A Conversation with Timothy Lepak, President and Cofounder of NAABT

It wasn't until I read a brief article on silobreaker.com that I learned about treatmentmatch.org. The article talked about how the website is leveraging their technology to help patients left without treatment after all 30 of Preventive Medicine Associates branches closed their doors. I thought it was really amazing to see the growing amount of support for these patients whose road to recovery was halted by a fraudulent act. What I really wanted to know was more about this free, online website that claims to have matched a total of 40,508 patients with 3,300 doctors nationwide as of this past Monday. I was lucky enough to have the opportunity to speak with Timothy Lepak, President and cofounder of the National Alliance of Advocates for Buprenorphine, which is responsible for treatmentmatch.org as well as two other websites

Can you tell me about what motivated you to start NAABT?

I had a friend who was addicted to heroine and opiates and no treatments worked for him; he couldn't quit. In 1999 he became involved in a study at Yale with buprenorphine and in a matter of weeks he went from talking about suicide to talking about starting classes in the fall. His cravings had subsided and he was really focusing on the positive things in his life. It wasn't until 2000 that made it even possible for doctors to prescribe buprenorphine because, since 1914, doctors were not allowed to prescribe any opiate drug to anyone who was addicted to opiates. When buprenorphine got approved, in late 2002, a lot of things started to happen. People were still dying and there were still older methods of treatment taking place there were changes taking place. At first, doctors were only allowed to treat 30 patients their first year and then 100 patients each year after that. We helped to get this rule changed by petitioning and bringing it to congress. It changed to 100 patients each year but that is still a problem. That's when we decided to start the website for people to become better educated on buprenorphine and the concept of addiction. There's a lot of stigma in the medical field in regards to addiction treatment. Many act like it's not as good of a medicine to practice. We try to educate people about addiction so we can get rid of this stigma. Once people understand it's no longer controversial. The question "how can you treat a drug addiction with a drug" slowly disappears and people realize that the medication helps these patients; they aren't just switching one addiction for another. Soon after NAABT began we saw the problem with people not being able to find doctors and we started treatmentmatch.org.

How exactly did treatmentmatch.org come about?

Well we noticed how difficult it is to find an appropriate doctor and one that is available. A good match is very hard to find because you need to consider issues like insurance and whether or not the doctor can treat your other ailments. There are still only 20,000 doctors able to prescribe buprenorphine and they are each limited to 100 patients a year. I've heard stories of doctors who've had patients die on the wait list. Another reason for the website is to encourage the patient to follow through with seeking help. When someone is finally ready to seek treatment they're usually in pretty bad shape and it's not easy to pick up the phone and call up a doctor only to hear a rejection. It's a horrible experience. So the website works like an online dating service except it connects doctors and patients. When patients register they state how far they are willing to travel for treatment. Then emails go out to doctors in those areas notifying them of the new patients seeking treatment. This way the patients are only hearing positive responses. The system works 24/7 so even at two in the morning a patient can get a response. It's like a lifeline going out to the patient.

Click here for a map of patients currently looking for treatment.

What are some problems affecting office-based addiction treatment?

Since the government started limiting and rationing the treatment of buprenorphine prices started going up. Now it's like the highest bigger gets the spot. Doctors can keep raising their prices until they are getting just enough patients. Some doctors are charging up to $400 cash only, instead of going through insurance, because of these limits. Limiting access is what's causing the diversion and the government's answer is to try and limit everything even more. Last year the DEA released a statement that they are going to show up announced to the offices of every buprenorphine doctor in the country. This lead a whole bunch of doctors who were involved in fraud to just up and leave their practices. This has resulted in a decrease in the rate of new doctors practicing and an increase in the rate of patients dropping out.

How do you get doctors to sign up with treatmentmatch.org?

Every month the District Attorney sends me a list of certified doctors. I send the doctors an email about getting on our system. Once they've filled out the paperwork they can select to be on a public locator or they can check a box that allows them to get direct emails notifying them when a patient signs up.

How do you get patients to sign up?

We do public service announcements on the radio, the subway, billboards, online advertisements, and we even display signs in pharmacies. But mostly we get patients through word of mouth. When people first reach out for help that's the time that people need to be there for them. The next time might not happen for months, or years, or it might never happen. This system is 24 hours and they can reach out whenever they want, not just between business hours. As of today we have 40,508 patients and 3,300 doctors nationwide. Just in the past 12 hours there have been 36 patients contacted. We've connected to about 80% of the patients who've signed up. Most of the ones we haven't reached out to yet are in rural areas where there are not as many doctors.

How is primary care being integrated into the addiction treatment offered by treatmentmatch.com?

We set up our system so that primary care is an integral part of treatment. The doctors we are connecting these patients to work in office-based practices. We list clinics as well but we really feel that the office-based environment is so much better. It also takes away the stigma in the sense that you are not standing in line for methadone treatment along with other methadone addicts; that can be very demoralizing. The way the government has treated the delivery system is inefficient. Whereas if you go to a doctor's office and are treated like you would be for any other condition it is much better for the patient and they have a positive experience that way. It makes more sense to go to a doctor who can also refer patients to further counseling or other treatment. Detox places have such poor success rates. It makes sense that detox would be ineffective considering what we now know about addiction; taking the drugs away doesn't help and it certainly explains why relapse rates are so high.