Medication Assisted Treatment

Transcription

1 Meeting the Needs of Your Clients: Building Competencies in Mental Health and Addiction Services Medication Assisted Treatment November 5, 2018 In partnership with:

2 House Keeping Because this is a webinar, attendees are muted Please type any questions you have into the Questions Box We are recording this webinar and will send out the link to everyone who registered at a later date. Type in questions below

3 Shelly A. Nolan, MS, LPC Director of Women s Services Department of Mental Health & Addiction Services

4 Shelly A. Nolan, MS, LPC Director of Women s Services Department of Mental Health & Addiction Services

5 What we know The opioid epidemic is impacting all 50 states Substance use disorders impact all races, ages, genders, and economic classes The problem is getting bigger and as a result more lives have been lost Addiction is a disease like any other medical problem but it is often viewed differently

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7 The CT epidemic

8 What are opioids Narcotic Medications used to treat and manage pain Common Names- Percocet, Oxycodone, Vicodin, Dilaudid, Codeine, etc. Pain scales Initially intended to be used short-term or for individuals with terminal illness People are prescribed these medication but not always educated on the high risk of addiction potential Some people have a harder time ending use than others

9 What happens when your doctor stops prescribing? Other people take opioid medications prescribed to someone else Sharing medications- here try this, it may help Safe storage & disposal Heroin Cheaper to buy on the street than prescription medications and more accessible You never know what you re getting often mixed with other substances Fentanyl

10 Recovery Orientation Language has power Substance use disorder vs. abuse or dependence The word addict Sometimes embraced within the recovery community however not appropriate within the treatment realm Recovery is a journey not an event Stigma Documentation follows the client Advocate for fact based, neutral & objective writing

11 What is MAT? SAMSHA defines MAT as: Medicated-Assisted Treatment (MAT) is the use of FDAapproved medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.

12 How does MAT help? Blocks opioids from accessing opioid receptors in the brain (partially or fully) Prevents withdrawal and cravings Increases positive birth outcomes for pregnant women If mom has withdrawal symptoms, so does baby which can lead to miscarriage Mom is connected to treatment with increased support Decrease illicit drug use Results in reduced risk of HIV, Hepatitis C and other infections Research shows that the mortality rate of untreated individuals using heroin is 15 times higher compared to individuals receiving methadone maintenance treatment (who have a similar mortality rate to the general public) *Source: Beacon Health Options White Paper on Opioid Crisis

13 Stages of Change

14 MAT Myth Busting Clients on methadone often nod out or seem drowsy Clients on MAT have no reason to use & can still get high The lower the dose, the better They should just be able to stop Isn t MAT replacing one addiction for another It s harder to kick methadone than heroin Methadone rots your bones and teeth MAT is forever, the person will never be drug free

15 Medication Assisted Treatment A key component to combating the opioid epidemic Naltrexone (Vivitrol) Buprenorphine (Suboxone) Methadone Opioid Addiction

16 Methadone Prescribed out of a federally regulated Opiate Treatment Program (OTP) which requires an individual to present to a clinic each day when they start and engage in monthly treatment (urine screenings, group/ individual counseling) Prevents onset of withdrawal symptoms for 24 hours Full opioid agonist. When on a stable therapeutic dose, you will not get high from illicit opioids When properly managed, it s a very safe medication with minimal side effects

17 Buprenorphine (Suboxone/ Subutex) Person can be prescribed medication by a doctor who has received specialized training May be PCP or in a behavioral health setting Sublingual film or tablet taken daily which reduces cravings to use Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression. These effects are weaker than those of full drugs such as heroin and methadone Best course of action is medication in combination with other support (group or individual therapy) Less overdose risk when using formulation combined with naloxone

18 Naltrexone (Vivitrol) Comes in pill form or more commonly in a monthly injectable Blocks the euphoric and sedative effects of opioids Unlike other MAT formulations, it activates the opiate receptors to reduce cravings If a person were to use an opioid, they would need to use more than normal to override the naltrexone putting them at an increased risk of overdose

19 One size does not fit all As with any medication, there are pros and cons to each type of MAT It s best for each person to discuss their history, current use, and goals for recovery with their prescriber so that an individualized plan can be tailored to them If at first you don t succeed, try something else

20 Alcohol Disulfiram/ Antabuse If person uses alcohol they will become ill Person needs to be committed to recovery Acamprostate/ Campral Daily medication to decrease cravings to use alcohol by restoring chemical balance in the brain Should be prescribed following detox or once use has been stopped Naltrexone/ Vivitrol Monthly injection aimed at reduces cravings to use Person must have a period of not using prior to starting

21 Nicotine Prescription medication used to limit cravings and reduce nicotine withdrawal symptoms Chantix, Zyban Over the counter nicotine replacement therapy in the form of patches, gum, lozenges, inhaler, Etc. Person starts at a dose and tapers down over time

22 Naloxone (Narcan) Prescription medication that reverses an opioid overdose Can be obtained at pharmacies throughout CT without a doctor s prescription and is covered by many insurance plans Should be on hand at any program where individuals with an opioid use disorder may be

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24 Connection to care CCAR Telephone Support Line or Access Line Information on walk-in assessment centers throughout the state at or Screening & Warm hand off to detox services Enhancement to provide transportation services statewide, when appropriate, to detox and between residential settings as of July 1, 2017 Beacon Health Options Resources Includes Interactive Map of all MAT providers

25 Presenter Contact Info Shelly Nolan, MS, LPC, Director of Women s Services Phone: shelly.nolan@ct.gov

26 Questions? For additional questions, contact Shelly at

27 Resource Substance Use Services Resource Page Meeting the Needs of Your Clients: Building Competencies in Mental Health and Addiction Services Upcoming Webinars December 10 January 14 February 11 March 11 April 8 A Guide to Crisis Prevention and De-Escalation Inspiring Internal Motivation: A Short Guide to Motivational Interviewing Adopting a Cultural Humility Approach Addressing Reproductive Health in Women Experiencing Homelessness Addressing the Needs of Older Populations Facing Homelessness Contact training@cceh.org for more information