Opioid Use Disorders as a Brain Disease Why MAT is so important. Ron Jackson, M.S.W., L.I.C.S.W.

Size: px
Start display at page:

Download "Opioid Use Disorders as a Brain Disease Why MAT is so important. Ron Jackson, M.S.W., L.I.C.S.W."

Transcription

1 Opioid Use Disorders as a Brain Disease Why MAT is so important Ron Jackson, M.S.W., L.I.C.S.W. Affiliate Professor School of Social Work University of Washington

2 Organization Name: CareOregon Course Title: Opioid & Substance Use Summit Location: Seaside, OR Date: April 24, 2018 Disclosure: It is the policy of the Oregon Medical Association (OMA) to ensure balance, independence, objectivity, and scientific rigor in its CME activities. To comply with the Standards for Commercial Support of the Accreditation Council for Continuing Medical Education (ACCME), the OMA requires members of the planning committee, applicable staff and faculty to disclose the existence of those commercial interests which produce, market, re-sell, or distribute health care goods or services consumed by, or used on patients with which he/she or their spouse/partner either: a) have a relevant financial relationship now, or b) have had a relevant financial relationship during the past 12 months. Non-profit companies, non-health care related companies and government organizations do not need to be included. The members of the faculty and planning committee and applicable staff for this conference have indicated that they have no financial relationships to disclose. Faculty members have declared that they will uphold the OMA s standards regarding CME activities and that any clinical recommendations are based on the best available evidence or are consistent with generally accepted medical practice. Please indicate in the comments section of the evaluation form whether you detect any instances of bias toward products manufactured by commercial interests. CME Credit: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Oregon Medical Association and Columbia Pacific CCO. The Oregon Medical Association (OMA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Oregon Medical Association designates this live activity for a maximum of 8 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

3

4

5 U.S. Opioid Epidemic

6 U.S. Opioid Epidemic

7

8

9 U.S. Drug Overdose Death Rates Source: NCHS, National Vital Statistics System, Mortality

10 U.S. Drug Overdose Death Rates by Age Group Source: NCHS, National Vital Statistics System, Mortality

11 U.S. Drug Overdose Death Rates 2016 Source: NCHS, National Vital Statistics System, Mortality

12 Rate per 100,000 Opioid-Related Drug Deaths Washington Oregon Alaska Idaho Centers for Disease Control and Prevention, National Center for Health Statistics; on CDC WONDER Online Database

13 Opioid-related drug deaths - WA

14

15 Drug-Drug Interactions CNS DEPRESSANTS SEDATIVE-HYPNOTICS ETHANOL, BARBITURATES, BENZODIAZEPINES OPIOID ANALGESICS MORPHINE, HEROIN, METHADONE, CODEINE, OXYCODONE, DEMEROL, FENTANYL

16 Opioids Dates to 4,000 BC Mimics endorphin activity Natural - Opium, morphine, codeine Semi-synthetic- Heroin, Dilaudid Synthetics - Darvon, Demerol, Fentanyl, Oxycontin (oxycodone)

17 HEROIN & OTHER OPIOIDS ACUTE USE SYMPTOMS DECREASED HEART RATE, BLOOD PRESSURE AND RESPIRATION RATE CONSTRICTED PUPILS DROOPING EYELIDS AND SLURRED SPEECH SLEEPINESS / SEDATION NAUSEA RELIEF OF PHYSICAL / EMOTIONAL PAIN (ANALGESIA)

18 HEROIN & OTHER OPIOIDS CHRONIC USE SYMPTOMS Constipation Decreased Sexual Interest Tolerance Hyperalgesia Heroin & Illicit Prescription Opioids: Criminal lifestyle to support habit Lifestyle changes Hepatitis and HIV infection through needle sharing and other hiv high risk acts

19 Opioid Withdrawal Syndrome Acute Symptoms FLU-LIKE SYMPTOMS RUNNY NOSE WATERY EYES DILATED PUPILS GOOSE FLESH STOMACH CRAMPS & DIARRHEA INCREASED HEART RATE & BLOOD PRESSURE INTENSE DISCOMFORT 4-7 days (short-acting opioids) days (methadone, if on long term)

20 Opioid Withdrawal Syndrome Protracted Symptoms Deep muscle aches and pains Insomnia, disturbed sleep Poor appetite Reduced libido, impotence, anorgasmia Depressed mood, anhedonia Drug craving and obsession

21 ADDICTION INVOLVES MULTIPLE FACTORS Biology/Genes Environment DRUG Brain Mechanisms Addiction

22 Drug Dependence: A Chronic Medical Illness Genetic Heritability twin studies Hypertension 25-50% Diabetes Type 1: 30-55%; Type 2: 80% Asthma 36-70% Nicotine 61% (both sexes) Alcohol 55% (males) Marijuana 52% (females) Heroin 34% (males) Voluntary Choice shaped by personality and environment Pathophysiology neurochemical adaptations Treatment Response Medications effectiveness and compliance Behavioral interventions McLellan, A.T., et.al., Drug Dependence, a Chronic Medical Illness Journal of the American Medical Association 284: , 2000.

23 If addiction is a chronic disease: Addiction treatment doesn t cure the disease. The goal of treatment is to: Provide patients the tools to help them manage their addiction and medications are among those tools Teach them how to use those tools to achieve and maintain recovery

24 Psychological and Social Problems X Counseling & social supports Addiction Opioid addiction treatment medicines X Brain changes and Dependence

25 Medications for the Treatment of Opioid Use Disorders Research clearly and consistently shows that medication assisted treatment for opioid use disorder saves lives and money. mortality rates were 75 percent higher among those receiving drug-free treatment compared to those receiving buprenorphine (or methadone) Health Affairs, August 2011 vol. 30 no

26 How do Medications for Opioid Addiction Work? There are three types of medications that can block the high : Agonists produce opioid effects Partial Agonists produce moderate opioid effects Antagonists block opioid effects

27 How do Medications for Opioid Addiction Work? Opioid Effect Full Agonist (e.g., methadone) Dose of Opioid Partial Agonist (e.g. buprenorphine) Antagonist (e.g. Naloxone)

28 How does methadone work? Methadone binds to the same receptor sites as other opioids. Orally effective Slow onset of action Long duration of action Slow offset of action

29 Treatment Outcome Data: Methadone 8-10 fold reduction in death rate Reduction of drug use Reduction of criminal activity Engagement in socially productive roles; improved family and social function Improved physical and mental health Reduced spread of HIV Excellent retention

30 Methadone Treatment For Opiate Addiction Lowers Health Care Costs Source: State of Washington, DSHS, Research & Data Analysis Division, Report 4.49fs, June, 2004

31 Buprenorphine Buprenorphine/ Naloxone

32 Formulations of Buprenorphine Buprenorphine is currently marketed for opioid treatment under the trade names: Subutex (buprenorphine) Zubsolv (buprenorphine/naloxone) (1 Mo. Inj.) Suboxone (buprenorphine/naloxone) Suboxone Sublingual Film (buprenorphine/naloxone) Sublocade 5.7 mg. bup./1.4 mg. nalox. 1.4 mg. bup./0.36 mg. nalox. Probuphine - 6 months implant requires surgical procedure 32

33 The Role of Buprenorphine in Opioid Treatment Partial Opioid Agonist Produces a ceiling effect at higher doses Has effects of typical opioid agonists these effects are dose dependent up to a limit Binds strongly to opiate receptor and is long-acting Safe and effective therapy for opioid maintenance and detoxification

34 Drug Addiction Treatment Act of 2000 (DATA 2000) Expanded treatment options to include both the general health care system and opioid treatment programs. Expanded the number of available treatment slots Allows opioid treatment in office settings Sets physician qualifications for prescribing the medication Comprehensive Addiction and Recovery Act (2016) Gives nurse practitioners and physician assistants the ability to prescribe buprenorphine in states where those medical professionals have full practice authority.

35 Physicians must: DATA 2000: Prescriber Qualifications Be licensed to practice by his/her state Have the capacity to refer patients for psychosocial treatment Originally limited to 30 patients later expanded to allow for 100 patients after the first year of experience; after two years can increase to 275 patients with some additional reporting requirements. Be qualified to provide buprenorphine (complete an 8 hour training) and receive a license waiver ARNPs and PA-Cs must: complete 24 hours of training. HHS plans to start issuing waivers to these professionals in Feb

36

37 The Prescription Opioid Addiction Treatment Study (POATS) Largest study ever conducted for prescription opioid dependence 653 participants enrolled Compared treatments for prescription opioid dependence, using buprenorphine-naloxone and counseling Conducted as part of NIDA Clinical Trials Network (CTN) at 10 participating sites across U.S. Examined detoxification as initial treatment strategy, and for those who were unsuccessful, how well buprenorphine stabilization worked 37

38 Take Home Messages News from the 42 month Follow-up Results revealed significant improvements at 42 months: 31.7% were abstinent from opioids and not on agonist therapy; 29.4% were receiving opioid agonist therapy but met no symptom criteria for current opioid dependence; 7.5% were using illicit opioids while on agonist therapy; 31.4% were using opioids without agonist therapy Weiss RD, et al. Long-Term Outcomes from the National Drug Abuse Treatment Clinical Trial Network Prescription Opioid Study. Drug and Alcohol Dependence 2015 (in press) 38

39 Opioid Antagonists Naltrexone Naltrexone for Extended- Release Injectable Suspension Revia or Depade Vivitrol

40 How Does Naltrexone Work? Naltrexone is an opioid receptor antagonist and blocks opioid receptors. This prevents the effects of selfadministered opioids. Naltrexone

41 What Does the Research Say? Naltrexone is effective for opioid and alcohol addiction: Reduces risk of re-imprisonment Lowers risk of opioid use, with or without psychological support Extended-release naltrexone addresses the issue of patient compliance

42 Naltrexone Hydrocholoride Marketed As: ReVia and Depade Indication Used in the treatment of alcohol or opioid dependence and for the blockade of the effects of exogenous administered opioids and/or decreasing the pleasurable effects experienced by consuming alcohol. Has not been found to be addictive or produce withdrawal symptoms when the medication is ceased. Administering naltrexone will invoke opioid withdrawal symptoms in patients who are physically dependent on opioids.

43 Extended-Release Naltrexone One 380mg injection deep muscle in the buttock, : every 4 weeks Dosing: Must be administered by a healthcare professional and should alternate buttocks each month. Blocks opioid receptors for one entire month compared to approximately 28 doses of oral naltrexone. It is not possible to remove it from the body once extended-release naltrexone has been injected. Pricing: $ per month (one injection)

44 Induction Burden Abstinence requirements: must be taken at least 7-10 days after last consumption of opioids

45 Heroin Overdose Prevention Studies have shown that heroin overdose is a preventable manner of death. Methods for overdose prevent include the following: Education of heroin users about dangerous drug interactions Education about rescue breathing and Good Samaritan laws Naloxone (Narcan ) distribution and education about its use.

46 Local Resources Treatment access Washington Recovery Help Line State and local drug trends Alcohol and Drug Abuse Institute (ADAI) at UW

47 National Resources Drug information and research findings National Institute on Drug Abuse (NIDA) Information and treatment locator Substance Abuse & Mental Health Services Administration

48 Clinical Guidance for Treating Pregnant and Parenting Women with OUD: nt//sma /sma pdf

MAT - ICAAD 2018 Ron Jackson, MSW, LICSW

MAT - ICAAD 2018 Ron Jackson, MSW, LICSW The ATTC Network Ten Regional Centers northwest@attcnetwork.org www.attcnetwork.org/northwest phone. 206-685-4419 1107 NE 45 th St, Ste 120, Seattle, WA 98105 http://attcnetwork.org/northwest U.S. Opioid

More information

Opioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine

Opioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine Natural derivatives of opium poppy - Opium - Morphine - Codeine Opioid Agonists Semi synthetics: Derived from chemicals in opium -Diacetylmorphine Heroin - Hydromorphone Synthetics - Oxycodone Propoxyphene

More information

Module II Opioids 101 Opiate Opioid

Module II Opioids 101 Opiate Opioid BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT Program May 2009 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT Program May 2010 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin

More information

2/21/2018. What are Opioids?

2/21/2018. What are Opioids? Opioid Crisis: South Carolina Responds Carolyn Bogdon, MSN, FNP-BC Coordinator for Emergency Department Medication Assisted Treatment Program Medical University of South Carolina Opioid Crisis: A Mounting

More information

Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center

Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States

More information

Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They?

Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They? Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They? Yngvild Olsen, MD, MPH Cecil County Board of Health Workgroup Meeting Elkton, MD October 8, 2013 Objectives

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice May 2013 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Case 32 yo female brought in after heroin overdose

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT Program May 2008 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin

More information

Medication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment

Medication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Medication Assisted Treatment MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Opioid Drugs Opium Morphine Heroin Codeine Oxycodone Roxycodone Oxycontin

More information

Overview of Opioid Use Disorder

Overview of Opioid Use Disorder Overview of Opioid Use Disorder Doug Burgess, MD Medical Director of Outpatient Services, Truman Medical Centers Assistant Professor of Psychiatry, University of Missouri- Kansas City Objectives History

More information

Opioids. October 29, Addiction Medicine Review Course CSAM, Newport Beach, CA

Opioids. October 29, Addiction Medicine Review Course CSAM, Newport Beach, CA Opioids October 29, 2010 Addiction Medicine Review Course CSAM, Newport Beach, CA Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Boston University School of Medicine Boston Medical

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT/FIT 2016 April 2016 Daniel P. Alford, MD, MPH Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research and Education

More information

Opioids. Sergio Hernandez, MD

Opioids. Sergio Hernandez, MD Opioids Sergio Hernandez, MD Required Slide Disclosures 1. SIGNIFICANT FINANCIAL INTERESTS NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT 2. GENERAL AND OBLIGATION INTERESTS All general

More information

MEDICATION ASSISTED TREATMENT

MEDICATION ASSISTED TREATMENT MEDICATION ASSISTED TREATMENT MODULE 14 ALLIED TRADES ASSISTANCE PROGRAM PREVENTATIVE EDUCATION: SUBSTANCE USE DISORDER Medication Assisted Treatment Types of Medication Assisted Treatment: Methadone Naltrexone

More information

Opioid Treatment in North Carolina SEPTEMBER 13, 2016

Opioid Treatment in North Carolina SEPTEMBER 13, 2016 Opioid Treatment in North Carolina SEPTEMBER 13, 2016 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2007 Source Where Respondent Obtained

More information

What Is Heroin? Examples of Opioids. What Science Says about Opioid Use Disorder and Its Treatment 6/27/2016

What Is Heroin? Examples of Opioids. What Science Says about Opioid Use Disorder and Its Treatment 6/27/2016 What Science Says about Opioid Use Disorder and Its Treatment Perilou Goddard, Ph.D. Department of Psychological Science Northern Kentucky University Examples of Opioids Agonists (activate opioid receptors)

More information

SUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION

SUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION SUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION What is the most important information I should know about SUBOXONE Film? Keep SUBOXONE Film in a secure place

More information

Pharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco

Pharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Pharmacotherapy for opioid addiction Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Disclosure slide No commercial conflicts to disclose. Gaps in current treatment of opioid

More information

Medications for Opioid Use Disorder. Charles Brackett, MD, MPH General Internal Medicine, DHMC

Medications for Opioid Use Disorder. Charles Brackett, MD, MPH General Internal Medicine, DHMC Medications for Opioid Use Disorder Charles Brackett, MD, MPH General Internal Medicine, DHMC Opioid Related Deaths are on the Rise in the US National Vital Statistics System Mortality File Deaths are

More information

Buprenorphine as a Treatment Option for Opioid Use Disorder

Buprenorphine as a Treatment Option for Opioid Use Disorder Buprenorphine as a Treatment Option for Opioid Use Disorder Joji Suzuki, MD Assistant Professor of Psychiatry Harvard Medical School Director, Division of Addiction Psychiatry Brigham and Women s Hospital

More information

Developed and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services

Developed and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services Developed and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services www.randallwebber.com MAT clients are still addicted Truth: MAT clients will experience withdrawal symptoms if they stop

More information

Substitution Therapy for Opioid Use Disorder The Role of Suboxone

Substitution Therapy for Opioid Use Disorder The Role of Suboxone Substitution Therapy for Opioid Use Disorder The Role of Suboxone Methadone/Buprenorphine 101 Workshop, December 10, 2016 Leslie Lappalainen, MD, CCFP, dip ABAM Prepared by Mandy Manak, MD, ABAM, CCSAM

More information

5/29/2015. Responding to the Opioid Crisis. Responding to the Opioid Crisis. Objectives

5/29/2015. Responding to the Opioid Crisis. Responding to the Opioid Crisis. Objectives Responding to the Opioid Crisis Responding to the Opioid Crisis David Cohen Ramsen Kasha Objectives Gain knowledge on Current opioid epidemic Historical perspective of opioids The impact of opioids on

More information

ROSC & MAT II: Opioid Treatment Services

ROSC & MAT II: Opioid Treatment Services ROSC & MAT II: Opioid Treatment Services September 23, 2015 Stan DeKemper Executive Director Indiana Credentialing Association on Addiction and Drug Abuse 1 GOALS Review medication assisted recovery Identify

More information

Opioid Use Disorders &Medication Treatment

Opioid Use Disorders &Medication Treatment Agency medical director comments Opioid Use Disorders &Medication Treatment Charissa Fotinos, MD, MSc Deputy Chief Medical Officer Washington State Health Care Authority Learning Objectives: 1) Review

More information

8/28/2017. Headlines. How Did We Get Here? Pain is the number one reason patients go the doctors office, urgent care and/or emergency room.

8/28/2017. Headlines. How Did We Get Here? Pain is the number one reason patients go the doctors office, urgent care and/or emergency room. Ashel Kruetzkamp, MSN, RN, SANE Headlines How Did We Get Here? Pain is the number one reason patients go the doctors office, urgent care and/or emergency room. Opiates are the most effective pain medication

More information

Analgesia for Patients with Substance Abuse Disorders. Lisa Jennings CN November 2015

Analgesia for Patients with Substance Abuse Disorders. Lisa Jennings CN November 2015 Analgesia for Patients with Substance Abuse Disorders Lisa Jennings CN November 2015 Definitions n Addiction: A pattern of drug use characterised by aberrant drug-taking behaviours & the compulsive use

More information

Medical Assisted Treatment. Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center

Medical Assisted Treatment. Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center Medical Assisted Treatment Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center Current Trends Prescription Drug Abuse/Addiction Non-medical use of prescription pain killers

More information

Opioid Use in Youth. Amy Yule M.D. March 2,

Opioid Use in Youth. Amy Yule M.D. March 2, Opioid Use in Youth Amy Yule M.D. March 2, 2018 An opioid is a substance that acts on opioid receptors Beta-endorphin Endogenous opioids Dynorphin Opiates Natural products of the poppy plant Morphine Heroin

More information

Disclosures. Topics of today s training 4/24/2017. Evolving Treads in Medication Assisted Treatment. Christopher J Davis D.O.

Disclosures. Topics of today s training 4/24/2017. Evolving Treads in Medication Assisted Treatment. Christopher J Davis D.O. Evolving Treads in Medication Assisted Treatment Christopher J Davis D.O. CAADC, FASAM Medical Director, The Ranch of Pennsylvania Medical Director, Pyramid Healthcare Diplomate of The American Board of

More information

HARM REDUCTION & TREATMENT. Devin Reaves MSW

HARM REDUCTION & TREATMENT. Devin Reaves MSW HARM REDUCTION & TREATMENT Devin Reaves MSW The mission of PAHRC is to promote the health, dignity, and human rights of individuals who use drugs and communities impacted by drug use. Recognizing that

More information

Charles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus

Charles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus Pain & Opioid Epidemic 2018 Charles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus Opioids 3400 BC Mesopotamia, Joy plant 1843 morphine by syringe 1874

More information

Substance Use Disorders (SUDs) and Medication Assisted Treatment (MAT) for Opiates

Substance Use Disorders (SUDs) and Medication Assisted Treatment (MAT) for Opiates Substance Use Disorders (SUDs) and Medication Assisted Treatment (MAT) for Opiates What is MAT? Medication Assisted Treatment (MAT) is the use of medications, in addition to counseling, cognitive behavioral

More information

ADDICTION ELEMENTS OF ADDICTION. Medication Assisted Treatment of Substance Use Disorders Ron Jackson, MSW, LICSW. Substance Use Disorder DSM 5

ADDICTION ELEMENTS OF ADDICTION. Medication Assisted Treatment of Substance Use Disorders Ron Jackson, MSW, LICSW. Substance Use Disorder DSM 5 ADDICTION Addiction is a brain disease shaped by behavioral and social context. Dr. Alan Leshner, Former Director National Institute on Drug Abuse Drug addiction is associated with altered cortical activity

More information

Identification and Treatment of Opioid Use Disorders in Primary Care Settings

Identification and Treatment of Opioid Use Disorders in Primary Care Settings Identification and Treatment of Opioid Use Disorders in Primary Care Settings 17th Annual Primary Care Symposium February 24, 2018 Kelly S. Barth, DO Associate Professor, Psychiatry & Internal Medicine

More information

Medication-Assisted Treatment. What Is It and Why Do We Use It?

Medication-Assisted Treatment. What Is It and Why Do We Use It? Medication-Assisted Treatment What Is It and Why Do We Use It? What is addiction, really? o The four C s of addiction: Craving. Loss of Control of amount or frequency of use. Compulsion to use. Use despite

More information

Treatment Alternatives for Substance Use Disorders

Treatment Alternatives for Substance Use Disorders Treatment Alternatives for Substance Use Disorders Dean Drosnes, MD, FASAM Associate Medical Director Director, Chronic Pain and SUD Program Caron Treatment Centers 1 Disclosure The speaker has no conflict

More information

LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE

LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE DR. SHILPA ADARKAR ASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRY & DRUG DEADDICTION CENTRE OF EXCELLENCE SETH GSMC & KEMH LONG TERM OPTIONS FULL AGONIST PARTIAL

More information

Buprenorphine pharmacology

Buprenorphine pharmacology Buprenorphine pharmacology Victorian Opioid Management ECHO Department of Addiction Medicine St Vincent s Hospital Melbourne 2018 Page 1 Opioids full, partial, antagonist Full Agonists - bind completely

More information

Talking with your doctor

Talking with your doctor SUBOXONE (buprenorphine and naloxone) Sublingual Film (CIII) Talking with your doctor Opioid dependence can be treated. Talking with your healthcare team keeps them aware of your situation so they may

More information

Medication-Assisted Treatment (MAT) Overview

Medication-Assisted Treatment (MAT) Overview Medication-Assisted Treatment (MAT) Overview 2014 Opiate Conference: Don t Get Me Started Hyatt Regency, Columbus, Ohio June 30-July 1, 2014 Christina M. Delos Reyes, MD Medical Consultant, Center for

More information

Medication Assisted Treatment:

Medication Assisted Treatment: Medication Assisted Treatment: A Training For Multidisciplinary Addiction Professionals Module III Medications 101 Goals for Module III This module reviews the following: Overview of three medications

More information

Opioid Use Issues: All the Players

Opioid Use Issues: All the Players Opioid Use Issues: All the Players Objectives After review, the participant will be able to: 1) Identify criteria for opioid use disorders Andrew J. McLean, MD, MPH Medical Director, ND Department of Human

More information

Addiction Overview. Diane A. Rothon MD. Causes Consequences Treatments. Methadone/Buprenorphine 101 April 1, 2017

Addiction Overview. Diane A. Rothon MD. Causes Consequences Treatments. Methadone/Buprenorphine 101 April 1, 2017 Addiction Overview Causes Consequences Treatments Methadone/Buprenorphine 101 April 1, 2017 Diane A. Rothon MD Why? would you listen to this presentation Review the definition and neurobiology of addiction

More information

SW OREGON OPIOID SUMMIT. Medication Assisted Recovery for Opioid Use Disorder. Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass

SW OREGON OPIOID SUMMIT. Medication Assisted Recovery for Opioid Use Disorder. Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass SW OREGON OPIOID SUMMIT Medication Assisted Recovery for Opioid Use Disorder Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass Opioid Agonists Mu (μ) receptors stimulated by opioids causing full

More information

Orexo completes 1,080 patient REZOLV study and reports on improved treatment of opioid dependent patients

Orexo completes 1,080 patient REZOLV study and reports on improved treatment of opioid dependent patients Press release Orexo completes 1,080 patient REZOLV study and reports on improved treatment of opioid dependent patients Uppsala, Sweden, September 2, 2016 Orexo AB (publ.) announces that the REZOLV retrospective

More information

Medication for Addiction Treatment (MAT)

Medication for Addiction Treatment (MAT) SBIRT Training Screening, Brief Intervention & Referral to Treatment Medication for Addiction Treatment (MAT) The Faith & Spirituality Integrated SBIRT Network Navigating the Training Welcome! These health

More information

Methadone and Naltrexone ER

Methadone and Naltrexone ER Methadone and Naltrexone ER Laura G. Kehoe, MD, MPH, FASAM Medical Director MGH Substance Use Disorder Bridge Clinic Assistant Professor of Medicine Harvard Medical School Disclosures Neither I nor my

More information

A prisoners guide to buprenorphine

A prisoners guide to buprenorphine A prisoners guide to buprenorphine 2 The Opium poppy In the land of far, far away the opium poppy grows. The seed pods of this poppy are scratched until they drip with a sticky resin called opium. Raw

More information

Prescription Opioid Addiction

Prescription Opioid Addiction CSAM-SCAM Fundamentals Prescription Opioid Addiction Presentation provided by Meldon Kahan, MD Family & Community Medicine University of Toronto Conflict of interest statement I received funds from Rickett

More information

OPIATES WHAT'S THE PROBLEM?

OPIATES WHAT'S THE PROBLEM? OPIATES WHAT'S THE PROBLEM? WHAT CAN WE DO? Caleb Banta Green PhD MPH MSW Senior Research Scientist Alcohol and Drug Abuse Institute Affiliate Associate Professor School of Public Health Affiliate Faculty

More information

Building capacity for a CHC response to Ontario's Opioid Crisis

Building capacity for a CHC response to Ontario's Opioid Crisis Building capacity for a CHC response to Ontario's Opioid Crisis Rob Boyd Oasis Program Director Luc Cormier, RN, MScN Community Health Nurse Sandy Hill Community Health Centre #AOHC2016 @rboyd6 @SandyHillCHC

More information

Medication Assisted Treatment. Karen Drexler, MD National Mental Health Program Director-Substance Use Disorders Department of Veterans Affairs

Medication Assisted Treatment. Karen Drexler, MD National Mental Health Program Director-Substance Use Disorders Department of Veterans Affairs Medication Assisted Treatment Karen Drexler, MD National Mental Health Program Director-Substance Use Disorders Department of Veterans Affairs Disclosures Employed by the Department of Veterans Affairs

More information

Buprenorphine: An Introduction. Sharon Stancliff, MD Harm Reduction Coalition September 2008

Buprenorphine: An Introduction. Sharon Stancliff, MD Harm Reduction Coalition September 2008 Buprenorphine: An Introduction Sharon Stancliff, MD Harm Reduction Coalition September 2008 Objective Participants will be able to: Discuss the role of opioid maintenance in reducing morbidity and mortality

More information

Buprenorphine for Family Medicine. Hannah Snyder, MD Addiction Medicine Fellow, UCSF 12/7/17

Buprenorphine for Family Medicine. Hannah Snyder, MD Addiction Medicine Fellow, UCSF 12/7/17 + Buprenorphine for Family Medicine Hannah Snyder, MD Addiction Medicine Fellow, UCSF 12/7/17 + Disclosures No conflicts of interest Off-label use of medications + Who here: Has taken care of a patient

More information

Vermont's Opioid Crisis and Response to the Crisis

Vermont's Opioid Crisis and Response to the Crisis Vermont's Opioid Crisis and Response to the Crisis Richard A. Rawson, Ph.D., Research Professor UVM Center for Behavior and Health Emeritus Professor UCLA Department of Psychiatry March 2018 The opioid

More information

Medication Assisted Treatment of an Opioid Use Disorder. J. Craig Allen, MD. Medical Director, Rushford

Medication Assisted Treatment of an Opioid Use Disorder. J. Craig Allen, MD. Medical Director, Rushford Medication Assisted Treatment of an Opioid Use Disorder J. Craig Allen, MD. Medical Director, Rushford Learning objectives At the conclusion of this activity, participants will be able to: Understand

More information

Treating Opioid Use Disorders: An Update for Counselors and Other Providers

Treating Opioid Use Disorders: An Update for Counselors and Other Providers Treating Opioid Use Disorders: An Update for Counselors and Other Providers Brad Shapiro, MD Medical Director Opiate Treatment Outpatient Program Zuckerberg San Francisco General THE DOSING WINDOW HISTORICAL

More information

Medication Assisted Treatment

Medication Assisted Treatment Meeting the Needs of Your Clients: Building Competencies in Mental Health and Addiction Services Medication Assisted Treatment November 5, 2018 In partnership with: House Keeping Because this is a webinar,

More information

USE OF BUPRENORPHINE FOR CHRONIC PAIN

USE OF BUPRENORPHINE FOR CHRONIC PAIN Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences USE OF BUPRENORPHINE FOR CHRONIC PAIN MARK SULLIVAN, MD, PHD PSYCHIATRY AND BEHAVIORAL SCIENCES ANESTHESIOLOGY AND

More information

Opioid Step Policy. Description. Section: Prescription Drugs Effective Date: April 1, 2018

Opioid Step Policy. Description. Section: Prescription Drugs Effective Date: April 1, 2018 Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Opioid Step Policy Page: 1 of 6 Last Review Date: March 16, 2018 Opioid Step Policy Description

More information

Buprenorphine Access in California

Buprenorphine Access in California Buprenorphine Access in California James J. Gasper, PharmD, BCPP Pharmacy Benefits Division Department of Health Care Services james.gasper@dhcs.ca.gov Source: CDPH Vital Statisitics Death Statistical

More information

BUPRENORPHINE/NALOXONE THERAPY DOM CLINICAL GUIDELINES AND RECOMMENDED CHANGES

BUPRENORPHINE/NALOXONE THERAPY DOM CLINICAL GUIDELINES AND RECOMMENDED CHANGES BUPRENORPHINE/NALOXONE THERAPY DOM CLINICAL GUIDELINES AND RECOMMENDED CHANGES BACKGROUND In September 2012, the Division of Medicaid (DOM) implemented criteria through electronic prior authorization (PA)

More information

Medication-Assisted Treatment (MAT) for Opioid Use Disorders

Medication-Assisted Treatment (MAT) for Opioid Use Disorders Medication-Assisted Treatment (MAT) for Opioid Use Disorders Sybil Marsh MA MD FASAM Department of Family Medicine and Community Health Case Western Reserve University/UHCMC Learning Objective 1 Following

More information

Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT)

Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT) Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT) For Apple Health clients served Fee-for-Service and through contracted Medicaid Managed Care Organizations Updated January

More information

Heroin, Fentanyl and Other Opioids. Steve Hanson

Heroin, Fentanyl and Other Opioids. Steve Hanson Heroin, Fentanyl and Other Opioids Steve Hanson Heroin/Opiates Neurotransmitter-receptor interactions To transmit instructions to cells, neurotransmitters interact with their receptors. receptor neurotransmitters

More information

MAT in the Corrections Setting

MAT in the Corrections Setting MEDICATION ASSISTED TREATMENT AND CORRECTIONS Frank Filippelli, DO, PhD September 2017 MAT in the Corrections Setting Who Does This Affect? What is MAT and What is the Evidence of Efficacy? Emphasis on

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Buprenorphine Implant for Treatment of Opioid Dependence File Name: Origination: Last CAP Review: Next CAP Review: Last Review: buprenorphine_implant_for_treatment_of_opioid_dependence

More information

9/13/2017. Buprenorphine Treatment (Suboxone) Disclosures. We ve Got a Big Opioid Problem. Selahattin Kurter, MD Spectrum Healthcare

9/13/2017. Buprenorphine Treatment (Suboxone) Disclosures. We ve Got a Big Opioid Problem. Selahattin Kurter, MD Spectrum Healthcare Buprenorphine Treatment (Suboxone) Selahattin Kurter, MD Spectrum Healthcare Board Certified in Psychiatry and Addiction Medicine Disclosures No financial reimbursement for this lecture Consultant for

More information

Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT)

Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT) Clinical Guidelines and Coverage Limitations for Medication Assisted Treatment (MAT) What has changed? Effective January 16, 2018, Coordinated Care will change the requirement for form HCA 13-333 Medication

More information

Medication Assisted Treatment. Michael Palladini, RPh MBA CAC

Medication Assisted Treatment. Michael Palladini, RPh MBA CAC Medication Assisted Treatment Michael Palladini, RPh MBA CAC palladini.michael@gmail.com History of MAT Addiction as a Disease The concept of addiction as a disease of the brain challenges deeply ingrained

More information

6/6/2018. Objectives. Outline. Rethinking Medication Treatment for Opioid Use Disorder

6/6/2018. Objectives. Outline. Rethinking Medication Treatment for Opioid Use Disorder Rethinking Medication Treatment for Opioid Use Disorder International Conference on Opioids June 10, 2018 Dustin Patil, MD Fellow, Addiction Psychiatry Boston Medical Center John Renner, MD Professor of

More information

Treatment of Opioid Use Disorder

Treatment of Opioid Use Disorder Treatment of Opioid Use Disorder Casia Horseman, MD Assistant Professor Department of Psychiatry and Behavioral Health The Ohio State University Wexner Medical Center Objectives Discuss the historical

More information

Treatment of Opioid Use Disorder

Treatment of Opioid Use Disorder Treatment of Opioid Use Disorder Casia Horseman, MD Assistant Professor Department of Psychiatry and Behavioral Health The Ohio State University Wexner Medical Center Objectives Discuss the historical

More information

Agenda. 1 Opioid Addiction in the United States. Evidence-based treatments for OUD. OUD Treatment: Best Practices. 4 Groups: Our Model

Agenda. 1 Opioid Addiction in the United States. Evidence-based treatments for OUD. OUD Treatment: Best Practices. 4 Groups: Our Model Agenda 1 Opioid Addiction in the United States 2 Evidence-based treatments for OUD OUD Treatment: Best Practices 4 Groups: Our Model 2 Groups is a national network of clinics providing affordable, evidencebased

More information

Prescription Opioids

Prescription Opioids What are prescription opioids? Prescription Opioids Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made

More information

Vivitrol Drug Court and Medication Assisted Treatment

Vivitrol Drug Court and Medication Assisted Treatment Vivitrol Drug Court and Medication Assisted Treatment Amy Black, CNP and Judge Fred Moses Court program Self-starters Mission Statement To provide court-managed, medically assisted drug intervention treatment

More information

Arwen Podesta, MD. ABIHM, ABAM, Forensic Psychiatry

Arwen Podesta, MD. ABIHM, ABAM, Forensic Psychiatry The State of Medicine in Addiction Recovery Arwen Podesta, MD ABIHM, ABAM, Forensic Psychiatry www.podestawellness.com 504-252-0026 http://www.addictionpolicy.org/ Overview Addiction is a serious, chronic

More information

People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, a practice called speedballing.

People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, a practice called speedballing. What is heroin? Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and Southwest Asia, Mexico, and Colombia. Heroin

More information

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Executive Summary

More information

Implementing Buprenorphine Treatment in Opioid Treatment Programs Webinar 2, October 3, 2018

Implementing Buprenorphine Treatment in Opioid Treatment Programs Webinar 2, October 3, 2018 Implementing Buprenorphine Treatment in Opioid Treatment Programs Webinar 2, October 3, 2018 Judith Martin, MD, Medical Director of Substance Use Services, San Francisco Department of Public Health Webinar

More information

Methadone and Naltrexone ER

Methadone and Naltrexone ER Methadone and Naltrexone ER Laura G. Kehoe, MD, MPH, FASAM Medical Director MGH Substance Use Disorder Bridge Clinic Assistant Professor of Medicine Harvard Medical School Objectives Review Full Opioid

More information

Medication Assisted Treatment. Nicole Gastala, MD

Medication Assisted Treatment. Nicole Gastala, MD Medication Assisted Treatment Nicole Gastala, MD Objectives Training Goals: To enhance the understanding of the participants in use of medication assisted therapy To increase the knowledge of participants

More information

Understanding and Combating the Heroin Epidemic

Understanding and Combating the Heroin Epidemic Understanding and Combating the Heroin Epidemic Kelly Dunn, Ph.D. Assistant Professor; Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences 1 Talk Outline What is causing the

More information

WR Fentanyl Symposium. Opioids, Overdose, and Fentanyls

WR Fentanyl Symposium. Opioids, Overdose, and Fentanyls Opioids, Overdose, and Fentanyls Outline: What are opioids? Why are we experiencing and opioid crisis? Potency, purity, and product How do opioids cause overdose and overdose deaths? What is naloxone and

More information

NALTREXONE DAVID CRABTREE, MD, MPH UNIVERSITY OF UTAH HEALTH, 2018

NALTREXONE DAVID CRABTREE, MD, MPH UNIVERSITY OF UTAH HEALTH, 2018 NALTREXONE DAVID CRABTREE, MD, MPH TREATMENT OF OPIOID USE DISORDER (OUD) Majority of people who develop OUD are not receiving treatment Only a small fraction of patients are offered treatment with medications

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This fact sheet discusses research findings on effective treatment approaches for drug abuse and addiction. If you re seeking treatment, you can call the Substance

More information

Addressing Alaska s Opioid Epidemic From Understanding to Action

Addressing Alaska s Opioid Epidemic From Understanding to Action Addressing Alaska s Opioid Epidemic From Understanding to Action The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction

More information

Serious Mental Illness and Opioid Use Disorder

Serious Mental Illness and Opioid Use Disorder Serious Mental Illness and Opioid Use Disorder Serious Mental Illness and Opioid Use Disorders Arthur Robin Williams, MD MBE Columbia University, Department of Psychiatry Nick Szubiak, MSW, LCSW Director,

More information

Wasted AN INTRODUCTION TO SUBSTANCE ABUSE

Wasted AN INTRODUCTION TO SUBSTANCE ABUSE Wasted AN INTRODUCTION TO SUBSTANCE ABUSE Dr. Brian L. Bethel Child and Family Therapist Independent Trainer and Consultant LPCC-S, LCDC III, RPT-S www.brianlbethel.com INTERPLAY COUNSELING & CONSULTING

More information

Opioid Withdrawal, Opioid Substitution, and HIV Infection

Opioid Withdrawal, Opioid Substitution, and HIV Infection Opioid Withdrawal, Opioid Substitution, and HIV Infection R. Douglas Bruce, MD, MA, MS Associate Clinical Professor of Medicine Yale University New Haven, Connecticut Learning Objectives After attending

More information

Medication Assisted Treatment as an alternative in Drug Courts*

Medication Assisted Treatment as an alternative in Drug Courts* Medication Assisted Treatment as an alternative in Drug Courts* National Drug Court Institute *portions of this presentation include adapted slides by Frances Levin, MD, Joshua Lee, MD, & Laurence Westreich,

More information

Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention

Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention The Accountable Community for Health of King County Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention May 7, 2018 1 Opiate Treatment & Overdose Prevention Project Goal Immediate:

More information

THE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE. Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept.

THE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE. Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept. THE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept. Public Health disclosures Dr. Martin has no conflict of interest to disclose.

More information

THE ADDICTION TRAP. A Treatment Approach Using Acceptance and Commitment Therapy (ACT) David C. Brillhart, PsyD April 24, 2018

THE ADDICTION TRAP. A Treatment Approach Using Acceptance and Commitment Therapy (ACT) David C. Brillhart, PsyD April 24, 2018 THE ADDICTION TRAP A Treatment Approach Using Acceptance and Commitment Therapy (ACT) David C. Brillhart, PsyD April 24, 2018 Organization: Mid-Valley Pain Clinic Course Title: The Addiction Trap: A Treatment

More information

Opioids and Heroin in Snohomish County. Marijuana and Opioid Prevention Training May 2018

Opioids and Heroin in Snohomish County. Marijuana and Opioid Prevention Training May 2018 Opioids and Heroin in Snohomish County Marijuana and Opioid Prevention Training May 2018 OPIOIDS 101 What are Opioids? Opioids 101 Opium Poppy Plant Opiates: A type of pain medication that is naturally

More information

BUPRENORPHINE and Office-Based Treatment of Opioid Use Disorder

BUPRENORPHINE and Office-Based Treatment of Opioid Use Disorder BUPRENORPHINE and Office-Based Treatment of Opioid Use Disorder Stephen A. Wyatt, DO Anthony Dekker, DO William Morrone, DO Funding for this initiative was made possible (in part) by Providers Clinical

More information

TELEPHONE SCREENING DEMOGRAPHIC INFO

TELEPHONE SCREENING DEMOGRAPHIC INFO TELEPHONE SCREENING Provider Name: Provider Signature: Date: How did you hear about the hotline? DEMOGRAPHIC INFO 1 = Spouse 2 = Friend 3 = Medical Provider 4 = Flyer 5 = Parent 6 = State Hotline 7 = Physician

More information