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New York State Office of Mental Health (OMH)

With a growing opioid epidemic in New York State that has included a large number of patients with psychiatric disorders, Gov. Andrew Cuomo mandated that the NY State Office of Mental Health (OMH) begin treating opioid use disorders, something that the 500 OMH clinics had never done to a significant extent. This is a dramatic change in a large state system. The Opioid Response Network is providing critical help in this process.

Up until now, mental health treatment and substance use disorder treatment in NY State have been overseen by two different state agencies: The Office of Alcoholism and Substance Abuse Services (OASAS) has overseen treatment for SUDs while OMH has overseen treatment for psychiatric disorders. Because of this, a patient with OUD who would visit an OMH clinic would be referred to an OASAS licensed clinic for treatment. Just as clinicians working in OMH clinics were uncomfortable treating OUD, clinicians in OASAS clinics were uncomfortable treating psychiatric illnesses. Altogether, this led to a fracturing of care for the most vulnerable of patients. This is about to change.

Marc Manseau, MD, who was working as OMH’s Associate Medical Director at the time, contacted ORN to help implement a five-phase program to integrate medications for addiction treatment (MAT) into all OMH clinics throughout the state. Until 2018, only Office of Alcohol and Substance Abuse Services (OASAS) clinics were treating OUD. “When the opioid crisis came along it became fairly clear that you can’t ignore it or send patients somewhere else, you have to integrate this treatment into the OMH clinics,” said Nasir Naqvi, MD, an ORN consultant who is the primary ORN clinician working with OMH on this initiative. For this project, Dr. Naqvi, ORN clinical expert and Addiction Psychiatrist works closely with ORN Medical Director Frances Levin, MD, at Columbia University.

The ORN technical assistance (TA) plan being implemented by OMH includes five phases:

  1. universal screening for OUD and identification;
  2. disseminating information about naloxone & how to obtain;
  3. effectively referring patients out where clinically indicated;
  4. within mental health clinics that have the capacity to provide MAT (buprenorphine and naltrexone), get physicians waivered, instituting policies & protocols for MAT and for urine screening; and
  5. providing full integrated treatment for people with OUD.

In the initial rollout of this plan, Dr. Manseau sought assistance from the ORN in:

  1. the design of and metrics for the clinic implementation plan,
  2. training and support materials that will be disseminated to clinic providers,
  3. assistance with slide decks for periodic webinars starting in March 2019, and
  4. access to clinical experts who can present as part of future webinars.

Dr. Manseau submitted the request in November 2018, and currently the OMH sites are at various stages of implementing the plan. The majority of the requests have completed phase 1—screening for OUD. While some clinics have already begun using MAT, the majority of the clinics are somewhere between phase 1 and phase 5, Dr. Naqvi said.

Because beginning a MAT program can be complex, Dr. Naqvi suspects a large number of technical assistance requests will come in to ORN. Navigating what will be a substantial influx of requests is just one of the challenges facing ORN and OMH. Fortunately, the technology transfer specialist team for ORN for NY State, led by Mike Chaple with the administrative support of Ariel Hurley. This team has vast prior experience handling large state agency requests, and the entire ORN team is working closely with OMH administration to develop a streamlined procedure for future TA requests that capitalize on the already strong relationship between OMH and the Columbia University Department of Psychiatry/New York State Psychiatric Institute, where Drs. Naqvi, Chaple and Levin, along with a number of senior OMH staff who are working on this initiative, are all faculty and clinical expert members.

“The underlying theme is that a lot psychiatrists are not comfortable treating OUD or any SUD for that matter, because they are used to sending patients to a specialist,” Dr. Naqvi said, noting there is a lot of misinformation and a lot of hesitation of OUD prescribing. The hope is this program will address clinicians’ concerns and create more opportunity for patients to be treated. If your state is considering creating a similar program to the one New York is undergoing, please contact ORN at orn@aaap.org or make a request at www.opioidresponsenetwork.org.