Overview of Opioid Use Disorder
|
|
- Sarah Lee
- 6 years ago
- Views:
Transcription
1 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
2 Objectives History and epidemiology of opioid use disorders Why do people become addicted to opiates and why is it difficult to stop Overview of medication assisted treatment of opioid use disorders Questions
3
4 TABLE Drug relationships for withdrawal Methadone, 1 mg, is equivalent to Codeine, 30 mg Dromoran, 1 mg Fentanyl, 0.01 mg Heroin, 1 2 mg Hydrocodone, 0.5 mg Hydromorphone, 0.5 mg Laudanum (opium tincture), 3 ml Levorphanol, 0.5 mg Meperidine, 20 mg Morphine, 3 4 mg Oxycodone, 1.5 mg Paregoric, 7 8 ml Textbook of Substance Abuse Treatment, 4 th ed. Galanter, M.D., Marc.
5 Opiate Use - A Brief History 1980s Mass opiophobia leading to reports of pain undertreatment 1898 Heroin synthesized as safer, non-addictive upgrade from morphine, mass distribution 1970 Controlled Substances Act categorized regulated drugs under 5 schedules 2000s JCAHO deems pain fifth vital sign, opioid prescribing further increased dramatic rise in opioid misuse, abuse, ED visits 3400 BC Opium poppy cultivated in Mesopotamia 1800s Morphine isolated from opium, widely used in Civil War 1916 Oxycodone synthesized as safer upgrade from heroin 1990s New extendedrelease opioids, expanded use 2010s abusedeterrent formulations, education and public awareness, drug monitoring programs TIME [
6 SOURCE: National Institute on Drug Abuse,
7 A Growing Problem Chronic pain is defined as pain beyond the usual aches and pains that lasts for at least 3 months 10 % of all Americans report pain lasting longer than one year (Centers for Disease Control and Prevention, NATIONAL Center for Health Statistics 2006) The use of Chronic Opioid Therapy has increased dramatically over the last 20 years Emphasis on pain control (Now considered a vital sign) Aggressive marketing Decreased time spent with patients Improved treatment outcomes Change in patient expectations Not enough prescriber education
8
9
10
11
12 Missouri Prescribing Patterns?
13
14 Non-Prescription Use of Opioids In a month, 4.3 million Americans use prescription painkillers nonmedically Last year, 1.9 million Americans met criteria for prescription opioid use disorder Average age of first use 21.2 Despite increase in opioid prescriptions, there has been no overall change in amount of pain reported by Americans.
15 Age at time of Opioid Abuse/Misuse
16 Overdose On the Rise The most common drugs involved in OD include Methadone Oxycodone (OxyContin) Hydrocodone (Vicodin) More people died from drug OD in 2014 than any year on record. More than 6/10 involved an opioid. From , 165,000 Americans died from overdoses related to prescription opioids Americans die every day from overdose of prescription painkillers
17 Rates of Hospital Inpatient and ED Visits for Opioid Overuse by Region
18 60,000 Causes of Death in America ,000 40,000 30,000 20,000 10,000 0 Drug Overdoses HIV/AIDS Car Crashes Gun Homicides Source: Centers for Disease Control
19 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: Note: The percentages do not add to 100 percent due to rounding. 1 The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor's Office/Clinic/Hospital/Pharmacy," and "Some Other Way." Source: SAMHSA, 2011 National Survey Drug Use and Health
20 Heroin Use in the USA - Increasing 580 people initiate heroin use daily 2014 heroin OD deaths >10,500 (quadrupled from 2002) Mortality rate tripled since 2010, more than doubled among 18- to 25-yearolds Among new heroin users, approximately 75% report having abused prescription opioids prior to using heroin
21 Prescription Street Value - Roughly $1/mg - Large number of purchasers naive to illegal drug market so cost fluctuates So why do people move to heroin? - One study found availability is a large factor
22 DSM- 5 Criteria for Substance Use Disorder 2 or more of the following: Failure to fulfill obligations at work, home or school Recurrent use in hazardous situations Continued use despite recurrent social or interpersonal problems Tolerance Withdrawal Larger amounts/longer period than intended Persistent desire to cut back/quit Great deal of time using or recovering from use Social, occupational, recreational activities given up Continued use despite knowledge of physical, psychological consequences INTENSE CRAVING
23 Addictive Behavior = Survival Behavior Gone Awry (Courtesy of Steve LaRowe, PhD) Over the course of evolution, we have developed circuits in our brains that promote our survival. Drugs of addiction activate this survival circuitry to an exaggerated degree, and with chronic use, essentially take it over. In the late stages of addiction, an individual is basically a survivalist doing whatever it takes to acquire and use drugs regardless of the costs. Motivation has changed
24 Hijacking the Basic Survival Circuitry (Courtesy of Steve LaRowe, PhD)
25 Survival Circuits (Courtesy of Steve LaRowe, PhD) 1. Reward Circuitry -- LIKING 2. Memory Circuitry 3. Motivation, Drive Salience Circuitry CRAVING/WANTING 3. Orbital-Frontal Cortex 1. VTA 1. Nucleus Accumbens 2. Hippocampus 2. Amygdala
26 Opioid withdrawal Opioid Withdrawal Flushing Diarrhea Muscle cramps Flu-like sxs Nausea Agitation Hallucinations Stomach cramps Sleep problems Sweating STOP DRUG Days
27 Opioid Withdrawal Syndrome Protracted Symptoms Deep muscle aches and pains Insomnia, disturbed sleep Poor appetite Reduced libido, impotence, anorgasmia Depressed mood, anhedonia Drug craving and obsession
28 Environment Exposure Physical Illness Cognition Genes Traumatic Experiences Perceived Norms Substance Use Disorder Learned Coping Strategies Positive Effects Withdrawal Mental Illness Support Group Access to Treatment
29 Treatment of Opioid Use Disorder Prevention Education Patients and the public in general Physicians Monitoring Prescription Monitoring Programs Physician prescribing practices Access to appropriate Treatment for chronic pain Treatment Detoxification Limited efficacy- high relapse rates Treat co-morbid illnesses 12-step and community support groups
30 Medications for the treatment of withdrawal symptoms Symptom relief Autonomic excitability (jittery,restless)- clonidine Nausea/vomiting- perphenazine, ondansetron Diarrhea- Lomotil, loperamide Muscle cramps- cyclobenzaprine, methacarbamol Pain- NSAIDS Insomnia- trazodone, zolpidem
31 Medication Assisted Treatment (MAT) of Opioid Use Disorder Pharmacological Methadone: reduces mortality and morbidity, illicit drug use, criminal activity Suboxone (buprenorphine): more accessible, less potential for euphoric effects or overdose Naltrexone: perhaps better for patients with current employment, Sobriety as a contigency
32 Methadone Long acting opioid with limited euphoric effect Highly structured programs Ability to level up Dosing: mg/day Downsides: Limited access and flexibility Highly stigmatized Expensive and time consuming Can be associated with sedation, constipation and potentially dangerous interactions with other medications May be most appropriate for those with more severe opioid use disorders- highly structured treatment
33 Methadone regulations Regulated by Substance Abuse and Mental Health Services Administration (SAMHSA) and state agency Only provided in opiate treatment programs One year history of dependence and current use 18 and older, if younger must have failed 2 non opiate treatments in the prior 12 months and guardian consent Daily dosing, limited take home if doing well in the program Take home dose increases with successful time in clinic, up to 2 week supply after a year and a maximum of a month supply after 2 years Psychosocial treatments
34 Buprenorphine/naloxone (Suboxone) Regulation: Drug Addiction Treatment Act, (DATA 2000) allowing qualified physicians to prescribe Schedule III, IV, and V medications for the treatment of opioid addiction. MDs can receive training and obtain special permission from the DEA to prescribe this Makes opiate dependence treatment more accessible Required to refer to substance abuse treatment
35 Suboxone Partial activation of opioid receptor sites Prevents withdrawal and cravings Ceiling effect makes them safer in terms of overdose Opioids are unable to produce effect/euphoria Suboxone also contains naloxone Opioid receptor blocker Not absorbed sublingually Prevents injection
36 Partial vs. Full Opioid Agonist death Opiate Effect Full Agonist (e.g., methadone) Partial Agonist (e.g. buprenorphine) Dose of Opiate Antagonist (e.g. Naloxone)
37 Suboxone Dosing: 8 16 mg/day, ceiling of 24-32mg/day Most common side effects Constipation, sweating Usually not much sedative effect Potentially dangerous in patients with severe liver disease, uncontrolled alcohol use and use of other sedating medications
38 Buprenorphine/naloxone Three Stages of treatment: Induction: 2-3 day period of observed administration must be in mild to moderate opiate withdrawal Can be done in the hospital or in community setting Stabilization: Meeting weekly to monitor SE and cravings adjust dose to curb cravings and minimize withdrawal Maintenance: achieved sobriety stable dose
39 Rough Graph of Suboxone Induction Opiates Suboxone 20 0 Pre-Treatment Day 1 Day 2 Category 4
40 Naltrexone How it works: blocks opioids from binding to their receptors No effect from opiates Decreased cravings Patients have to be free from opioids for several days prior to starting this medication Can cause nausea, headaches and rare cases of liver damage. Prescription opiates will not work for pain control Available as a long acting injection (Vivitrol) Useful in individuals whose livelihood is contingent on sobriety
41 Duration of Treatment Substance use disorders are chronic diseases Genetics, life experiences, coping strategies, long term exposure to substances and other factors all contribute to the development of the condition. Not substituting one drug for another Decision to taper or stop is based on clinical picture and personal choices about treatment Like any other treatment, it is based on analysis of risk v. benefits
42
43 What treatment looks like html
44 Questions?
Module II Opioids 101 Opiate Opioid
BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!
More informationOpioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine
Natural derivatives of opium poppy - Opium - Morphine - Codeine Opioid Agonists Semi synthetics: Derived from chemicals in opium -Diacetylmorphine Heroin - Hydromorphone Synthetics - Oxycodone Propoxyphene
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 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 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 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 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 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 informationOpioids. Sergio Hernandez, MD
Opioids Sergio Hernandez, MD Required Slide Disclosures 1. SIGNIFICANT FINANCIAL INTERESTS NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT 2. GENERAL AND OBLIGATION INTERESTS All general
More informationOpioid Treatment in North Carolina SEPTEMBER 13, 2016
Opioid Treatment in North Carolina SEPTEMBER 13, 2016 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2007 Source Where Respondent Obtained
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 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 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 informationMain Questions. Why study addiction? Substance Use Disorders, Part 1 Alecia Schweinsburg, MA Abnromal Psychology, Fall Substance Use Disorders
Substance Use Disorders Main Questions Why study addiction? What is addiction? Why do people become addicted? What do alcohol and drugs do? How do we treat substance use disorders? Why study addiction?
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 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 informationCharles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus
Pain & Opioid Epidemic 2018 Charles P. O Brien, MD, PhD University of Pennsylvania No financial conflicts, patents, speakers bureaus Opioids 3400 BC Mesopotamia, Joy plant 1843 morphine by syringe 1874
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 information5/29/2015. Responding to the Opioid Crisis. Responding to the Opioid Crisis. Objectives
Responding to the Opioid Crisis Responding to the Opioid Crisis David Cohen Ramsen Kasha Objectives Gain knowledge on Current opioid epidemic Historical perspective of opioids The impact of opioids on
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 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 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 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 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 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 informationAddressing Alaska s Opioid Epidemic From Understanding to Action
Addressing Alaska s Opioid Epidemic From Understanding to Action The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction
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 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 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 informationOpioid Overdose Epidemic A Crises and Opportunity
Opioid Overdose Epidemic A Crises and Opportunity Samuel M. Silverman MD, FAPA, DFASAM Assistant Clinical Professor, UConn Medical School Director, Medical Education Rushford, A Hartford HealthCare Partner
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 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 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 informationMedication Assisted Treatment. Michael Palladini, RPh MBA CAC
Medication Assisted Treatment Michael Palladini, RPh MBA CAC palladini.michael@gmail.com History of MAT Addiction as a Disease The concept of addiction as a disease of the brain challenges deeply ingrained
More informationPrescription Opioid Addiction
CSAM-SCAM Fundamentals Prescription Opioid Addiction Presentation provided by Meldon Kahan, MD Family & Community Medicine University of Toronto Conflict of interest statement I received funds from Rickett
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 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 informationPharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco
Pharmacotherapy for opioid addiction Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Disclosure slide No commercial conflicts to disclose. Gaps in current treatment of opioid
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 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 informationOpioid Epidemic Update
Opioid Epidemic Update - 2018 Talal Khan MD Addiction Psychiatrist Pine Rest What are Opioids? Opiates are alkaloid compounds naturally found in the opium Poppy plant. Papaver somniferum The psychoactive
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 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 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 informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
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 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 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 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 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 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 informationThe Unseen Consequences of Prescription Drug Abuse. Stephen Loyd, M.D.
The Unseen Consequences of Prescription Drug Abuse Stephen Loyd, M.D. Stephen Loyd, M.D. Receives no commercial support, in any form, from pharmaceutical companies or anyone else Medical Director for Substance
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 informationDeveloped and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services
Developed and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services www.randallwebber.com MAT clients are still addicted Truth: MAT clients will experience withdrawal symptoms if they stop
More informationPAIN & ANALGESIA. often accompanied by clinical depression. fibromyalgia, chronic fatigue, etc. COX 1, COX 2, and COX 3 (a variant of COX 1)
Pain - subjective experience associated with detection of tissue damage ( nociception ) acute - serves as a warning chronic - nociception gone bad often accompanied by clinical depression fibromyalgia,
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 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 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 informationMayors Opioid Summit PATTERNS AND TRENDS OF THE OPIOID EPIDEMIC IN BROWARD COUNTY TYPES OF OPIOIDS DEFINITION OF OPIOID. Pill Press from China
The Opioid Epidemic In Broward County 8/24/217 Mayors Opioid Summit PATTERNS AND TRENDS OF THE OPIOID EPIDEMIC IN BROWARD COUNTY Jim Hall Senior Epidemiologist Center for Applied Research on Substance
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 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 informationUnderstanding and Combating the Heroin Epidemic
Understanding and Combating the Heroin Epidemic Kelly Dunn, Ph.D. Assistant Professor; Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences 1 Talk Outline What is causing the
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 informationAddressing Opiate Abuse
Addressing Opiate Abuse William B. Lawson, MD, PhD, DLFAPA Associate Dean of Health Disparities University of Texas at Austin Dell Medical School william.lawson@austin.utexas.edu Opioids Medications that
More informationHeroin, Fentanyl and Other Opioids. Steve Hanson
Heroin, Fentanyl and Other Opioids Steve Hanson Heroin/Opiates Neurotransmitter-receptor interactions To transmit instructions to cells, neurotransmitters interact with their receptors. receptor neurotransmitters
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 informationOpioids Research to Practice
Opioids Research to Practice May 2013 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Case 32 yo female brought in after heroin overdose
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 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 informationStrategies to Manage The Opioid Crisis
Strategies to Manage The Opioid Crisis Matt Feehery, LCDC Senior Vice President & CEO PaRC (Prevention & Recovery Center) Behavioral Health Services February 1, 2018 A Pill for Your Pain But my doctor
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 informationAttitudes Toward Medication-Assisted Treatment Within a Drug Court Program. Caroline Allison. Dr. Kathleen Moore, Ph.D.
Running Head: MEDICATION-ASSISTED TREATMENT ATTITUDES Attitudes Toward Medication-Assisted Treatment Within a Drug Court Program Caroline Allison Dr. Kathleen Moore, Ph.D. Department of Mental Health Law
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 informationWhat is an opioid? What do opioids do? Why is there an opioid overdose crisis? What is fentanyl? What about illicit or bootleg fentanyls?
What is an opioid? What do opioids do? Why is there an opioid overdose crisis? What is fentanyl? What about illicit or bootleg fentanyls? What is an opioid? What do opioids do?: The term opioid can be
More informationEvidence-Based Practices for the Treatment of Opioid Use Disorder. Zach Ludwig, LPC Corporate Director Clinical Programs Bradford Health Services
Evidence-Based Practices for the Treatment of Opioid Use Disorder Zach Ludwig, LPC Corporate Director Clinical Programs Bradford Health Services Objectives Review the scope of the opioid epidemic Discuss
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 informationRecognizing Narcotic Abuse and Addiction and Helping Those With It
Recognizing Narcotic Abuse and Addiction and Helping Those With It Michael McNett, MD Medical Director for Chronic Pain Member, WI Med Society Opioid Subcommittee Ancient History 1995: OxyContin approved
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 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 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 informationTop 10 narcotic pain pills
Top 10 narcotic pain pills Click to go to the item or just scroll down the page. Doctors Respond to FDA Panel Recommendations FDA Considers Banning Popular Prescription Pain Medications and. Top 10 Natural
More informationMedication for Addiction Treatment (MAT)
SBIRT Training Screening, Brief Intervention & Referral to Treatment Medication for Addiction Treatment (MAT) The Faith & Spirituality Integrated SBIRT Network Navigating the Training Welcome! These health
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 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 informationPreventing Opioid Misuse and Use: The Lucky Preventionist s Guide to Strategic Planning
Preventing Opioid Misuse and Use: The Lucky Preventionist s Guide to Strategic Planning 1 2 LUCK Where Preparation Meets Opportunity Opioids: Understanding how we got here How History Repeats Some Opiate
More informationOpioids and Opioid Addiction: Practical Management Approaches
Opioids and Opioid Addiction: Practical Management Approaches Yngvild Olsen, MD, MPH Medical Director Institutes for Behavior Resources Inc/REACH Health Services Conflict of Interest No financial or advisory
More information8/28/2017. Headlines. How Did We Get Here? Pain is the number one reason patients go the doctors office, urgent care and/or emergency room.
Ashel Kruetzkamp, MSN, RN, SANE Headlines How Did We Get Here? Pain is the number one reason patients go the doctors office, urgent care and/or emergency room. Opiates are the most effective pain 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 informationA Prescription for Education. Hillary Dubois, Director of Prevention Services Amanda Sandoval, Asst. Director of Prevention Services
A Prescription for Education Hillary Dubois, Director of Prevention Services Amanda Sandoval, Asst. Director of Prevention Services Addiction Release of abnormally large amounts of neurotransmitters, mainly
More informationModule Two: Pharmacotherapies for Opioid Substitution Treatment
Module Two: Pharmacotherapies for Opioid Substitution Treatment Neurobiology of Addiction Pharmacology of Opioids Methadone Buprenorphine Pharmacokinetics of Methadone & Buprenorphine Opioid effects Intoxication
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 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 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 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 informationThe Future of Prevention: Addressing the Prescription Drug Abuse and the Opioid/Heroin Epidemic in our Country
Integrating Primary and Behavioral Health Care Through the Lens of Prevention July 14, 2016 New Orleans, Louisiana The Future of Prevention: Addressing the Prescription Drug Abuse and the Opioid/Heroin
More informationOPIATES AND ADDICTION MEDICATIONS. Dr. Carroll W. Thornburg, D.O Chief Medical Officer in Primary Care and Addiction Services
OPIATES AND ADDICTION MEDICATIONS Dr. Carroll W. Thornburg, D.O Chief Medical Officer in Primary Care and Addiction Services Dr. Carroll W. Thornburg, D.O Chief Medical Officer in Primary Care and Addiction
More information2004-L SEPTEMBER
BULLETIN INTELLIGENCE Buprenorphine: Potential for Abuse Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E NDIC Within the past 2 years buprenorphine a Schedule III
More informationThe Rising Tide of Prescription Opioid Use Disorders and Current Treatment Options
The Rising Tide of Prescription Opioid Use Disorders and Current Treatment Options Michelle R. Lofwall, MD UK Dept of Psychiatry November 4, 2008 Outline for Today s Talk Past & current state of affairs
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 information