The Opioid Treatment Programs at the Addiction Institute of Mount Sinai offer medications and a suite of services to help thousands of people with opioid use disorder reclaim their lives each year.
In 2021, drug overdose deaths in the United States surpassed 100,000 annually for the first time, according to CDC data. The vast majority — 75,673 —were caused by opioids, up from 56,064 the year before. One factor in those lost lives is fentanyl, a powerful opioid that is increasingly prevalent in the illicit drug supply.
Yet deaths due to opioid use disorder (OUD) are preventable, and effective treatments are available. The Opioid Treatment Programs at the Addiction Institute of Mount Sinai provides medications and other services to more than 3,500 patients with OUD at eight clinics in New York City.
“We treat the entire person. The first step is helping them to stop using opioids, then we start to work on recovery of all life areas,” said Teri Friedman, Senior Director of Addiction Services at Mount Sinai Beth Israel. “We try to help patients reach the highest level of functioning in all areas of their lives.”
Buprenorphine and Methadone Clinics Are Just the Beginning
Mount Sinai has a long history of treating substance use. Its predecessors, Beth Israel Medical Center and, before it, Manhattan General Hospital, were pioneers in addiction treatment. Harold Trigg, MD, Marie Nyswander, MD, and Vincent Dole, MD, launched the Methadone Maintenance Treatment Program in 1965. More than half a century later, the program is now known as the Opioid Treatment Programs at the Addiction Institute of Mount Sinai, and it continues to help patients with opioid use disorder reclaim their lives.
Medication is the gold-standard treatment for OUD. Methadone and buprenorphine/naloxone are FDA-approved and able to decrease cravings and relieve withdrawal symptoms. Mount Sinai’s outpatient Opioid Treatment Programs provides those medications at outpatient clinics in Manhattan and Brooklyn.
Yet medications alone cannot restore lives. “As we embrace recovery, we come to an understanding that every recovery path is different from the next. We meet patients where they’re at,” said Cheryl Marius, Director of the Opioid Treatment Program clinics at Mount Sinai Beth Israel.
Those clinics also provide:
- One-on-one therapy
- Group counseling
- Peer counseling
- Case management
- Educational and vocational counseling
- Annual physicals and general medical care
- Psychiatric evaluation and medication management
- Referrals for mental health treatment
- HIV counseling and testing
- Hepatitis C testing and telemedicine
As part of Mount Sinai, the programs are well connected to help patients access the care they need, said Annie Levesque, MD, Medical Director of the Opioid Treatment Program at the Addiction Institute at Mount Sinai West. “We’re embedded in the Addiction Institute, so our patients have access to a greater level of care. We can easily refer them to other services as needed, such as more intensive group therapy or inpatient detox for other substances.”
Addressing Disparities in Addiction Treatment
Methadone has been prescribed to people with OUD for decades. Buprenorphine/naloxone is a newer treatment, with a better safety and side effect profile than methadone, Dr. Levesque said. And because there is less regulation around buprenorphine, it can be prescribed in more settings, including doctor’s offices. Yet in many treatment programs, there are sharp racial and socioeconomic disparities in treatment. Patients with private health insurance are more likely to receive buprenorphine prescriptions from their doctor, avoiding daily visits to a methadone clinic.
At Mount Sinai’s opioid treatment clinics, all patients are given the option of treatment with either methadone or buprenorphine. Many patients who have been on methadone for some time prefer to continue with that medication, Marius said. But counselors and patients take many factors into consideration when determining the best path forward. “We provide individualized treatment for each patient,” Dr. Levesque said.
The frequency of a patient’s clinic visits depends on their progress through the program, regardless of which medication they choose. Early in the process, patients come to the clinic daily for their medication, which ensures that they are in regular contact with their counselor. Patients who are stable for some time and not using illicit drugs may progress to coming less frequently to pick up their medications, perhaps as infrequently as once a month. “Your recovery determines your schedule,” Marius said.
Rethinking Treatment for Opioid Use Disorder
Treating OUD remains an uphill battle. Both the disorder and the medications prescribed to treat it are subject to significant stigma. “More people need to accept that this is a medical disease,” Marius said. One common misconception within the medical community is that patients who take methadone have just swapped one drug for another. “Methadone is a medication, just as insulin is a necessary treatment for diabetes,” Friedman says.
Another mistaken belief is that patients with OUD should be referred for short-term detox, or that they should eventually taper off treatments like methadone. “In fact, long-term maintenance treatment is considered the best quality of care,” Dr. Levesque said.
Dr. Levesque and her colleagues at the Opioid Treatment Program are pushing back against the stigma, training others in the medical field and conducting research to improve access to treatment — and save more lives.
“Despite the high number of deaths, opioid use disorder is highly undertreated,” Dr. Levesque said. “As physicians we need to be referring patients to treatment and making sure we connect them to these treatments that work.”
Learn more about the Addiction Institute of Mount Sinai and the Opioid Treatment Program.