Medication Assisted Treatment: Right for you, Right for your Recovery? Robert Matylewicz, DO, FASAM Medical Director, Clarity Way Inc.
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1 Medication Assisted Treatment: Right for you, Right for your Recovery? Robert Matylewicz, DO, FASAM Medical Director, Clarity Way Inc. Elements Behavioral Health Diplomate, American Board of Addiction Medicine
2 Historically Treatment options were limited with little long term follow up. - Typical Inpatient Detox and rehab in a 28 day program -Comfort medications or agonist taper; typically with methadone - 12 step programs for follow up after rehab (AA/NA) - Federally regulated methadone clinics in communities. - effective but controversial
3 Objectives Identify the medications used in medication assisted treatment. Understand the role of medication assisted treatment in recovery. Have a better understanding of how to present MAT to your patients or refer them for treatment/mat.
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22 Medication Assisted Treatment (MAT) MAT is treatment for opioid addiction that includes the use of medication along with counseling and other support. The most common medications used in MAT are : 1. Methadone 2. Buprenorphine 3. Naltrexone
23 Medication Assisted Treatment What medications can be used for treatment of Opioid Use Disorders in the United States?? DATA 2000 Methadone by prescription (pain only) DEA CII Naltrexone by prescription
24 Partial Agonist /Antagonist Medications Buprenorphine (Suboxone) DATA 2000 DEA X number Limited prescribers by design Waived Physician (??) Limits 30,100, 275 (recent) Is a CIII substance and further regulated some states. Naltrexone (Vivitrol) Initially approved for Alcohol dependence then Opioid Dependence NOT a controlled Substance No limited prescribers No additional training
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29 The Future Detoxification for opiates unless paired with a long acting antagonist (Vivitrol, Naltrexone Implant), longitudinal monitoring and CM will not be seen as medically appropriate Treating depression and other co-occurring disorders will become more important The use of agonists for opiate dependency will be seen through a medical lens rather than a spiritual lens Agonist therapy by itself will never suffice low retention, high cooccurring substance misuse
30 What Doesn t Work? Detox by itself No better than no treatment Medications for cocaine, stimulants Oral naltrexone for opiate dependency OD risk SBIRT (Screening, Brief Intervention, Referral to Treatment) You must do more
31 Drug Treatments: What Works? Standard treatment counseling and community support Longer treatment is always better than shorter treatment but the setting may be less important UDS Monitoring + rewards/consequences improves outcomes across a range of drug dependencies No single medication treatment works better than 40% of the time at 1 year Reduced use is more common and stable than abstinence in the first year following treatment
32 Ensuring Opiate Clients Get Medications
33 Opioid Use Disorder -addiction is a brain disorder its symptoms may be drugs, alcohol, gambling, sex.. -long term treatment is needed as in traditional medical disease states Diabetes model/cvd -Return to functioning and treatments may change with time. -Medication alone is never the answer -Treat co-occurring MH diagnoses MDD, BP, Mood DO, ADD,PTSD -Treat co-occurring Medical diagnoses DM2,HTN,CAD,MS,DJD Abstinence Opioid Use Disorder MAT
34 Treatment Concerns Inpatient treatment is becoming increasingly difficult even with tools such as ASAMs PPC. Every benefits plan is different. Be prepared for quick discharges and transfers to lower levels of care. Include the patient in the treatment plan so they are not surprised. We can no longer NOT discuss treatment options with our patients. Informed consent is expected. Change happens slowly and is often bidirectional. Treatments will change over time. Fostering those changes is our responsibility as providers
35 Questions? Thoughts? MAT is not drug substitution MAT is not effective without a complete treatment plan Detox only is not treatment Not one treatment works for everyone Cravings are real and relapse is real AEDs save lives. Narcan saves lives too
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