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Montana is launching a pilot treatment program to treat stimulant use disorders — like meth use — aimed at “filling a gap” in the state’s continuum of care for substance use disorders.

The program called Treatment of Users of Stimulants, or TRUST, will work with people struggling with amphetamine, methamphetamine and cocaine addictions and was launched in collaboration with the Department of Public Health and Human Services, the Montana Primary Care Association and the Behavioral Health Alliance of Montana.

The treatment uses a combination of best practice, evidence-based intervention strategies to address stimulant use disorder, said Tammera Nauts, the director of integrated behavioral health at MPCA. Nauts was a lead on the TRUST project.

The program incorporates contingency management — a type of therapy that works with incentives and rewards — cognitive behavioral therapy, community reinforcement approach, motivational interviewing, physical exercise and self-help mutual support.

“Up until this point, we have not had a specific treatment intervention that were so targeted to stimulant use disorder,” Nauts said. “This is definitely filling a gap in Montana.”

Stimulant use, specifically meth, has been on the rise, Nauts said, and health care professionals have historically been less equipped to treat it than opioid addiction.

“We’ve put a lot of effort into the treatment of opioid use disorders, through the use of medication assisted therapies and treatment interventions, but there is still not an FDA approved medication regime in place for meth or stimulant use disorders,” she said.

The annual meth-related death rate in Montana was 7.2 per 100,000 in 2019, above the national average of 5.7 per 100,000, according to statistics from the DPHHS. The state health department estimates that about 79,000 Montanans have a substance use disorder.

Child and Family Services Division reported that more than 65% of out-of-home placements, like temporarily putting a child in foster care, involve substance use. Meth is the most common drug related to those placements, according to DPHHS.

“I’ve worked in treatment for 30 years and it used to be that we would see that people come in with either an opioid or stimulant use, but now over the last five years what we’re seeing is people are coming in with both,” Nauts said.

The facilities in the one-year pilot project are Benefis Health System and Alluvion Health in Great Falls, Alternatives, Inc. and Rimrock Foundation in Billings, Bullhook Community Health Center in Havre and Southwest Montana Community Health Center in Butte.

The facilities have just begun to enroll patients. To date, eight people are enrolled, said DPHHS spokesperson Jon Ebelt. Over two years, DPHHS estimates the program could treat up to 420 people.

In October, DPHHS plans to expand the project by contracting an additional six new providers by January 2022.

TRUST is funded, in part, through a nearly $1 million federal grant from the Substance Abuse and Mental Health Services Administration, DPHHS officials wrote in a press release. The state has also proposed a waiver to use Medicaid funding, pending federal approval. This would make the program more widely available, DPHHS said.

Nauts believes this is the first project with contingency management incentives of its kind and breadth in the U.S., although other states are implementing similar projects.

“Without a doubt the future in Montana is bright,” she said. “(TRUST) belongs here because we know it works.”

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