Therapeutic Considerations of Psychopharmacology of Opiate use Disorder

Transcription

1 Therapeutic Considerations of Psychopharmacology of Opiate use Disorder Presenter: Linda Shaffer MA, Ed.S., LCAS, MAC June 13, 2018

2 Thomas Durham, PhD Director of Training NAADAC, the Association for Addiction Professionals

3 Produced By NAADAC, the Association for Addiction Professionals

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6 Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

7 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

8 Webinar Presenter Linda Shaffer MA, Ed.S., LCAS, MAC FOOTHILLS CONSULTING ASSOCIATES 615 South Dekalb Street Your SHELBY, NC PHONE: FAX:

9 Webinar Learning Objectives Participants will learn how to identify appropriate patients for agonist therapy and will identify alerts to potentially inappropriate patients for agonist therapy. Participants will identify the benefits of utilizing a patient-centered approach to treatment of co-occurring disorders. Participants will become familiar with collaboration avenues between therapists and prescribing physicians.

10 Polling Question #1 Which of the following best describes your professional affiliation? a. Physician b. Nurse c. Counselor d. Social worker e. Psychologist

11 What are your thoughts about medication assisted opiate treatment? How about methadone vs buprenorphine? Type you answers, comments, and any questions into the question box in the right hand panel on your screen and at the end of the webinar answers can be read and questions can be posed for further discussion

12 HIGH RISK PATIENTS People with chronic pain with poor prognoses for resolving pain = resistance to taper People with multiple active SA diagnoses = diversion risk

13 APPROPRIATE CANDIDATES Have no or treatable chronic pain issues Have history of overcoming other addictions or have no other active addictions Have social supports Have current employment or good potential for employment (diversion risk) Failed attempts with previous agonist medications

14 PATIENT CENTERED APPROACH Personal Goals/progress Personal Interventions Appointment scheduling Tapering differences Program guidelines

15 PROGRAM GUIDELINES Consequences for missed appt Discharge criteria Medication counts Office behavior UDS results Diversion Handout click on the handout box in the right hand panel of your screen

16 THERAPY APPROACHES Motivational Interviewing Roll with resistance! Cognitive Behavioral Identify non supportive cognitive patterns. Existential What is your purpose in life? Medication assisted treatment only? Thoughts on this. Group therapy

17 OUTPATIENT OFFICE-BASED CONSIDERATIONS Sign a contract or treatment agreement? violations Drug testing frequency/lab requirements violations Payment for services Co-occurring dx and other controlled substances Medication accountability Medical Emergencies/surgeries Transportation barriers

18 CO-OCCURING DISORDERS Considerations Considerations

19 National Survey on Drug use and Health (2016) Of all adults with any mental illness: 18.5% meet criteria for SUD Of all adults with no mental iilness: 5.4% meet criteria for SUD

20 1. Previous diagnoses are they sound? 2. ADHD/PTSD/other anxiety/bi-polar 3. Consider drug induced psychoses (bath salts/meth) 4. Alternatives to controlled substances 5. Stimulants and/or benzodiazepines (compounding effect of bup and bzo) 6. Beware of triangulation with therapist and Dr.

21 Collaboration with Prescribers

22 COLLABORATION THOUGHTS Respect each other s skills Notes to chart, e mails, stickies Clt thoughts, clinical thoughts Big picture as therapist Focus as doctor Team meals, presentations etc.

23 PATIENT COUNTS PA s, NP s and new MD prescribers = 30 patients for one year. move up to 100 patients after one year waivers up to 275 *SA continuing education required.

24 INSURANCE REQUIREMENTS Therapy and Dr s notes are required by both Medicaid and 3 rd party insurers to get prior authorizations for agonist medications. Lab results are also requested. (in house or refer out?)

25 SUMMARY Patient Selection Accountability of patients Address all dx including physical ailments Utilize patient centered treatment plans Collaborate with other professionals Self care

26 Polling Question # 2 Which of the following best describes your belief about medication-assisted treatment? a. MAT should be a lifelong commitment in recovery b. MAT is never appropriate in recovery c. MAT can be a bridge to abstinence

27 Any new thoughts, questions, insights or contributions?

28 BIBLIOGRAPHY Quick guide for physicians: based on TIP 40: clinical guidelines for the use of buprenorphine in the treatment of opiod addiction. (2005). Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Salcedo-Talboy, E. (2008). Substance abuse treatment for persons with co-occurring disorders inservice training: based on a Treatment Improvement Protocol, TIP 42 (pp. 1-7). Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Your treatment with suboxone film [Pamphlet]. (n.d.).

29 Thank You! Linda Shaffer MA, Ed.S., LCAS, MAC FOOTHILLS CONSULTING ASSOCIATES 615 South Dekalb Street Your SHELBY, NC PHONE: FAX:

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31 Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

32 Upcoming Webinars June 27, 2018 July 25, 2018 Picking up the Pieces for Wholeness and Recovery By Dana DeDolf, MA, LPC, CADCIII, MAC Early Recovery Nutrition Education By Jeffrey Lang, PhD, LCADC, CCS July 11, 2018 Cognitive Therapy and Compulsive Sexual Behavior By William Brock, PhD August 8, 2018 Authentic Self-Care for Addiction Professionals By Cary Hopkins Eyles, MA, CAP, RYT

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34 WEBINAR SERIES INDEPENDENT STUDY COURSES Over 145 CEs of free educational webinars are available. Education credits are FREE for NAADAC members. MAGAZINE ARTICLES In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one article is eligible for CEs. FACE-TO-FACE SEMINARS NAADAC offers face-to-face seminars of varying lengths in the U.S. and abroad. Earn CEs at home and at your own pace (includes study guide and online examination). CONFERENCES NAADAC Annual Conference, October , Houston, TX CERTIFICATE PROGRAMS Demonstrate advanced education in diverse topics with the NAADAC Certificate Programs: Recovery to Practice Conflict Resolution in Recovery National Certificate in Tobacco Treatment Practice

35 Thank you for joining! NAADAC 44 Canal Center Plaza, Suite 301 Alexandria, VA phone: / fax: / naadac@naadac.org NAADACorg Naadac NAADAC