Patient Initiation: Buprenorphine/Naloxone
|
|
- Marian Black
- 6 years ago
- Views:
Transcription
1 Patient Initiation: Buprenorphine/Naloxone Kristin Wason, MSN, APRN, CARN Office-Based Addiction Treatment Program Boston Medical Center *Images used for educational purposes only. All copyrights belong to image owners*
2 Outline Referral Screener Intake Provider Visit Patient Education Case Study
3 Outline Referral Screener Intake Provider Visit Patient Education Case Study
4 Buprenorphine/Naloxone: Treatment Referral Requirements DSM-5 diagnosis of opioid use disorder (OUD) Able to meet program requirements Patient must agree with program goals Improve withdrawal and craving of opioid Cessation/improvement in illicit use Restoration of physiological function PCSS-MAT: Treatment Options for Opioid Dependence
5 DSM-5: Opioid Use Disorder (1) Table 1 (1/2): Summarized DSM-5 diagnostic categories and criteria for opioid use disorder Category Impaired Control Criteria Opioids used in larger amounts or for longer than intended Unsuccessful efforts on desire to cut back or control use Excessive amount of time spent obtaining, using, or recovering from opioids Craving to use opioids Social Impairment Failure to fulfill major role obligations at work, school, or home as a result for recurrent opioid use Persistent or recurrent social or interpersonal problems that are exacerbated by opioids or continued use of opioids despite these problems Reduced or given up important social, occupational, or recreational activities because of opioid use Table adapted from: Brezing & Bisaga (2015). Psychiatric Times. DSM V OUD Checklist:
6 DSM-5: Opioid Use Disorder (2) Table 1 (2/2): Summarized DSM-5 diagnostic categories and criteria for opioid use disorder Category Risky Use Criteria Opioid use in physically hazardous situations Continued opioid use despite knowledge of persistent physical or psychological problem that is likely caused by opioid use Pharmacological Criteria Tolerance as demonstrated by increased amounts of opioids needed to achieve desired effect: diminished effect with continued use of the same amount Withdrawal as demonstrated by symptoms of opioid withdrawal syndrome; opioids taken to relieve or avoid withdrawal Table adapted from: Brezing & Bisaga (2015). Psychiatric Times. DSM V OUD Checklist:
7 Referral Appropriateness for Buprenorphine Chronic pain: pain must not require full agonist management Consider opioid tolerance - Will partial agonist be effective? Does not require a higher level of care than specified treatment setting Not actively polysubstance using If so, is willing to detox or address use other substances ASAM (2015). Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
8 Referral Process Many self-refer PCP or other provider Probation/court system Family, friend Referral: review chart for appropriateness If not appropriate: refer to another level of care If appropriate: proceed to screener
9 Case Study (1) Patient is a 32-year-old male, new to primary care. At his initial PCP visit, he reports using heroin IV daily for the past six months. He also reports history of chronic back pain s/p MVA. PT works in construction. He is currently sleeping on friends couches, but plans to move back into a sober house once he is able to stop using.
10 Case Study (2) PT requests refills for gabapentin 600 mg TID, and clonazepam 1 mg BID. He also requests a referral to the buprenorphine treatment program in which you work. His new PCP refills the gabapentin, but defers the clonazepam at this time. Referrals are placed for buprenorphine/ naloxone treatment and psychiatry. PT is agreeable to plan. Is this patient a potential candidate for treatment with buprenorphine/naloxone in an office-based setting? Any concerns?
11 Case Study Appropriate Referral? Yes He is a potential candidate for bupe/nlx treatment Meets the DSM-5 criteria for OUD He is working full time, suggesting some level of stability Requesting treatment is a good indication of motivation for recovery There are also hints of prior successes in recovery, since he was previously living in a sober house
12 Case Study Any Concerns? Yes - There are still some concerns Request for benzodiazepine Unknown pain level Some stability concerns remain as patient has relatively unstable housing We do not know how much heroin he is using daily
13 Case Study Chart Review: One PCP visit resulted in referral for bupe/nlx treatment 4 ED visits in the past year mostly related to substance use (abscess requiring I&D and antibiotics, 2 overdoses, back pain requesting narcotics) No hospitalizations, no surgeries, no admissions for mental health treatment No safety threats
14 Outline Referral Screener Intake Provider Visit Patient Education Case Study
15 OBAT Screening Occurs in-person or over phone Includes: Demographics Substance use history Medical and mental health history Social history Treatment goals Boston Medical Center s Office Based Addiction Treatment Program Policy and Procedure Manual: Screener Template *Place reference: paste link from EdX Resource
16 Screener: Demographics
17 Screener: Substance Use History
18 Screener: Safety Information
19 Screener: Treatment History
20 Screener: Prior Treatment for Substance Use Disorder Prior treatment utilizing methadone, buprenorphine, injectable naltrexone Location, length of treatment, dose, reason for discontinuing treatment
21 Screener: Criminal History
22 Screener: Mental Health History
23 Screener: Medical History and Pain
24 Screener: Surgical History and Family History
25 Screener: Social Support and Stability
26 Screener Information Summarized and reviewed by clinical team If appropriate: schedule intake and waivered provider appointments If not appropriate, refer to another level of care
27 Case Study Phone Screen Results (1) Patient is screened for buprenorphine treatment The patient is a 32-year-old male who reports the following substance abuse history: Heroin first use age 20, last use yesterday. Reports using 1 gram daily (IV) Oxycodone first use age 18, last use 6 years ago. Reports taking 5-6 x30 mg tabs daily (PO, IN) Cocaine first use age 19, last use 1.5 months ago. Reports using ½ 1 gram 1 2x/week. (IN, IV) Benzo first use age 24, last use 1 week ago. Reports using 1 2 mg clonazepam PO once weekly, when he can t find heroin. Has never been prescribed. States he is willing to go without.
28 Case Study Phone Screen Results (2) Illicit Suboxone first use age 26, last use 2 months ago. Reports using 8 mg tab/film 1 2x weekly Denies alcohol and amphetamine use Has shared needles in past, currently uses the needle exchange program Reports 3 overdoses in lifetime, hospitalized for 1 overdose, naloxone was administered in 2 ODs Longest recovery time is 1 year, occurred summer 2014 summer 2015 when Rx d bupe/nlx Reports 20 detoxes, 2 residentials, and 1 bupe maintenance program = 16 mg/day for 1 yr, did well, d/c due to incarceration
29 Case Study Phone Screen Results (3) Currently on probation x 1 year. Not facing any time. No other legal issues or outstanding cases Mental health history: self-report of anxiety, never engaged in behavioral health services Medical history: significant for + HCV test at detox, chronic pain of 8/10 daily, pain is 2/10 with heroin Currently living on a friend s couch. In past, lived at a sober house, loved it, hopes to return Goals for buprenorphine treatment are stop using, get a good job, and repair relationships I ve damaged
30 Case Study Move forward to Intake? Using the information obtained from the screener and the chart review, would you: Move this patient forward to intake process for buprenorphine/naloxone treatment in an OTP setting? Move this patient forward to intake for buprenorphine treatment in a primary care setting? Refer to methadone maintenance due to high opioid tolerance and pain?
31 Case Study Move forward to Intake? Yes and Yes. Patient would be appropriate to progress to intake for treatment with buprenorphine/naloxone in either an OTP or a primary care/office-based treatment setting No major red flags for safety issues or active severe medical or mental health disease Some minor concerns about Benzo use. However, Benzo use does not appear to be at a high level as he is primarily using clonazepam once weekly to self-treat heroin withdrawal, he has never been prescribed, and is willing to go without benzodiazepines
32 Case Study Refer to Methadone Instead? No, this patient would not need to be referred to methadone maintenance Buprenorphine/naloxone has worked well in the past Patient s tolerance is not so high that bupe/nlx would not cover his dependency Pain score 8/10 without opioids, 2/10 with opioids, this is manageable Minimal polysubstance use
33 Outline Referral Screener Intake Provider Visit Patient Education Case Study
34 Intake: Initial Visit with Treatment Team Substance use history reviewed Education on buprenorphine/naloxone Guidelines and consents reviewed and signed (copies given to patient) Counseling requirement Pharmacy selection Consent for release of information as needed to social services, corrections, outside providers. Boston Medical Center s Office Based Addiction Treatment Program Policy and Procedure Manual: Intake Note Template and Treatment Agreement:
35 istock Intake: Laboratory Testing Urine toxicology screen and/or oral swab toxicology screen CBC, CMP/hepatic panel, HCG, RPR, hepatitis A, B & C serologies, HIV, TB, sexually transmitted infections ** Labs will be ordered based upon current clinical information ASAM (2015), BMC (2016)
36 Outline Referral Screener Intake Provider Visit Patient Education Case Study
37 Provider Visit Physical examination/assessment Review laboratory and toxicology results Check prescription drug monitoring program Confirmation of DSM-5 diagnosis: opioid use disorder Determine appropriateness of treatment with buprenorphine/ naloxone in clinical setting ASAM (2015), BMC (2016)
38 Provider Visit: Clinical Team Coordination Clinical team management under the guidance of the provider Nurse care manager model: nurses follow patient weekly and decrease with stabilization Waivered provider visits at least every three months Communication with provider ongoing: EMR, phone, in-person communication Follow up with PCP based on medical needs, provider preference AHRQ (2016)
39 Case Study Continued (1) Patient progresses to a nurse intake for treatment with buprenorphine: 1. In addition to a urine toxicology screen, what labs would you consider ordering? 2. Would you encourage a consent for release of information? If so, for whom?
40 Case Study Continued (2) Labs to consider ordering: HCV RNA, HCV genotype, hepatic panel. Depending on info gathered at intake and/or provider visit, may consider HIV, HAV and HBV serologies, CBC other labs Yes, would want signed releases for: Probation Consent for release to counseling with licensed clinician or psychiatry once he is connected
41 Outline Referral Screener Intake Provider Visit Patient Education Case Study
42 Patient Education Description Medication Administration Safety and Storage Overdose Prevention
43 Patient Education: Description Buprenorphine/Naloxone - What is it? FDA-approved medication for opioid dependence Tablet, film, buccal formulations Also available as an implant, and soon injectable formulation Scheduled/controlled medication Most states require valid government ID at pharmacy Long half-life SAMHSA (2016)
44 Patient Education: Description Buprenorphine/Naloxone - Formulations All images are used for illustration and educational purposes only. Copyrights belong to the image owners. HMS, course instructors and partner organizations do not endorse any commercial products. Suboxone.com
45 Patient Education: Description Buprenorphine/Naloxone How it Works Binds to opioid receptors to help treat opioid cravings and withdrawal Ceiling effect Blocks effects of opioids when taken as prescribed because the buprenorphine hangs on very tightly to opioid receptors (high affinity) not letting other opioids bind. Long half-life - only needs to be taken once, or twice daily Will result in physical dependence since bupe/nlx is an opioid Free Patient Educational Pamphlet on Buprenorphine
46 Patient Education: Medication Administration Tablets - dissolve under the tongue Film - under tongue or inside of cheek (Suboxone), inside of cheek only (Bunavail) Saliva should pool in front of mouth Do not drink/eat/smoke until after the medication is completely dissolved For tablets: 3 5 minutes or longer to dissolve For film:1 3 minutes to dissolve SAMHSA (2016)
47 Patient Education: Medication Administration Precautions Side-Effects: nausea, headache, sweating, constipation Potential Adverse Reactions: precipitated withdrawal, dependency, intoxication, allergic reactions, orthostatic hypotension, irregular heartbeat, insomnia, blurred vision, dizziness, and sleepiness. Neonatal abstinence syndrome. Adverse Events Specific to Suboxone Film: tongue sores/ulcers SAMHSA (2014) Suboxone.com
48 Patient Education: Medication Administration Interactions CNS Depressants Buprenorphine/naloxone with benzodiazepines, alcohol, or other CNS depressants increases risk: sedation, respiratory depression, and overdose Careful assessment determining appropriateness for treatment Monitor use of CNS depressants prior to treatment and during treatment PCSS-MAT Interactions of Benzodiazepines and Buprenorphine
49 Patient Education: Medication Administration Opioid Dependency Buprenorphine: partial agonist patients will become dependent If patients suddenly stop buprenorphine, withdrawal will occur If not opioid dependent, may become dependent Females of childbearing age neonatal abstinence syndrome risk The longer people are engaged in treatment the better they do Addiction is a chronic disease (like HTN, DM, asthma.)
50 Patient Education: Medication Administration Special Populations Liver Impairment: Monitor labs and physical symptoms Education about signs & symptoms of liver impairment Pregnancy Encourage patient to inform treatment team Reinforce that treatment will continue Most change to mono-tab (buprenorphine) Pain Buprenorphine/naloxone can only be prescribed for OUD, but it can help manage pain Providers can work together to help manage pain safely
51 Patient Education: Safety Storage Proper Storage and Handling Review any program policies on lost/stolen/destroyed medications Never share pills, even with the best of intentions Education regarding avoidance of pediatric exposure Provide the Poison Control Center phone number: This brochure available for free at:
52 Patient Education: Overdose Prevention Recommended for all patients entering treatment for substance use disorders Especially important for patients struggling with ongoing opioid use
53 Patient Education: Overdose Prevention Never use alone Do not lock the door Same dealer Test shot Sterile supplies Have naloxone on hand, know how to use Support system should have naloxone and know what to do Overdose looks like: blue lips and finger tips
54 Patient Education: Overdose Prevention Steps to Reverse an Overdose 1. Assess the scene 2. Assess the person 3. Call Rescue breathing 5. Administer naloxone
55 Patient Education: Overdose Prevention Overdose-lifeline.org Narcan.com Evzio.com All images are used for illustration and educational purposes only. Copyrights belong to the image owners. HMS, course instructors and partner organizations do not endorse any commercial products. Prescribe to Prevent - Prescribing information as well as patient education materials
56 Review of To Do s Prior to Starting Treatment Intake Complete Treatment agreement and consents reviewed and signed Recommended: Counseling in process with trained clinician Toxicology performed and reviewed Blood work complete and reviewed Cleared for treatment by waivered provider Once all of the above occurs, schedule buprenorphine/naloxone induction.
57 Outline Referral Screener Intake Provider Visit Patient Education Case Study
58 Case Study During this patient s intake for treatment with buprenorphine: What teaching points would you want to reinforce?
59 Case Study Teaching Points Review buprenorphine/naloxone pharmacology Emphasize that benzodiazepine and other sedative (gabapentin) use is dangerous when combined with Bupe/Nlx Signs of liver impairment since HCV status being worked up Proper storage of medication, especially since patient s living situation unstable Overdose prevention/naloxone training
60 Unit Resources: PCSS-MAT: Treatment Options for Opioid Dependence - A great website for providers that offers free webinars, modules, podcasts, calendar of live events making available the most effective medication-assisted treatments to serve patients in a variety of settings. This particular webinar discusses the pros and cons of the three primary treatment options for opioid use disorders: methadone, buprenorphine and naltrexone. Also considers issues of psychiatric co-morbidity or chronic pain, and how these conditions can be addressed in the context of treatment for OUD. Bup.Practice - DSM 5 Opioid Use Disorder Checklist - Buppractice is a website that provides 8 hours of qualified training for DATA2000 waivers as required by the DEA to prescribe buprenorphine. Currently MDs are required to complete 8 hours of qualified addiction training. NPs and PAs are required to complete an additional 16 hrs of training, for a total of 24 hrs. Additional 16 hrs can be done online through ASAM of PCSS-MAT.
61 ASAM (2015). Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use SAMHSA (2016) - Medication Assisted Treatment: Buprenorphine SAMHSA - Free Patient Educational Pamphlet on Buprenorphine PCSS-MAT - Current Understanding of the Interaction of Benzodiazepines and Buprenorphine : This module reviews some of the literature on combining these drugs, as well as alternative treatments for the anxious buprenorphine patient. Protecting Others and Protecting Treatment - Safe Storage (Free Brochure) Harm Reduction Coalition - a national advocacy and capacitybuilding organization that promotes the health and dignity of individuals and communities impacted by drug use. Prescribe to Prevent - Prescribing information and patient education materials
History of Present Illness (HPI) Assessment and Plan Template
History of Present Illness (HPI) Assessment and Plan Template Templates for induction and follow-up appointments for medication assisted treatment (MAT) in opioid use disorder (OUD). Consider saving this
More informationKurt 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 informationNURSING INTAKE. Provider Name: Provider Signature: Nursing Summary. Are you pregnant at this time?
NURSING INTAKE Provider Name: Provider Signature: Date: Nursing Summary Are you pregnant at this time? 3 = Don t know 4 = Tubal ligation 5 = Menopause 6 = History of hysterectomy 7 = Other: 8 = N/A patient
More informationMedication-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(Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines)
Buprenorphine Initiation and Maintenance in Pregnancy (Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines) Assessment The diagnosis of OUD should be confirmed by DSM-5
More information2/21/2018. 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 informationAppendix F Federation of State Medical Boards
Appendix F Federation of State Medical Boards Model Policy Guidelines for Opioid Addiction Treatment in the Medical Office SECTION I: PREAMBLE The (name of board) recognizes that the prevalence of addiction
More informationInterdisciplinary Management of Opioid Use Disorder in Rural Primary Care Settings
Interdisciplinary Management of Opioid Use Disorder in Rural Primary Care Settings BRIAN GARVEY, MD, MPH REBECCA CANTONE, MD OREGON HEALTH & SCIENCE UNIVERSITY SCAPPOOSE RURAL HEALTH CENTER Disclosures
More informationOpiate Use Disorder and Opiate Overdose
Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5
More informationFY17 SCOPE OF WORK TEMPLATE. Name of Program/Services: Medication-Assisted Treatment: Buprenorphine
FY17 SCOPE OF WORK TEMPLATE Name of Program/Services: Medication-Assisted Treatment: Buprenorphine Procedure Code: Modification of 99212, 99213 and 99214: 99212 22 99213 22 99214 22 Definitions: Buprenorphine
More informationBuprenorphine 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 informationWasted 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 informationMedications 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 informationNURSING FOLLOW-UP: BUPRENORPHINE/NALOXONE BUPRENORPHINE/NALOXONE CLINIC VISITS
Provider Name: NURSING FOLLOW-UP: BUPRENORPHINE/NALOXONE Provider Signature: Date: BUPRENORPHINE/NALOXONE CLINIC VISITS Once stable, schedule clinic visits every 2 to 4 weeks, with refills that coincide
More informationOpioids 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 informationAcute General Medical and Surgical Admission:
Acute General Medical and Surgical Admission: Managing Substance Use Disorders in Patients Who are Severely Ill Scott Grantham, MD Executive Director, Behavioral Health Saint Francis Health System By the
More informationTalking 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 informationIdentification 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 informationTELEPHONE 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 informationOpioid dependence and buprenorphine treatment
Opioid dependence and buprenorphine treatment David Roll, MD Revere Family Health, Cambridge Health Alliance Instructor in Medicine, Harvard Medical School Joji Suzuki MD Medical Director of Addictions
More informationUnderstanding Medication in Addiction Treatment for Drug Court Participants
Understanding Medication in Addiction Treatment for Drug Court Participants Introduction This pocket guide is for drug court participants who may be prescribed or considering medication as a part of addiction
More informationClinical 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 informationClinical 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 informationA COLLABORATIVE CARE APPROACH
MASSACHUSETTS NURSE CARE MANAGER MODEL OF OFFICE BASED ADDICTION TREATMENT: CLINICAL GUIDELINES A COLLABORATIVE CARE APPROACH 2018 Boston Medical Center Updated: March 9, 2018 [Type text] Page 0 TABLE
More informationNORTHWEST AIDS EDUCATION AND TRAINING CENTER. Opioid Use Disorders. Joseph Merrill M.D., M.P.H. University of Washington April 10, 2014
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Opioid Use Disorders Joseph Merrill M.D., M.P.H. University of Washington April 10, 2014 Opioid Use Disorders Importance of opioid use disorders Screening and
More informationTreatment 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 informationRevised 9/30/2016. Primary Care Provider Pain Management Toolkit
Revised 9/30/2016 Primary Care Provider Pain Management Toolkit TABLE OF CONTENTS 1. INTRODUCTION Page 1 2. NON-OPIOID SERVICES &TREATMENTS FOR CHRONIC PAIN Page 2 2.1 Medical Services Page 2 2.2 Behavioral
More informationHospitals Role in Addressing the Opioid Crisis
Hospitals Role in Addressing the Opioid Crisis Webinar 5: Buprenorphine in the Emergency Department November 14, 2017 Agenda Hospital Based Buprenorphine Initiatives Yngvild Olsen, M.D., Medical Consultant,
More informationRationale & Strategy For Integrating Buprenorphine Treatment Into Community Health Centers
Rationale & Strategy For Integrating Buprenorphine Treatment Into Community Health Centers Marwan S. Haddad, M.D. Community Health Center, Inc. Connecticut September 16, 2008 Community Health Center, Inc.
More informationMedical Assisted Treatment of Opioid
Medical Assisted Treatment of Opioid Dependence with XR-NTX(Vivitrol) Michael McNamara DO, FACN Medical Director Mental Health Center of Greater Manchester Manchester NH Outline Overview of Opioid Dependence
More informationOpioid Use Disorder Treatment: Buprenorphine Treatment Basics
Opioid Use Disorder Treatment: Buprenorphine Treatment Basics Daniel Warren, MD Eastern Oregon Coordinated Care Organization Provider Forum on Chronic Noncancer Pain Management Pendleton, OR February 24,
More informationSerious 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 informationSubstance 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 informationMark Edlund, MD, PhD RTI International. Photo courtesy of The Herb Museum, Vancouver, BC
Opioid Use Disorders and Their Treatment Mark Edlund, MD, PhD RTI International Photo courtesy of The Herb Museum, Vancouver, BC Acknowledgements Funded by NIDA R01 DA022560-01 NIDA R01 DA034627 NIDA R01
More informationOpioids 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 informationMedication 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 informationAN INTRODUCTION TO THE TREATMENT OF OPIOID USE DISORDERS IN PRIMARY CARE
AN INTRODUCTION TO THE TREATMENT OF OPIOID USE DISORDERS IN PRIMARY CARE Valerie Carrejo, MD Assistant Professor UNM Family Medicine Advances in Primary Care April 14, 2017 Objectives Review the basic
More informationManagement of Opioid Use Disorder in Primary Care
1 Northwest ATTC presents Management of Opioid Use Disorder in Primary Care Joseph O. Merrill, MD, MPH University of Washington Associate Professor of Medicine 4/26/2018 Today s Presenter 2 Joseph Merrill,
More informationMedication 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 informationOpioid Dependence and Buprenorphine Management
Opioid Dependence and Buprenorphine Management Kevin Kapila, MD Fenway Health Medical Director of Behavioral Health Instructor in Medicine Harvard Medical School Learning Objectives Understand the rationale
More informationSUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program
SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets Risk Evaluation and Mitigation Strategy (REMS) Program Office-Based Buprenorphine Therapy for Opioid Dependence: Important Information for Prescribers
More informationBuprenorphine: 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 informationPOLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences POLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE MARK DUNCAN, MD November 8, 2018 SPEAKER
More informationThe CARA & Buprenorphine Prescribing for APNs & PAs
The CARA & Buprenorphine Prescribing for APNs & PAs William J. Lorman, JD, PhD, MSN, PMHNP-BC, CARN-AP FIAAN Assistant Clinical Professor, Drexel University, Philadelphia, PA V. P. & Chief Clinical Officer,
More informationAn overview of Medication Assisted Treatment (MAT) and acute pain management on MAT
An overview of Medication Assisted Treatment (MAT) and acute pain management on MAT Goals of Discussion Recognize opioid use disorder (OUD) Discuss the pharmacology of medication assisted treatments (MAT)
More informationOptimizing Suboxone in Opioid Addicts
Optimizing Suboxone in Opioid Addicts David Chim, D.O. Integrated Substance Abuse Programs Dept. of Psychiatry, UCLA K30 Translational Research Interest March 24, 2009 dchim@mednet.ucla.edu www.uclaisap.org
More information201 KAR 9:270. Professional standards for prescribing or dispensing Buprenorphine-Mono-Product or Buprenorphine-Combined-with-Naloxone.
201 KAR 9:270. Professional standards for prescribing or dispensing Buprenorphine-Mono-Product or Buprenorphine-Combined-with-Naloxone. RELATES TO: KRS 311.530-311.620, 311.990 STATUTORY AUTHORITY: KRS
More informationMedication-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 informationTapering Opioids Best Practices*
Tapering Opioids Best Practices* Chuck Hofmann, MD, MACP 5 th Annual EOCCO Office Staff and Provider Summit September 28, 2017 Disclosure No Conflicts of Interest to report Learning Objectives Understand
More informationOpioid 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 informationMedication 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 informationClinical 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 informationOpioid 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 informationSUBOXONE (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 informationSTARTING SUBOXONE IN PRIMARY CARE
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences STARTING SUBOXONE IN PRIMARY CARE MARK DUNCAN MD UNIVERSITY OF WASHINGTON OBJECTIVES 1. Review evidence of how to
More informationMEDICATION 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 informationMedication 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 informationSubstance Use Disorders
Substance Use Disorders Substance Use Disorder This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars monthly to address topics related to risk adjustment documentation and
More informationSubstitution 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 informationMedical 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 informationVivitrol 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 informationMAT IN PREGNANCY KAYLA LIFE STAGE 1: ADOLESCENCE LIFE STAGE 2: EARLY ADULTHOOD. family History of addiction. addiction to oral opioids
MAT IN PREGNANCY R. COREY WALLER MD, MS PRINCIPAL, HEALTH MANAGEMENT ASSOCIATES FACULTY, INSTITUTE FOR HEALTHCARE INNOVATION (IHI) CHAIR, LEGISLATIVE ADVOCACY COMMITTEE, ASAM KAYLA LIFE STAGE 1: ADOLESCENCE
More informationMedications 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 informationBuprenorphine 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 information9/9/2016. Drug Name (select from list of drugs shown) Bunavail Buccal Film (buprenorphinenaloxone) Suboxone Sublingual Film (buprenorphine-naloxone)
9/9/2016 Prior Authorization Form PASSPORT HEALTH PLAN KENTUCKY MEDICAID Buprenorphine Products This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,
More informationQuick Guide. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
Quick Guide For Physicians Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction Buprenorphine Clinical Guide Contents Why a Quick Guide?....................
More informationJohn Murphy DO, MS Lynx Healthcare
Addiction to Pain Medication and Treatment John Murphy DO, MS Lynx Healthcare No Disclosures Objectives 1 Understand basic neurobiology and learning theory around opioid addiction 2 Identify aberrant behavior
More informationMAT 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 informationBuprenorphine Prescribing as a Patient- Centered Medical Home Enhancement
Buprenorphine Prescribing as a Patient- Centered Medical Home Enhancement TANNER NISSLY DO, BOB LEVY MD FASAM, MICHELE MANDRICH MSW, CMPE AS YOU ENTER, PLEASE SET UP TO PARTICIPATE IN OUR POLL EVERYWHERE
More informationOpioid Overdose: Risks, Clinical Features, Treatment, and Reduction of Negative Consequences
Opioid Overdose: Risks, Clinical Features, Treatment, and Reduction of Negative Consequences Joji Suzuki, MD Assistant Professor of Psychiatry Harvard Medical School Director, Division of Addiction Psychiatry
More informationMEDICATION GUIDE SUBOXONE (Sub OX own) (buprenorphine and naloxone) Sublingual Film for sublingual or buccal administration (CIII)
MEDICATION GUIDE SUBOXONE (Sub OX own) (buprenorphine and naloxone) Sublingual Film for sublingual or buccal administration (CIII) IMPORTANT: Keep SUBOXONE in a secure place away from children. Accidental
More informationInjectable naltrexone (XR-NTX) A RETROSPECTIVE STUDY OF ITS ACCEPTANCE IN A COMMUNITY RECOVERY SETTING BRIANNE FITZGERALD MSN, PMHNP, CARN-AP
Injectable naltrexone (XR-NTX) A RETROSPECTIVE STUDY OF ITS ACCEPTANCE IN A COMMUNITY RECOVERY SETTING BRIANNE FITZGERALD MSN, PMHNP, CARN-AP Overview Gavin Foundation Injectable naltrexone Community report
More informationWilson C, Fagan E. Providing office-based treatment of opioid use disorder. Ann Fam Med. 2017;15(5):481.
Supplemental material for Wilson C, Fagan E. Providing office-based treatment of opioid use disorder. Ann Fam Med. 2017;15(5):481. Courtenay Gilmore Wilson, PharmD 1,2 E. Blake Fagan, MD 1,3 1 Mountain
More informationSuboxone, Zubsolv, Bunavail (buprenorphine with naloxone sublingual tablets and film), Buprenorphine sublingual tablets
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.32 Subject: Suboxone Drug Class Page: 1 of 7 Last Review Date: June 24, 2016 Suboxone Drug Class Description
More informationVermont Hub and Spoke Model Treatment Need Questionnaire
Vermont Hub and Spoke Model Treatment Need Questionnaire Friday, June 30, 2017 John Brooklyn, MD Assistant Professor of Family Medicine and Psychiatry University of Vermont Burlington, Vermont Webinar
More informationBUPRENORPHINE-NALXONE 101
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences BUPRENORPHINE-NALXONE 101 MARK DUNCAN MD UNIVERSITY OF WASHINGTON GENERAL DISCLOSURES The University of Washington
More informationAn Internist s Guide to Unhealthy Alcohol Use. Ryan Graddy, MD JHU SOM
An Internist s Guide to Unhealthy Alcohol Use Ryan Graddy, MD JHU SOM Disclosures None Learning Objectives Understand the terminology used to describe unhealthy alcohol use Identify means of screening
More informationBuprenorphine & Controlled Substance Treatment Agreement
Buprenorphine & Controlled Substance Treatment Agreement I agree to accept the following treatment contract for buprenorphine office-based opioid addiction treatment: 1. I will keep my medication in a
More informationOpioids 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 informationMedication-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 informationMAT 101: TREATMENT OF OPIOID USE DISORDER
MAT 101: TREATMENT OF OPIOID USE DISORDER WITH SPECIAL EMPHASIS ON BUPRENORPHINE/NALOXONE ICADD May 22, 2018 Alicia Carrasco, MD Debby Woodall, LCSW, ACADC Magni Hamso, MD, MPH Terry Reilly Health Services
More informationClinical Guidelines for the Pharmacologic Treatment of Opioid Use Disorder
Clinical Guidelines for the Pharmacologic Treatment of Community Behavioral Health (CBH) is committed to working with our provider partners to continuously improve the quality of behavioral healthcare
More informationIdentifying and managing Opioid Use Disorder. Workers Compensation and Auto/No-Fault Continuing Education May 25, 2017
Identifying and managing Opioid Use Disorder Workers Compensation and Auto/No-Fault Continuing Education May 25, 2017 Administrative details Course accreditation Continuing education credits for our courses
More informationLinking Opioid Treatment in Primary Care. Roxanne Lewin M.D.
Roxanne Lewin M.D. The Facts Fewer than 10 percent of individuals with an alcohol use disorder and only about 20 percent of individuals with an opioid use disorder receive specialty treatment. Many individuals
More informationOpioid Analgesics: Responsible Prescribing in the Midst of an Epidemic
Opioid Analgesics: Responsible Prescribing in the Midst of an Epidemic Lucas Buffaloe, MD Associate Professor of Clinical Family and Community Medicine University of Missouri Health Care Goals for today
More informationInitiation of Medication in Treating Opioid Use Disorder.
Initiation of Medication in Treating Opioid Use Disorder. Colleen T. LaBelle MSN RN-BC CARN Program Director STATE OBAT B Nurse Manager Boston Medical Center OBAT Executive Director MA IntNSA *Images used
More informationOpioid Initiative Wave I Treating Opioid-Use Disorder in the ED Part 2
Opioid Initiative Wave I Treating Opioid-Use Disorder in the ED Part 2 Presenter Eric Ketcham, MD, MBA Reuben J. Strayer, MD BUPRENORPHINE IN THE E.D.: Initiating Medication Assisted Treatment for Opioid
More informationBuilding 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 informationImplementing 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 information6/6/2018. 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 informationRule Governing the Prescribing of Opioids for Pain
Rule Governing the Prescribing of Opioids for Pain 1.0 Authority This rule is adopted pursuant to Sections 14(e) and 11(e) of Act 75 (2013) and Sections 2(e) and 2a of Act 173 (2016). 2.0 Purpose This
More informationHARM 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 informationDisclosures. 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 informationMEDICATION GUIDE SUBOXONE (Sub OX own) (buprenorphine and naloxone) Sublingual Tablets (CIII)
MEDICATION GUIDE SUBOXONE (Sub OX own) (buprenorphine and naloxone) Sublingual Tablets (CIII) IMPORTANT: Keep SUBOXONE in a secure place away from children. Accidental use by a child is a medical emergency
More informationOpioids. 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 informationScreening, Identification, Counseling, and Treatment of Opioid Use Disorder
Screening, Identification, Counseling, and Treatment of Opioid Use Disorder Joji Suzuki, MD Assistant Professor of Psychiatry, Harvard Medical School Director, Division of Addiction Psychiatry, Brigham
More informationMedication 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 informationBuprenorphine 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 informationGOALS AND OBJECTIVES
SUBOXONE AND VIVITROL: ARE THERE DISPARITIES SURFACING IN MEDICATION ASSISTED TREATMENTS? P R E S E N T E D B Y D R. K I AM E M AH A N I A H & D R. M Y E C H I A M I N T E R - J O R D AN GOALS AND OBJECTIVES
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More information