 1988 (CLIA) waiver should be completed by the Member prior to receiving Naltrexone/Vivitrol services in the event the Provider does not complete an in house urine drug screen (States that they have been clean of Alcohol/Opioids). https://www.cms.gov

How do I obtain reimbursement for providing Naltrexone/Vivitrol services? Counseling treatment requires outpatient authorization through the CT BHP ProviderConnect online portal at www.ctbhp.com Claims for counseling/med management are submitted through the Hewlett Packard Enterprise (HPE) website:

www.ctdssmap.com

What billing codes are used when billing Naltrexone/Vivitrol services? A complete fee schedule and coding list is available by provider type and specialty through the HP Enterprise website at

www.ctdssmap.com Click on 'Provider Fee Schedule Download' under the “Provider” tab

How can I provide Buprenorphine/Suboxone services for CT Medicaid Members? Must be a Connecticut licensed physician or nurse practitioner. Must be enrolled in the Connecticut Medical Assistance Program (CMAP). Enrollment in CMAP can be completed online

through Hewlett Packard Enterprises website: www.ctdssmap.com Click Provider Enrollment under the Provider Tab. 1-(800) 842-8440

Complete the Drug Addiction Treatment Act Course (DATA 2000). The list of training agencies can be found on the SAMHSA website: http://www.samhsa.gov/medication-assisted-treatment or by visiting one of the participating agency websites listed below:

AAAP- www.aaap.org/education training/buprenorphine ASAM- www.asam.org/education/certification-and-moc APA- http://education.psychiatry.org/ AOAAM- http://www.aoaam.org/ Dates/times of trainings are outlined on each site. There is a cost for the course.

Only once the above training is complete, a physician must notify the SAMHSA Center for Substance Abuse Treatment (CSAT) of their intent to practice this form of medication-assisted treatment by completing a waiver application. Application for waiver can be found on the SAMHSA website: http://www.samhsa.gov/medication-assisted-treatment. The process to obtain the waiver takes approximately 45 days

Pharmacy Authorization: Suboxone film (sublingual) is currently listed on the CMAP Preferred Drug List and does not require prior authorization. Generic buprenorphine tablets are currently on the Non-Preferred Drug List and require prior authorization. The prescription is authorized by submitting a State of CT DSS Drug Prior Authorization Request Form. The form is available on the www.ctdssmap.com website. Completed request forms are faxed and processed within 2 hours.

Medication Assisted Treatment (MAT) for Substance Use

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RESOURCES – FOR PROVIDERS

RESOURCES – FOR MEMBERS

How can I find MAT providers and more information about MAT services?The CT Behavioral Health Partnership website has a MAT Provider locator map http://www.ctbhp.com/medication-assisted-treatment.html or call CT BHP at 1-877-552-8247 TTY: 1-866-218-0525. Hours of Operation: Mon – Fri. 9am – 7pm

How can I be listed on the CT BHP MAT Provider Locator Map?There is a direct email link on the MAT Provider locator map to request additions and/or updates to the MAT Provider locator map.

How can I find MAT resources?Here are some electronic links to resources that may help:

American Society of Addiction Medicine (ASAM) represents physicians who provide care for patients with addictions. http://www.asam.org/about-us

The American Association of Addiction Psychiatry is an international organization that educates, influences, and encourages excellence in practice, policy and prevention for the field of addiction psychiatry. http://www.apa.org/about/division/div50.aspx

SAMHSA's Medication-Assisted Treatment of Opioid Use Disorder Pocket Guide provides guidelines on various types of approved medications, screening and assessment tools and best practices for patient care for physicians using MAT for patients with opioid use disorder. http://store.samhsa.gov/product/Medication-for-the-Treatment-of-Alcohol-Use-Disorder-Pocket-Guide/SMA15-4907POCKETGUID

SAMHSA’s MATx app provides practitioners with information on treatment approaches, buprenorhpine prescribing, clinical support tools and treatment locators. http://store.samhsa.gov/apps/mat/

HUSKY Health Pain Management Program where Connecticut Medical Assistance Program (CMAP)

providers may readily access information and tools to safely and effectively manage patients dealing with chronic pain conditions. http://www.huskyhealthct.org/providers/providers_pain_management.html

HUSKY HEALTH Pain Management and Primary Care Provider (PCP) Toolkit. The PCP Pain Management Toolkit is a comprehensive guide for Primary Care Providers (PCPs) supporting the safe and effective treatment of chronic pain in the primary care setting. http://www.huskyhealthct.org/providers/providers_pain_toolkits.html

Medication Assisted Treatment (MAT) for Substance Use

TOOLKIT

How can I find MAT providers?The CT Behavioral Health Partnership website has a MAT Provider locator map http://www.ctbhp.com/medication-assisted-treatment.html www.ctbhp.com or call CT BHP at 1-877-552-8247 / TTY: 1-866-218-0525. Hours of Operation: Mon – Fri. 9am – 7pm

How can I find MAT resources?Here are some links to resources that may help:

o Connecticut Behavioral Health Partnership (CT BHP) 1-877-552-8247 http://www.ctbhp.com/medication-assisted-treatment.html

o HUSKY Healthcare 1-800-859-9889 www.huskyhealth.com

o United Way-211 Dial 211 www.211ct.org

o Department of Mental Health & Addiction Services http://www.ct.gov/dmhas/cwp/view.asp?q=335224

o Department of Social Services (DSS) Programs & Services www.ct.gov/dss/cwp/view.asp?a=2345&q=490632

o Connecticut Community for Addiction Recovery https://ccar.us/services/

o Advanced Behavioral Health (ABH) http://www.abhct.com/Programs_Services/

o Connecticut Department of Consumer Protection http://www.ct.gov/dcp/cwp/view.asp?a=4302&Q=506542&PM=1

o Narcotics Anonymous http://ctna.org/

o CT Alcoholics Anonymous www.ct-aa.org/home/

o Addictions and Recovery.org http://www.addictionsandrecovery.org/

o American Society of Addiction Medicine http://www.asam.org/public-resources/pain-and-addiction

o Substance Abuse and Mental Health Services Administration www.samhsa.gov/medication-assisted-treatment

o Partnership for Drug Free Kids http://www.drugfree.org/

Medication Assisted Treatment (MAT) for Substance Use

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What is Recovery?Recovery is:

A lifestyle About becoming alive, free from substances and/or addictive patterns A process of self-empowerment and personal choice Individualized ways to initiate and maintain recovery

Stages of Recovery:

Stages of Recovery provided by Connecticut Community for Addiction Recovery

RECOVERY PRINCIPLES

Medication Assisted Treatment (MAT) for Substance Use

TOOLKIT

Stages of Recovery provided by Connecticut Community for Addiction Recovery

Stage 5: Fullfillment• Identify and follow through on life’s purpose• Live within an aura of peace/serenity• Dramatically reduce worrying• Realize acceptance• Discover high level of morality and integrity• Exhibit confidence balanced with humility• Embrace the concept of being precious and insignificant at the same time• Feel gratitude that penetrates all actions