Alternatives to Buprenorphine
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- Priscilla Wells
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1 Alternatives to Buprenorphine Charles Morgan, MD, FASAM, FAAFP Medical Director Bridgeton, NJ Westfield, PA New York, NY Cherry Hill, NJ Northfield, NJ 1
2 2
3 Heroin Purity increasing Pharmaceuticals Expense Availability The Fifth Vital Sign Opioids Can Now Be Drugs of Entry 3
4 Ventral Tegmental Area Locus Coeruleus Nucleus Accumbens Limbic System 4
5 Endorphins Mu Receptor Delta Receptor 5
6 Evolutionary Biology Instincts Pain relief Endurance Orgasm 6
7 Prefrontal Cortex Stop Midbrain Go 7
8 Endocannabinoids GABA Dopamine Glutamate Others 8
9 AA 1935 Akron, Ohio Bill Wilson & Bob Smith NA 1953 Sun Valley, California More than 58,000 meetings in 131 countries by nd Largest 12 Step Movement Jimmy Kinnon 9
10 #Big Book Distributed 21, 234, From historical lists & GSO data Library of Congress AA Big Book One of the top 88 most influential books in the United States
11 Since Mid 1960 s Nyswander & Dole JAMA, 1976 Criteria for Admission to Program Restrictions 11
12 Synthesized 1963 Drug Abuse Office and Treatment Act 1972 (called for long lasting, non-addictive, antagonists to treat opioid dependence) Naltrexone 50mg Approved by FDA 1984 Vivitrol (Alkermes) Approved
13 Late 1970 s Anesthesia and Pain Late 1990 s Off Label Detoxification DATA 2000 Approved
14 22 Year Old with Opioid Dependence Age of 1 st Opioid = 15 Years Old = 7 years = 2005 Buprenorphine available in
15 Cost Restrictive X Numbers Caps Geography Physical Dependence Bias Risk of Loss Diversion Scrutiny Not Universally Accepted by Boards, Legal System & Others Double Edge Sword 15
16 Definition The preparation for treatment Relieve Suffering Safety Establish Relationships and Trust Medical Work Up 16
17 Myalgia Cravings Irritability Piloerection Diaphoresis Rhinorrhea Lacrimation Mood Swings Kicking Restlessness 17
18 Tremor Leaving Treatment Arthralgia Mydriasis Spontaneous Ejaculation Nausea Vomiting Abdominal Cramps Diarrhea Motor Agitation 18
19 Buprenorphine Methadone 19
20 Phenobarbital Clonidine Muscle Relaxants Anti-Emetics Anti-Inflammatory Anti-Diarrhea Anti-Spasmodics 20
21 Phenobarbital Tramadol Muscle Relaxants Anti-Emetics Anti-Inflammatory Anti-Diarrhea Anti-Spasmodics 21
22 Phenobarbital Reversal with naloxone followed by Naltrexone 22
23 Reversal Under Anesthesia 23
24 Staff Environment Comfort measures Hydrotherapy Massage Acupuncture Introduction of Ongoing Care 12 Step Involvement Sleep 24
25 Continuing Withdrawal PAWS Poly Substance Dependence 25
26 Brain Regrowth Synaptic Pruning Mindfulness Studies Fake it until you make it Stick with the Winners Avoid People, Places & Things 26
27 PTSD Substance Induced Mood Disorder Adjustment Disorders Borderline, Antisocial, or Cluster B characteristics 27
28 Hepatitis C HIV Heart Disease Peripheral Vascular Problems Malnutrition Renal Disease 28
29 Full Antagonist Lock & Key Dose 50 mg per Day or 50mg Every Other Day Monitor Liver Functions Initial Side Effects Accommodation Like a Salve 29
30 Legal System Health Care Professionals Others at Risk 30
31 Oral Parenteral Once per month Better outcomes Better compliance 31
32 Gabapentin Melatonin Relaxing Tea Avoid Valerian & Kava Kava Ibuprofen 32
33 Family EAP Programs Employers Legal System Sponsors and 12 step members 33
34 Group Support Supervision of Milieu 34
35 There will come a time when nothing stands between us and a drink except our Higher Power. We have a daily reprieve contingent upon the maintenance of our spiritual condition. 35
36 Trust Hope Acceptance 36
37 Contingency Management Mindfulness Dialectic Behavior Therapy Cognitive Behavioral Therapy Meditation 37
38 Think it Through A Day at a Time 38
39 Reliance on the strength they already have Get to know your patient Compassion Love 39
40 Boredom Tolerance of Discomfort Tolerance of Pleasure Change Vocabulary: Getting High 40
41 There will come a time when nothing stands between us and a drink except our Higher Power. We have a daily reprieve contingent upon the maintenance of our spiritual condition. 41
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