Jiyoon Park

Drug overdose is the leading cause of accidental death in the U.S., according to the American Society of Addiction Medicine. The open-access treatment model, developed and implemented by a team of Yale researchers, has the potential to become a key component of treatment for people addicted to opioids.

Led by School of Medicine professor Lynn Madden, the research team recorded the behavior of patients with opioid abuse disorder at the APT Foundation, a substance abuse rehabilitation center in New Haven. Madden, also the CEO of APT, worked with five other professors from  the School of Medicine. The study was conducted over 10 years; one year prior to the open-access model’s implementation and nine years after its initiation at the facility. The study was published online on Feb. 17 and will soon be printed in the journal Addiction.

The open-access model is defined in the paper as a framework “where prospective patients are enrolled rapidly in methadone maintenance treatment, irrespective of their ability to pay, and provided with real-time access to manifold group and individual treatment options from which they are free to choose.”

The study demonstrated that the open-access model is effective for a variety of reasons, including its ability to quickly process patient requests and distribute medication. The new method prescribes multiple measures like walk-in evaluations and same-day treatment to ensure short waiting periods. Before the open-access model, APT’s average time between prescription and distribution was 21 days; since then, the wait time is usually under 24 hours, according to the study.

“On average, APT admits eligible prospective patients onto methadone the same day that they present for an evaluation, irrespective of their ability to cover the cost of treatment,” said APT Director of Research and senior author Declan Barry.

Because of its high turnaround rate, APT was able to greatly increase the number of patients treated. At the start of the study, the facility was treating 1,431 patients with opioid use disorder; by the end of the observation, 4,051 people had access to medication.

At a local level, the study enabled treatment for many New Haven residents. Founded in 1970, APT has two treatment centers in the city and two others in the suburbs of North Haven and West Haven. Some of the open-access model strategies, like walk-in evaluations, have been implemented across all of APT’s substance abuse programs.

Of the data collected in the study, the primary treatment method for patients with opioid abuse was a methadone prescription. The drug is commonly used as a substitute treatment for more addictive opioids. According to American Addiction Centers, it decreases an addict’s dependency on drugs like heroin and prescription painkillers while simultaneously diminishing the pains of withdrawal.

Experts in the field have called methadone not just a safe option for substance abuse but a necessary one to combat the national opioid epidemic.

“I stand behind the decades of data showing methadone’s effectiveness and with appropriate monitoring,” said Jeanette Marie Tetrault, an addiction treatment specialist and a physician at the APT Foundation. “I think the risk-benefit [assessment] is clear in demonstrating benefit.”

According to the paper, the open-access model did not have a problem subsidizing the high demand for methadone treatment. Through the Affordable Care Act’s expansion of drug treatment coverage to include methadone, APT was able to take advantage of larger patient volume when grant funding decreased.

Nevertheless, the APT Foundation was able to keep costs low for their clients. By keeping the costs of methadone low, the open-access model maintained a treatment retention rate over 80 percent per 90 days.

A patient, who asked to remain anonymous to protect his name from association with substance abuse, said that the foundation has done a good job treating his alcoholism. He was still in the process of filing paperwork for his most recent enrollment, but he had not faced any substantial barriers to receiving treatment.

“What Dr. Madden and her team have done, which I am a big fan of, is that they have essentially eliminated two major barriers to treatment: wait-time and the need to be able to cover the cost of treatment,” Barry said. “Given the tremendous need for scale-up of methadone maintenance — and other forms of medication-assisted treatment — to stem the tide of the current opioid epidemic, I would encourage public health officials and treatment providers to consider [the open-access model] more closely.”

Allen Siegler | allen.siegler@yale.edu