Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
|
|
- Alban Williamson
- 6 years ago
- Views:
Transcription
1 Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
2 Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States in 2015 (16.3 per 100,000) was more than 2.5 times the rate in 1999 (6.1). Drug overdose death rates increased for all age groups, with the greatest percentage increase among adults aged (from 4.2 per 100,000 in 1999 to 21.8 in 2015). In 2015, adults aged had the highest rate (30.0). In 2015, the age-adjusted rate of drug overdose deaths among non-hispanic white persons (21.1 per 100,000) was nearly 3.5 times the rate in 1999 (6.2). The four states with the highest age-adjusted drug overdose death rates in 2015 were West Virginia (41.5), New Hampshire (34.3), Kentucky (29.9), and Ohio (29.9). In 2015, the percentage of drug overdose deaths involving heroin (25%) was triple the percentage in 2010 (8%). Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics
3 Percentage of drug overdose deaths involving selected drug categories: United States, 2010, 2014, and 2015 Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics. 2017
4 Age-adjusted drug overdose death rates, by sex United States, Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics. 2017
5 Source: Annual Overdose Death Reports, Maryland Vital Statistics Administration
6 DSM-V Definition Opiate Use Disorder Opioids are often taken in larger amounts or over a longer period than was intended A persistent desire or unsuccessful efforts to cut down or control opioid use A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects Craving, or a strong desire or urge to use opioids Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids Important social, occupational, or recreational activities are given up or reduced because of opioid use Recurrent opioid use in situations in which it is physically hazardous Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance Tolerance* Withdrawal* * Experiencing these symptoms while taking opioids solely under appropriate medical supervision is an exception to (does not meet) these criteria for OUD. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
7 Medication Assisted Treatment MAT is a comprehensive approach that combines approved medications with counseling and other behavioral therapies to treat patients with opioid use disorder Scientific evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more effective in the treatment of opioid use disorder than short-term detoxification programs aimed at abstinence, Nora D. Volkow, M.D Director of the National Institute on Drug Abuse (NIDA) Opioid detoxification may be good for a lot of things, but staying off opiates is not one of them Walter Ling, MD Professor Emeritus of Psychiatry and the Founding Director of the Integrated Substance Abuse Programs (ISAP) at UCLA
8 Pharmacotherapy FDA approved medications for the treatment of an opioid use disorder 1. Full opiate agonist: Methadone 2. Partial opiate agonist Buprenorphine 3. Opiate antagonist Naltrexone/Vivitrol
9 Counseling and other Behavioral Therapies Psychosocial and Behavioral Different Levels of Care Inpatient Residential Outpatient Partial Hospitalization Program (PHP Intensive Outpatient (IOP) Outpatient Peer Based Recovery Support Alcoholics Anonymous & Narcotics Anonymous SMART Recovery Peer Support Specialists
10 Pharmacotherapy Opiate Agonist and Partial Agonist Clark et al. (2015) Journal of Substance Abuse Treatment.57,75-80
11 Methadone Full Agonist Goals of treatment Suppress opioid withdrawal. Block the effects of illicit opioids. Reduce opioid craving and stop or reduce the use of illicit opioids. Promote and facilitate patient engagement in recovery oriented activities including psychosocial intervention. Withdrawal management with methadone must be done in an Opioid Treatment Program or inpatient setting There are 2 exceptions!!! The American Society of Addiction Medicine (2015) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
12 Exceptions If a patient has an opioid dependency and is admitted to the hospital for a primary medical problem other than opioid dependency, such as a myocardial infarction, the patient may be administered methadone or buprenorphine to prevent opioid withdrawal that would complicate the primary problem [Title 42 Code of Federal Regulations 8.11.i2]. If a patient reports to the hospital with opioid withdrawal as a primary problem, the patient may be treated for no more than 3 days. This is an exception made by the DEA [Title 21, Code of Federal Regulations, Part (b)] and is also known as the 3 day rule. For the 3 day rule, the following conditions must be implemented: 1. Not more than one day s medication may be administered or given to a patient at one time. 2. Treatment may not be carried out for more than 72 hours. 3. The 72-hour period cannot be extended or renewed.
13 Adverse Reactions Contraindicated Methadone Hypersensitivity Warnings and Precautions Cardiac conduction effects Respiratory depression Diversion and misuse are possible Severe bronchial asthma or hypercapnia Physical dependence Paralytic ileus Drug interactions with medications metabolized by cytochrome p450 Pregnancy - metabolism may need increased dose
14 Safety Faul M, Bohm M, Alexander C. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies United States, MMWR Morb Mortal Wkly Rep 2017;66:
15 Safety Faul M, Bohm M, Alexander C. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies United States, MMWR Morb Mortal Wkly Rep 2017;66:
16 Buprenorphine Partial Agonist Goals of treatment Suppress opioid withdrawal. Block the effects of illicit opioids. Reduce opioid craving and stop or reduce the use of illicit opioids. Promote and facilitate patient engagement in recovery oriented activities including psychosocial intervention. Access to Care Drug Addiction Treatment Act of 2000 (DATA 2000) 8 hour training to prescribe buprenorphine Comprehensive Addiction and Recovery Act (CARA) 24 hour training to prescribe buprenorphine Waiver gives the prescriber the ability to prescribed buprenorphine in office-based settings.
17 Formulations Buprenorphine (Subutex) -Sublingual Tablet - Used mostly in pregnant patients Suboxone (Buprenorphine + naltrexone) - Sublingual Film - Also available as a generic tablet Zubsolv - Sublingual Tablet - Maryland Medicaid preferred choice Bunavail -Sublingual Film Probuphine -Subdermal Inplant -Requires specific Risk Evaluation and Mitigation Strategy (REMS) training
18 Peak Effect
19 Phases of Buprenorphine Treatment Induction Find the patient's ideal daily dose of buprenorphine to minimizes side effects and craving 12 to 16 mg/day 2 to 4 days Stabilization 6 to 8 weeks following induction. Patient is no longer experiencing withdrawal symptoms or intense cravings. Main goal of stabilization is to eliminate opioid use - patient reports - confirmed by urine drug testing. Maintenance Maintenance phase lasts indefinitely (SAMHSA 2004). Long-term maintenance is recommended due to high relapse rates. For example, in one study of 255 individuals, approximately 87% relapsed at 3 months (Ling 2009). During this phase, the patient is maintained at a comfortable dose and reports minimal craving or side effects.
20 Pharmacotherapy Opiate Agonist and Partial Agonist Clark et al. (2015) Journal of Substance Abuse Treatment.57,75-80
21 Adverse Effects Generally well tolerated Side effects reported with these medications include Headache Anxiety Constipation Perspiration Fluid retention in lower extremities Urinary hesitancy Sleep disturbance QT-interval prolongation does not seem to be an adverse effect associated with treatment with buprenorphine Patients with opioid use disorder and concurrent alcohol, sedative, hypnotic, or anxiolytic use disorders should receive more intensive monitoring during office-based treatment with buprenorphineto minimize the risk of adverse events
22 Safety Emergency department (ED) visits involving buprenorphine increased substantially from 3,161 in 2005 to 30,135 visits in 2010, as availability of the drug increased In 2010, most buprenorphine-related ED visits were classified as nonmedical use of pharmaceuticals (52 percent, or 15,778 visits), followed by patients seeking detoxification or substance abuse treatment (24 percent, or 7,372 visits) and adverse reactions (13 percent, or 4,017 visits) Buprenorphine-related ED visits involving nonmedical use of pharmaceuticals increased 255 percent from 4,440 visits in 2006 to 15,778 visits in 2010 Additional drugs were involved in 59 percent of buprenorphine-related ED visits involving nonmedical use of pharmaceuticals in 2010 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 29, 2013). The DAWN Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD.
23
24 Buprenorphine vs. Methadone Cochrane Database of Systematic Reviews (2016) Low to moderate quality evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence Methadone or buprenorphine appeared equally effective Clinician or treatment system factors may contribute to the choice of pharmacotherapy Maintenance treatment with buprenorphine appeared more effective than detoxification or psychological treatments.
25 Naltrexone - Antagonist Goals of treatment To prevent relapse to opioids in patients who have already been detoxified and are no longer physically dependent on opioids Block the effects of illicit opioids. Reduce opioid craving and stop or reduce the use of illicit opioids. Promote and facilitate patient engagement in recovery oriented activities including psychosocial intervention. Formulations Oral Naltrexone Extended-Release Injectable Naltrexone For patients in occupations that do not permit opioid agonist treatment In areas such as public safety, transport of hazardous materials, licensed drivers, and healthcare, some employees are not allowed to use methadone and, in some cases, buprenorphine.
26 Formulations Oral Naltrexone (Revia) Important that the patient has been adequately detoxified from opioids and is no longer physically dependent Patients should be free from short-acting opioids for about 6 days before starting naltrexone Patients should be free from long-acting opioids such as methadone and buprenorphine for 7 10 days.? Naloxone challenge Oral naltrexone seems to be most useful when there is a support person to administer and supervise the medication Extended-Release Injectable Naltrexone (Vivitrol) Give every 4 weeks by deep intramuscular injection Naltrexone dosing before re-entry (incarceration/inpatient rehab) may serve to prevent relapse and overdose Injection site reactions May be more suitable for patients who have issues with adherence.
27 Adverse Effects Both oral and extended-release injectable generally well tolerated Side effects reported with these medications include Insomnia Lack of energy/sedation Anxiety Nausea and/or vomiting Abdominal pain/cramps Headache, Cold symptoms Extended-release injectable naltrexone injection site reactions There is no recommended length of treatment with oral naltrexone or extended-release injectable naltrexone. Duration depends on clinical judgment and the patient s individual circumstances Because there is no physical dependence associated with naltrexone, it can be stopped abruptly without withdrawal symptoms
28 Questions
Acute 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationOpioid 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 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 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 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 informationCorporate 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 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 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 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 informationTreatment Team Approaches in Substance Abuse Treatment
Treatment Team Approaches in Substance Abuse Treatment PLANT A SEED AND WATCH IT GROW 2 Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
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 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 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 informationOpioid 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 informationMedication Assisted Treatment of Substance Use Disorders
3 rd Annual Challenges & Innovations in Rural Psychiatry Conference Medication Assisted Treatment of Substance Use Disorders June 22, 2016 Medication Assisted Treatment of Substance Use Disorders Richard
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 informationMAT - 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 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 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 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 informationMEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER
MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER JOHN E LOPES Jr., DHSC, PA-C Associate Professor, Physician Assistant Program Central Michigan University and Project Director Medication-assisted
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 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 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 informationBuprenorphine is the most effective office-based treatment available for heroin and prescription opioid addiction
Buprenorphine is the most effective office-based treatment available for heroin and prescription opioid addiction The Problem The overdose death rate in Missouri and in the country has been rising for
More informationWhat 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 informationVivitrol Vs. Suboxone
Vivitrol Vs. Suboxone Vivitrol - Naltrexone Indicated for opiate dependence and alcohol withdrawal pure antagonist 380mg once every 4 weeks IM Peak plasma concentration in 2 hrs, followed by a second peak
More informationSUBSTANCE USE DISORDER IN ADOLESCENT POPULATION
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences SUBSTANCE USE DISORDER IN ADOLESCENT POPULATION ANNABELLE SIMPSON, MD UNIVERSITY OF WASHINGTON GENERAL DISCLOSURES
More informationAgenda. 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 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 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 informationSHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE
SHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE INDICATION Naltrexone is a pure opiate antagonist licensed as an adjunctive prophylactic therapy in the maintenance
More informationTreatment 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 informationTreatment 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 informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Probuphine, Sublocade) Reference Number: CP.PHAR.289 Effective Date: 11.16.16 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the
More informationNALTREXONE 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 informationOpioid Use Disorders as a Brain Disease Why MAT is so important. Ron Jackson, M.S.W., L.I.C.S.W.
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 Organization Name: CareOregon Course Title:
More informationTreatment 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 informationPennsylvania Coordinated Medication Assisted Treatment: A Penn State and Pennsylvania Psychiatric Institute Story
Pennsylvania Coordinated Medication Assisted Treatment: A Penn State and Pennsylvania Psychiatric Institute Story Sarah Sharfstein Kawasaki, MD Director of Addictions Services, Pennsylvania Psychiatric
More informationOverview 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 informationIn 2008, an estimated 282,000 persons
National Survey of Substance Abuse Treatment Services The N-SSATS Report January 28, 2010 Similarities and Differences in Opioid Treatment Programs that Provide Methadone Maintenance or Buprenorphine Maintenance
More informationGuidance for naltrexone prescribing
Document level: Drug Alcohol (Trustwide) Code: DA7 Issue number: 2 Guidance for naltrexone prescribing Lead executive Authors details Type of document Target audience Document purpose Lead Clinical Director
More informationSupporting Sustained Recovery for Opioid Use Disorder
Supporting Sustained Recovery for Opioid Use Disorder RCPA Conference Hershey, PA October 3, 2018 Agenda Scope of the opioid epidemic Medication-assisted treatment (MAT) What does MAT involve? What are
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 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 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 informationArwen 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 informationMedication 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 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 informationCombating the Crisis: Medication Assisted Treatment DISCLOSURES DISCLAIMER 2/15/2019
Combating the Crisis: Medication Assisted Treatment for Opioid Use Disorder Kiley Boeding, PharmD PGY I Pharmacy Resident Iowa City Veterans Affairs Healthcare System DISCLOSURES Dr. Boeding does not have
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 informationMethadone. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.41 Subject: Methadone Page: 1 of 8 Last Review Date: March 18, 2016 Methadone Description Dolophine
More informationAddiction to Opioids. Marvin D. Seppala, MD Chief Medical Officer
Addiction to Opioids Marvin D. Seppala, MD Chief Medical Officer Mayo Clinic Opioid Conference: Evidence, Clinical Considerations and Best Practice Friday, September 30, 2016 26 y.o. female from South
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 informationExpanding Access To Medication Assisted Treatment for Opioid Use Disorders to Patients in the Hospital
Expanding Access To Medication Assisted Treatment for Opioid Use Disorders to Patients in the Hospital August 28, 2018 Hosted by John A. Renner, Jr., MD, DLFAPA Professor of Psychiatry Boston University
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 informationManagement Options for Opioid Dependence:
Management Options for Opioid Dependence: Policy Implications and Recommendations Dan Ollendorf, PhD Sarah Jane Reed, MSc New England CEPAC Goal: To improve the application of evidence to guide practice
More informationMethadone Maintenance 101
Methadone Maintenance 101 OTP/DAILY DOSING CLINICS - ANDREW PUTNEY MD Conflicts of Interest - Employed by Acadia HealthCare 1 Why Methadone? At adequate doses methadone decreases opioid withdrawal symptoms
More informationQuestions & Answers About Probuphine. Here are the answers to some questions you may have about the Probuphine implant:
Questions & Answers About Probuphine Here are the answers to some questions you may have about the Probuphine implant: 1. Can my doctor prescribe and insert Probuphine? 2. What should I do after the Probuphine
More informationMedication for the Treatment of Alcohol Use Disorder. Pocket Guide
Medication for the Treatment of Alcohol Use Disorder Pocket Guide Medications are underused in the treatment of alcohol use disorder. According to the National Survey on Drug Use and Health, of the estimated
More informationLONG 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 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 informationHistory 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 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 informationWelcome to the Braeburn Access Program for PROBUPHINE (buprenorphine) implant for subdermal
Welcome to the Braeburn Access Program for PROBUPHINE (buprenorphine) implant for subdermal administration CIII Dear Health Care Provider, Welcome to the Braeburn Access Program. As you are aware, Braeburn
More informationMedication Assisted Treatment: Right for you, Right for your Recovery? Robert Matylewicz, DO, FASAM Medical Director, Clarity Way Inc.
Medication Assisted Treatment: Right for you, Right for your Recovery? Robert Matylewicz, DO, FASAM Medical Director, Clarity Way Inc. Elements Behavioral Health Diplomate, American Board of Addiction
More informationROSC & 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 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 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 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 informationMethadone 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 informationOpioid dependence: Detoxification
Opioid dependence: Detoxification What is detoxification? A. Process of removal of toxins from the body? B. Admitting a drug dependent person in a hospital and giving him nutrition? C. Stopping drug use
More informationThe available evidence in the field of treatment of opiate: The experience of developing the WHO clinical guidelines
The available evidence in the field of treatment of opiate: The experience of developing the WHO clinical guidelines Background, Objectives and Methods Systematic reviews (SRs) published by Cochrane Drugs
More informationClinical Policy: Buprenorphine-Naloxone (Bunavail, Suboxone, Zubsolv) Reference Number: CP.PMN.81 Effective Date: Last Review Date: 02.
Clinical Policy: (Bunavail, Suboxone, Zubsolv) Reference Number: CP.PMN.81 Effective Date: 09.01.17 Last Review Date: 02.18 Line of Business: Medicaid See Important Reminder at the end of this policy for
More informationADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines
The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least
More informationRestoration of Parenting Ability Through Treatment for Substance Use Disorders
Restoration of Parenting Ability Through Treatment for Substance Use Disorders DEBRA M. BARNETT, MD Board Certified in General Psychiatry, Addiction Psychiatry, Geriatric Psychiatry, and Forensic Psychiatry
More informationfor Opioid Dependence Buprenorphine/Naloxone Bunavail TM Suboxone Film Zubsolv Policy Number: MCP-072 Revision Date(s): 2/25/13; 4/4/17
Subject: Buprenorphine/Naloxone and Buprenorphine Original Effective Date: 8/26/09 for Opioid Dependence Buprenorphine/Naloxone Bunavail TM Suboxone Film Zubsolv generic Buprenorphine/Naloxone sublingual
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 information9/13/2017. 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 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 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 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 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 informationTreating Opioid Addiction
Treating Opioid Addiction Some people who start taking opioid pain medications eventually have serious problems with them and become addicted. Every day, 68 people die in the US from opioid overdose. More
More informationNoel Schenk MD. Davis Behavioral Health
Noel Schenk MD Davis Behavioral Health Michael Botticelli Director of National Drug Control Policy What is Addiction? Addiction is defined as a chronic, relapsing brain disease that is characterized by
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 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 information