THERAPEUTIC CONSIDERATIONS OF PSYCHOPHARMACOLOGY OF OPIATE USE DISORDER. Presenter: Linda Shaffer MA, Ed.S., LCAS, MAC

Transcription

1 THERAPEUTIC CONSIDERATIONS OF PSYCHOPHARMACOLOGY OF OPIATE USE DISORDER Presenter: Linda Shaffer MA, Ed.S., LCAS, MAC

2 LEARNING OBJECTIVES Know who to put on agonist (buprenorphine) therapy? Client contracts Benefits of a patient-centered approach How to address co-occurring disorders How to collaborate with prescribers

3 Who Are You?

4 What are your thoughts about medication assisted opiate treatment? methadone vs buprenorphine?

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

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

7 GROUP PROJECTS (POOR CANDIDATE) (GOOD CANDIDATE)

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

9 PROGRAM GUIDELINES Consequences for missed appt Discharge criteria Medication counts Office behavior UDS results Diversion handout

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

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

12 CO-OCCURING DISORDERS Considerations

13 NATIONAL SURVEY ON DRUG USE AND HEALTH (2002) Serious ) Mental Illness+ SA = 23.2% vs 8.2% NO SMI = 8.2% SA NO SA = 7% SMI

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

15 COLLABORATION WITH PRESCRIBERS

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

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

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

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

20 ANY NEW THOUGHTS OR INSIGHTS OR CONTRIBUTIONS?

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