This presentation will address efforts by the ATTC Network to decrease the gap between research and practice and to influence understanding of factors that enhance uptake of innovations. This presentation outlines how pairing research with innovative dissemination techniques can enhance the use of EBPs related to MAT. The presentation will provide an overview of the Buprenorphine Suite, a training product designed by the ATTC Network to provide the SUD treatment field with the tools to access and adopt NIDA treatment protocols. Additionally this presentation will identify research undertaken by the Network which identifies barriers to providing MAT to minority populations.

1. Closing the gap between research and practice:
Successful technology transfer strategies in combating
resistance to medication-assisted treatment
Addressing Resistance to
Medication-Assisted Treatment
An ATTC Network Panel Presentation
American Association for the Treatment
of Opioid Dependence (AATOD)
2012 National Conference

2. Panel Agenda
• About the Addiction Technology
Transfer Center (ATTC) Network
• Utilizing Medication-Assisted
Treatment (MAT)
• NIDA/SAMHSA Blending Initiative
Overview: A focus on medication-
assisted treatment
• MAT in Special Populations

3. The ATTC Network 2007-2012
Southern
Coast
3

5. The ATTC Network’s Vision
All professionals who address the needs of individuals with, or
who are at risk of having, substance use disorders will utilize
effective, culturally responsive practices that lead to improved
healthcare and long-term health and wellness.

6. What is Technology Transfer?
Southern
Coast

7. What is Technology Transfer?
Copyright 2010 ATTC Network

8. Panel Agenda
• About the Addiction Technology
Transfer Center (ATTC) Network
• Utilizing Medication-Assisted
Treatment (MAT)
• NIDA/SAMHSA Blending Initiative
Overview: A focus on medication-
assisted treatment
• MAT in Special Populations

9. Medication-Assisted
Treatment (MAT) is the use
of medication, combined
with counseling and
behavioral therapies, to
provide a whole patient
approach to the treatment
of substance use disorders.
(http://www.dpt.samhsa.gov )

10. Medications for Alcohol Dependence
 Naltrexone (ReVia®, Vivitrol®, Depade®)
 Disulfiran (Antabuse®)
 Acamprosate Calcium (Campral®)
Medications for Opioid Dependence
Methadone
Buprenorphine (Suboxone® and
Subutex®)
Naltrexone

11. Research has Demonstrated that MAT is Effective
 Clinical trials have demonstrated efficacy of MAT for opioid
dependent patients (Bickel et al., 1988; Amass et al., 2004; Ling et al., 2010).
 MAT is cost effective & provides more health benefits than
providing treatment without medication (M. Connock et al., 2007)
 Research to date confirms lower risk of abuse, overdose, and
toxicity and diminished withdrawal symptoms when using
medication assisted treatment (Burns et al., 2009).
 Published by SAMHSA as Treatment Improvement Protocol (TIP)
43, MAT is a widely recognized evidence based practice.

12. MAT is Not Widely Utilized to Tx SUDs
 According to SAMHSA, only 22.3% of patients seeking
treatment for a SUD received medication-assisted treatment
in the form of Methadone or Buprenorphine (SAMHSA, N-SSATS
Report, 2008).
 The University of Georgia’s National Treatment Center Studies
found that out of the programs responding to the study only:
 14.3% used Buprenorphine,
 10.7% used Methadone,
 15.2% used Naltrexone, and
 16.5% used Disulfiram
(Knudsen et al., 2010 – from a 2007 study)

13. If MAT is effective, why isn’t it more widely used?
Two-thirds of organizations' efforts to
implement change fail (Damschroder et al., 2009).

14. If MAT is effective, why isn’t it more widely used?
 Treatment philosophy may influence MAT
adoption. For example, persons endorsing a 12-
step model perceive less interest in addiction
medication (McGovern et al., 2004).
 Lack of knowledge from physicians
about medication assisted
treatment (Mark et al., 2003).

15. If MAT is effective, why isn’t it more widely used?
 SAMHSA surveys of physicians who
have been certified to prescribe
buprenorphine indicate that
complexity of induction, medication
costs, and regulatory limits have posed
barriers to prescribing (Thomas et al., 2008).

16. If MAT is effective, why isn’t it more widely used?
What do you think?
What is your experience?

17. Strategies to Increase the Use of MAT
 Address Attitudes
 Providers' perceptions about the beliefs of their peers are likely to
influence use of medications to treat opiate dependence (Rieckmann et al.,
2007).
 Offer Training
 Training improves staff attitudes and beliefs (Johnson et al., 2005; Knudsen et
al., 2005; Rieckmann et al., 2011).
 Increase Opportunities for Experience
 Experience with medications (for counselors) leads to more positive
perspectives (Thomas et al., 2003; Knudsen et al., 2005).

18. Strategies to Increase the Use of MAT
 Participate in Research Networks
 Research network participation helps promote positive attitudes toward
EBPs (Campbell et al., 2003; Levant et al., 2008).
 Integrate Appropriate Structural and Procedural Supports in
Physicians’ Office Settings
 While physician knowledge of effectiveness and an organization’s
positive attitude toward medications are important, physicians are
dependent on structural and procedural supports in their office settings
to allow for MAT (Wallack et al., 2010).

19. Strategies to Increase the Use of MAT
What would
you suggest?

20. Strategies to Increase the Use of MAT
What the ATTC Network is Doing …
Examples of Product Development Strategies
• Curricula
• Marketing/Outreach Materials
Examples of Educational Strategies
• Online Courses, Regional Presentations & Trainings
• Learning Collaboratives
Examples of Organizational Change Strategies
• Process Improvement
• Coaching
Examples of Systems Transformation Efforts
• Collaborations with state officials to address varying state requirements,
regulations and funding

21. Panel Agenda
• About the Addiction Technology
Transfer Center (ATTC) Network
• Utilizing Medication-Assisted
Treatment (MAT)
• NIDA/SAMHSA Blending Initiative
Overview: A focus on medication-
assisted treatment
• MAT in Special Populations

22. NIDA/SAMHSA
Blending Initiative
Overview: A Focus on Medication-
Assisted Treatment
Thomas E. Freese, Ph.D.
University of California – Los Angeles
Pacific Southwest ATTC
tfreese@mednet.ucla.edu

23. NIDA/SAMHSA
Blending Initiative
According to Webster’s Dictionary
definition
To Blend means:
a. combine into an integrated whole;
b. produce a harmonious effect
http://www.merriam-webster.com/dictionary/blend

24. What is the Blending Initiative?
• GOAL: To move important scientific findings into
mainstream addiction treatment
• Developed in 2001, NIDA and SAMHSA’s Center
for Substance Abuse Treatment came together to
work on a common vision:
– Improve substance use disorder treatment and
accelerate the dissemination of research-based
findings into community-based practice.

25. The NIDA/SAMHSA Blending
Initiative encompasses three
components:
• Regional Blending Conferences
• State Agency Partnerships
• Blending Teams

26. Regional Blending Conferences
• Enhance bi-directional communication
among:
• researchers,
• practitioners,
• and policy-makers
• Share innovative scientific findings about
drug abuse and addiction
• Convene in different regions of the country

27. State Agency Partnerships
• NIDA and SAMHSA work closely with federal
and state policy-makers to help identify
strategies to accelerate the adoption of
science-based practices.

28. Blending Teams
• Use NIDA research findings to design user-
friendly science-based tools for use in treatment
settings soon after research results are published.
• Teams include members from:
– SAMHSA-CSAT Addiction Technology Transfer Center
(ATTC) Network,
– NIDA researchers, and
– Community treatment providers participating in the
NIDA Drug Abuse Treatment Clinical Trials Network
(CTN).

29. Blending Process
Selected CTN protocols
or other NIDA
Research
Hand-Off Meeting
Create the charge for Blending Team
Blending Team
Develop dissemination strategies and products

30. Current Blending Initiative
Packages

31. Blending Initiative Packages
Available in Spanish

32. A Focus on Medication-Assisted
Treatment
BUPRENORPHINE/NALOXONE

33. Buprenorphine Treatment:
A Training for Multidisciplinary
Addiction Professionals
Buprenorphine and Buprenorphine/Naloxone
Help Patients Quit Opiate Abuse Goal: to disseminate
information and
enhance awareness
among multi-
disciplinary addiction
professionals about
buprenorphine
treatment
http://www.nida.nih.gov/NIDA_notes/NNvol19N3/Successful.html

34. Buprenorphine Treatment:
A Training for Multidisciplinary
Addiction Professionals
Products in Package:
– 6-hour classroom training including a training
manual, PowerPoint slides, and the short movie,
“Put Your Smack Down! A Video About
Buprenorphine”
– Annotated bibliography and research articles

35. Short-Term Opioid Withdrawal
Using Buprenorphine
Goal: to instruct treatment providers about
the 13-day buprenorphine intervention.
Buprenorphine/Naloxone
Product in Package:
– 4-hour classroom
training program
including
PowerPoint slides
and a CD Buprenorphine

36. Results: Present and Opioid
Negative 0001 (Inpatient)
Clonidine Bup/Nx
% of Individuals present at end of taper
90
80
70
60
50
40
30
20
10
0
Day 3-4 Day 7-8 Day 10-11 Day 13-14
% of opioid free urines

37. Results: Present and Opioid
Negative 0002 (Outpatient)
Clonidine Bup/Nx
% of Individuals present at end of taper
90
80
70
60
50
40
30
20
10
0
Day 3-4 Day 7-8 Day 10-11 Day 13-14
% of opioid free urines

38. Buprenorphine Treatment for Young
Adults: Findings and Strategies from a
NIDA Clinical Trials Network Study
Goal: to present the results of a
buprenorphine trial conducted with young
adults.
Product in Package:
3-hour classroom
training program
including PowerPoint
slides and a CD

39. Results: Opioid Positive
Urine Tests

40. Buprenorphine-Related Blending
Initiative Products
OUTCOMES

41. The ATTC Network has:
• Completed 764 Blending Product Trainings from
January 2005-September 2011 (with a total of
15,958 people)
– 134 Buprenorphine Treatment (3,317 people)
– 18 Short Term Opioid Withdrawal Using
Buprenorphine (801 people)
– 22 Buprenorphine for Young Adults (318
people)

42. The ATTC Network has:
• Printed and distributed 567,000 brochures
introducing each of the Blending Initiatives
materials to the field
• Recruited and prepared trainers in every
ATTC Region to teach the Blending Initiative
materials
• Developed and distributed ancillary products
to enhance the reach of the official NIDA
products, such as curriculum infusion
packages for addiction studies educators at
colleges and universities.

43. The ATTC Network has:
• Presented information on the Blending
Initiative at State, Regional, and National
conferences to:
– Increase awareness about the training
materials
– Identify new opportunities to train
using the blending products

44. Products Currently
Under Development
1. POATS (Prescription Opioid Addiction
Treatment Study)**
2. Onsite HIV Rapid Testing Blending
Initiative

45. Product
Dissemination
Download the Products for FREE! Find upcoming trainings offered
through SAMHSA’s ATTC Network!
Go to http://www.attcnetwork.org/blendinginitiative

46. Panel Agenda
• About the Addiction Technology
Transfer Center (ATTC) Network
• Utilizing Medication-Assisted
Treatment (MAT)
• NIDA/SAMHSA Blending Initiative
Overview: A focus on medication-
assisted treatment
• MAT in Special Populations

47. MAT with Special Populations
Erin Hobbs, M.P.A.
University of Missouri – Kansas City
ATTC National Office
hobbse@umkc.edu

48. Agenda
• Overview of the Project
• Data Collection
• Products Developed
• Next Steps

49. Overview of the Project
Purpose of the Project
SAMHSA grant (TI-10-014) to increase awareness, provide
education, and promote access to medication-assisted treatment
(MAT) in four specific racial and ethnic minority populations:
African Americans Hispanic/Latinos
Asian/Pacific Native Americans/
Islanders Alaska Natives

50. Overview of the Project
Purpose of the Project
Goals of the Grant:
1. Collect data and resources to inform the development of
products
2. Develop outreach materials for each of the special
populations
3. Create training programs for MAT providers designed to
enhance professionals’ knowledge and skills related to
reaching and educating the special populations about MAT
4. Plan for additional trainings and dissemination of materials

51. Overview of the Project
Structure Utilized to Achieve Goals

52. Agenda
• Overview of the Project
• Data Collection
• Products Developed
• Next Steps

53. Literature Review
• Four Annotated Bibliographies Completed
March 2011 by SALIS
• Focused on marketing and persuasion
strategies to promote access to and
utilization of healthcare services in general,
and BH treatment in particular for each of
the four special populations

54. Environmental Scan
• Completed March 2011 Facilities Reporting Pharmacotherapy Use,
2002 - 2007
• Overview of the relative 60%
use and growth in use of 40%
MAT among treatment
20%
facilities captured in the
N-SSATS survey 0%
2002 2003 2004 2005 2006 2007
Any Pharmacotherapy Antabuse
Naltrexone Buprenorphine
Metadone

55. Focus Group Goals
1. To understand the perceived benefits and barriers of MAT
2. To identify attitudes, values and social norms surrounding
substance use
3. To learn how experiences and perspectives with MAT differ
among various cultural groups
4. To prepare the substance abuse treatment workforce to
engage minority populations in MAT

56. Study Design- Overview
• 8 qualitative focus groups, 90 minutes each
• Four minority populations
– African American
– American Indian
– Asian American/Pacific Islander
– Hispanic/Latino
• 10-12 participants per group using MAT for 6 months
• Outpatient behavioral health clinics & substance abuse
treatment centers
• New York, Los Angeles (2), Honolulu, Chicago,
Oklahoma City (2), Seattle

57. Participants
• 68 participants 14
12
– 15 African American
10
– 18 Asian American 8
Female
– 19 Hispanic Latino 6 Male
– 16 Native American/ 4 Transgender
American Indian 2
0
Afr. Asian H/L Native
Age Distribution of Participants Am. Am. Am.
25
20 • Primarily
15 unemployed
Participants
10 • Mostly high school
5 educated
0
20s 30s 40s 50s 60s 70s 80s

58. Broad Themes
Benefits/Barriers related to MAT
Motivation to use MAT
Role of Family/Significant others
Access to treatment/Barriers
Self-Efficacy
Influence of provider/clinic
MAT as drug v. MAT as medication

59. Provider Online Survey
Provider Online Survey
• Survey sent to 510 individuals in
September 2011
• 42% response rate
• Average age = 47 (26~76)
• Average years in field = 13.5 (1~41)
• Purpose:
√ Assess provider opinions regarding the use of MAT in the treatment of
patients or clients with substance use disorders, and
√ Assess the extent to which counselors and clinicians are comfortable
using different types of communication approaches to talk to their
clients about using MAT as part of their treatment recovery plan.

60. Provider Online Survey

61. Agenda
• Overview of the Project
• Data Collection
• Products Developed
• Next Steps

62. Products
Outreach Materials
• Brochures
• Pass-along Cards
• Posters
• Website
2 Online Courses
• SUD Tx Providers
• Primary Care Practitioners

63. Outreach Materials
Prototypes

64. Outreach Materials Pilots
Four 60-minute Pilot Focus Groups, 20 Participants
• Phoenix, AZ (2)
• Kansas City, MO
• Jefferson City, MO
Purpose of groups were to assess for:
 Intellectual capacity – was information presented in a way recipients could
easily understand?
 Knowledge acquisition – were the materials effective in improving
recipients’ knowledge of MAT?
 Readiness to Change – were the materials effective in improving recipients
willingness to utilize MAT?
 General Appearance – were the materials visually appealing and formatted
for ease of use?

65. Final Outreach Materials

66. Training Program
Online Courses
A training program designed to enhance treatment and medical professionals’
general knowledge of medication-assisted treatment (MAT) and improve
providers’ skills related to reaching and educating identified minority
populations about MAT.
Two Courses:
1. MAT with Special Populations for
Treatment Professionals
(NAADAC, NBCC and NASW)
2. MAT with Special Populations for
Medical Professionals
(CME)

67. Training Program
MAT with Special Populations
(for Treatment Professionals) ATTCeLearn.org
• 3 Required Core Modules
(2 hours each)
• 4 Special Population Modules
(1.5 hours each)
• Narrated Presentations,
Videos, Readings, Quizzes, Homework
Pilot Completed in March 2012
• 114 participants
– Clinical Supervisors
– Clinicians Now Open for Enrollment!
– Recovery Specialists

68. Training Program
Participants were asked to rate
their knowledge of…
Poor Excellent

69. Training Program
MAT with Special Populations
(for Medical Professionals)
• 3 Required Core Modules
(2 hours each)
• 4 Special Population Modules
(1.5 hours each)
• Narrated Presentations,
Videos, Readings, Quizzes, Homework
Currently in Pilot (Concludes April 30, 2012)
• 140 participants
– Physicians
– Medical Faculty
– Other Medical Professionals (PAs, Nurses..)

70. MAT Resource Website
ATTCnetwork.org/MAT

71. Agenda
• Overview of the Project
• Data Collection
• Products Developed
• Next Steps

72. Next Steps
• Data currently being developed into two academic
papers, one based upon focus group methodology, one
focused on client identity and recovery
• Poster at College on Problems of Drug Dependence
(CPDD), June 2012 in Palm Springs, CA
• Marketing and distribution of outreach materials to
providers
• eBlasts
• Postcards
• Web Banners
• Promotion of
Online Training Program

73. Panel Questions?
Closing the gap between research and practice:
Successful technology transfer strategies in combating
resistance to medication-assisted treatment
Panel Agenda
• About the Addiction Technology Transfer Center (ATTC) Network
• Utilizing Medication-Assisted Treatment (MAT)
• NIDA/SAMHSA Blending Initiative Overview: A focus on
medication-assisted treatment
• MAT in Special Populations
Erin Hobbs Thomas Freese Laurie Krom
hobbse@umkc.edu tfreese@mednet.ucla.edu kroml@umkc.edu