Naltrexone Overview. Todd Korthuis, MD, MPH ECHO-MAT Conference February 14, 2017
|
|
- Neil Reed
- 5 years ago
- Views:
Transcription
1 Naltrexone Overview Todd Korthuis, MD, MPH ECHO-MAT Conference February 14, 2017
2 Pharmacotherapy for Opioid Use Disorder % Mu Receptor Intrinsic Activity Full Agonist: Methadone ( How High ) Partial Agonist: Buprenorphine 10 0 no drug low dose Drug Dose Antagonist : Naltrexone high dose ( How Much )
3 Naltrexone for Opioid Use Opioid antagonist Blocks opioid μ, κ, and δ receptors Requires patient fully detoxified Oral formulation 50mg once daily Effective for treatment retention & opioid abstinence 1 Few drug-drug interactions 2 No CYP 450 metabolism Disorder Poor adherence limits effectiveness 1 Minozzi Cochrane McCance-Katz 2001
4 XR-Naltrexone for Opioid Dependence Intramuscular injection lasts 28d Efficacious compared to placebo: Comer: 60 U.S. heroin users at 8 weeks 1 Krupitsky: 250 Russian heroin users at 24 wks 2 Also effective for treatment of alcohol dependence 3 Improves retention in treatment 1 Comer Arch Gen Psych Krupitsky Lancet Garbutt JAMA 2005
5 Naltrexone Safety Minor side effects in treatment of alcohol and opioid dependence 1 Long-term mortality comparable to BUP/NX, Methadone in Australian cohort studies 2 Limited hepatotoxicity VA Data No increased hepatotoxicity 3 Russian RCT (42% HIV+, 88% HCV+) No difference in SAE or liver enzyme elevation by HIV or HCV status 4, 5 1 Lobmaier Reece Tetrault Krupitsky Mitchell McCance-Katz 2001
6 After 6 months Relapse: 43% Naltrexone 64% Usual Treatment Overdoses: 0 Naltrexone 7 Usual Treatment Lee NEJM
7 CTN-0055 Main Results XR-NTX acceptable to patients and providers Among AUD: Treatment Initiation by 4 weeks 92% XR-NTX vs. 93% TAU Treatment Retention at 16 weeks 83% XR-NTX vs. 50% TAU Among OUD: Treatment Initiation by 4 weeks 42% XR-NTX vs. 100% TAU Treatment Retention at 16 weeks 100% XR-NTX vs. 50% TAU
8 XR-NTX Induction General Principles Induction procedures will vary based on: Individual patient s medical needs Clinician s comfort level All patients should be advised regarding potential for precipitated withdrawal if they have recently taken opioids 8
9 Goal of XR-NTX Induction To safely initiate XR-NTX Avoid precipitated withdrawal Avoid opioid relapse prior to XR-NTX dosing 9
10 Recommended Clinical Detoxification and Naltrexone Induction Procedures Sigmon, Nunes, Woody et. al. Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice. Am J Drug Alc Abuse, 2012; 38(3):
11 Tailoring XR-NTX Induction to Patient 1. Alcohol use disorder and no recent opioid use 2. Opioid use disorder and no recent opioid use 3. Opioid and/or alcohol use disorder with recent opioid use 11
12 XR-NTX Induction Alcohol use disorder and no recent opioid use Proceed directly to XR-NTX, if: Negative self-report of opioid use, and UDS negative for opioids If in doubt, perform naloxone challenge 12
13 XR-NTX Induction Opioid use disorder and no recent opioid use Proceed to XR-NTX when: Negative self-report of opioid use UDS negative for opioids Negative naloxone challenge Preferred, but may be omitted per clinician discretion (e.g. patient enrolling on release from jail) 13
14 14 XR-NTX Induction Opioid and/or alcohol use disorder with recent opioid use: Always requires naloxone challenge Tailor to level of anticipated opioid withdrawal Mild Non-opioid medications for symptom management Moderate-Severe Non-opioid medications for symptom management Opioid-Assisted Detox Buprenorphine May consider outpatient home detox Methadone
15 Streamlined Naltrexone Induction Procedures 5-Day Columbia Induction Protocol* Bup/nx Oral Naltrexone XR- Naltrexone Withdrawal Prophylaxis Monday 2mg-8mg - - Supportive Meds Tuesday - - Supportive Meds Wednesday - 1-3mg - Supportive Meds Thursday mg - Supportive Meds Friday - 25mg 380mg im Supportive Meds *Sullivan, Bisaga, & Nunes, AJP 2017
16 Extended-Release Naltrexone Directions for Use
17 The XR-NTX Kit 17 One vial of XR-NTX microspheres One vial of diluent One 5-mL syringe One 1-inch 20-gauge preparation needle Two 1.5-inch 20-gauge administration needles with aqua needle protection device Two 2-inch 20-gauge administration needles with orange needle protection device
18 XR-NTX Storage XR-NTX is shipped in temperaturecontrolled conditions XR-NTX should always be kept refrigerated at temperatures 2 8 C, F, not frozen Unrefrigerated XR-NTX microspheres can be stored at temperatures not exceeding 25 C or 77 F for no more than 7 cumulative days prior to administration
19 XR-NTX Preparation Must be prepared and administered by a healthcare professional Parenteral products should be visually inspected for particulate matter and discoloration prior to administration Do not substitute for the components in the carton Must be removed from refrigerator for at least 45 minutes prior to administration, and allowed to reach room temperature Use the preparation needle to add the diluent to the microspheres vial Mix powder and diluent by shaking vial vigorously for approximately 1 minute, ensuring the dose is thoroughly suspended
20 XR-NTX Preparation (Continued) Once suspension is reconstituted, administer immediately Withdraw suspension immediately into the syringe using same preparation needle Replace preparation needle with one of the administration needles provided (1.5 inches or 2 inches) Body habitus: assure that proper needle is selected and that the needle length is adequate for intramuscular administration Inadvertent subcutaneous injection of XR-NTX may increase likelihood of severe injection site reactions Prepare 4.2 ml of suspension to administer 4 ml immediately by deep intramuscular (IM) injection into the upper, outer quadrant of the gluteal muscle Dispose of used and unused items in proper waste containers
21 XR-NTX Administration XR-NTX given as an IM gluteal injection every 4 week Inject into the upper, outer quadrant of the buttock, deep into the muscle The buttock should be alternated per monthly injection XR-NTX must not be administered intravenously, subcutaneously, or in the adipose layer. Remember to aspirate for blood before injection. Should be administered with caution to patients with thrombocytopenia or any coagulation disorder
22 What Could Possibly Go Wrong? Precipitate Opioid Withdrawal Sudden onset of new diaphoresis, papillary dilatation, restlessness, rhinorrhea, arthralgias, vomiting, diarrhea, tremor, anxiety/irritability, or piloerection Needle clogging Firm pressure Switch needles is needed Can be avoiding by administering at room temp immediately Post-injection nausea Injection site reaction
23 Risk of Precipitated Withdrawal % Mu Receptor Intrinsic Activity Full Agonist (e.g. heroin) 70 ( How High ) Partial Agonist (e.g. buprenorphine) no drug low dose Antagonist (e.g naltrexone) high dose 23 Drug Dose ( How Much )
24 Management of Precipitated Withdrawal Prevention Goal: zero precipitated withdrawals Withdrawal symptoms typically mild for those with negative UDS Non-opioid medications for symptom management 24
25 Re-Induction onto XR-NTX Within 35 days of the previous dose Usually safe regardless of UDS or selfreported recent use since NTX blockade effective up to 35 days Beyond 35 days since previous dose Risk of re-developing physical dependence increased Negative opioid UDS required Naloxone challenge (if clinically indicated) 25
26 Thank You
27 Supplemental Slides
28 Naloxone Challenge why? A more comfortable XR-NTX induction Performed to confirm the absence of opioids The presence of opioids during naltrexone induction may precipitate uncomfortable withdrawal symptoms 28
29 Naloxone Challenge: Method Dose: min total 0.8 mg naloxone Preferred route: 1) IV, 2) SC, 3) IM, or 4) IN Observe for opioid withdrawal at least 10 minutes when IV 30 minutes when SC, IM, or IN Positive naloxone challenge: onset of new opioid withdrawal symptoms and/or signs of worsening symptoms COWS flow sheet 29
30
31 Positive Naloxone Challenge Provide non-opioid medications to treat withdrawal symptoms. Encourage patient to continue to abstain from opioids. Have patient return daily for repeat UDS and naloxone challenge until both are negative. 31
32 Negative Naloxone Challenge If opioid withdrawal symptoms do not worsen or emerge following the naloxone challenge Proceed to XR-NTX administration 32
33 Provider Acceptance of XR-NTX Survey results from 107 providers in 12 HIV clinics 22% of providers said they currently intend to recommended XR-NTX Intent to Recommend XR-NTX Associated with: For Opioid Use Disorder aor (95% CI) For Alcohol Use Disorder aor (95% CI) High belief medication is effective 8.5 (1.6, 44.3) 9.2 (2.3, 36.5) Buprenorphine waiver 5.3 (1.3, 21.6) 1.06 (0.27, 4.08) High social norm 16.5 (3.9, 68.9) 5.3 (1.6, 17.2) Korthuis AMERSA abstract 2014
34 Patient Acceptability Survey of 657 community-based injection opioid users, Vancouver, BC 1 52% Willing to try XR-NTX for opioid use disorder Prescreening of 113 patients: 98% opioid users (n=60), 100% risky alcohol users (n= 82) were definitely or maybe willing to participate in a trial of XR-NTX. 1 Ahamad, Korthuis 2015 ASCP
35 Role of Buprenorphine for Naltrexone Induction (Moderate-Severe Withdrawal, Brief taper) Day 1 Day 2 Day 3 Buprenorphine Dose 4mg, repeat to total of 8-16mg Half of day 1 dose Half day 2 dose Wait 1-3 days for naloxone challenge Non-opioid meds for symptom relief 35
36 Role of Buprenorphine for Induction (Moderate-Severe Withdrawal, 7-day taper) Buprenorphine Dose Day 1 4mg, repeat to total of 12-16mg Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 12mg 10mg 8mg 4mg 2mg 2mg 36 Wait at least 3 days for naloxone challenge Non-opioid meds for symptom relief CTN 002
37 Role of Oral Naltrexone for Induction Opioid use disorder When unable to proceed to XR-NTX same day Give 25mg-50mg po and have patient return next day Alcohol use disorder As bridging measure until XR-NTX induction 12mg-50mg QD Waiting hrs after last dose of oral NTX to begin XR-NTX decreases nausea 37
Naltrexone Overview. Todd Korthuis, MD, MPH ECHO-MAT Conference November 7, 2017
Naltrexone Overview Todd Korthuis, MD, MPH ECHO-MAT Conference November 7, 2017 Disclosure Information Speaker/Planner: Todd Korthuis, MD, has nothing to disclose. 2 Pharmacotherapy for Opioid Use Disorder
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 informationOpioids Research to Practice
Opioids Research to Practice CRIT/FIT 2016 April 2016 Daniel P. Alford, MD, MPH Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research and Education
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 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 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 informationMain Results and Clinical Implications of the X:BOT Trial: XR-Naltrexone vs. Buprenorphine-Naloxone Film
Main Results and Clinical Implications of the X:BOT Trial: XR-Naltrexone vs. Buprenorphine-Naloxone Film July 31 st, 2018 Hosted by John A. Renner, Jr., MD, DLFAPA Professor of Psychiatry Boston University
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 informationBuprenorphine and MAT 101
Buprenorphine and MAT 101 Why is Medication Assisted Treatment so Important for Recovery? KEN SAFFIER, MD 7 TH ANNUAL INTEGRATION SUMMIT DECEMBER 8, 2016 Disclosures: u Ken Saffier, MD, has nothing to
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 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 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 informationOverview of Medication Assisted Treatment Methadone, Buprenorphine and Naltrexone
Overview of Medication Assisted Treatment Methadone, Buprenorphine and Naltrexone Alexander Y. Walley, MD, MSc Associate Professor of Medicine Director, Addiction Medicine Fellowship Boston University
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 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 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 informationRates of Opioid Overdose Deaths, Sales, and Treatment Admissions: US,
Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions: US, 1999 21 8 Rates of Prescription Painkiller Sales, Deaths, and Substance Abuse Treatment Admissions (1999 21) 7 Rate 6 5 4 3 Sales per
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 informationPharmacotherapy for Opioid Dependence in Correctional Settings: Research Findings and Recommendations
Pharmacotherapy for Opioid Dependence in Correctional Settings: Research Findings and Recommendations Robert P. Schwartz, M.D. Rschwartz@friendsresearch.org Friends Research Institute www.friendsresearch.org
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 informationSW OREGON OPIOID SUMMIT. Medication Assisted Recovery for Opioid Use Disorder. Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass
SW OREGON OPIOID SUMMIT Medication Assisted Recovery for Opioid Use Disorder Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass Opioid Agonists Mu (μ) receptors stimulated by opioids causing full
More informationNaltrexone (Extended-Release Naltrexone [XR- NTX]) primer for MAT mentors
Naltrexone (Extended-Release Naltrexone [XR- NTX]) primer for MAT mentors Joshua D. Lee MD MSc New York University School of Medicine Department of Population Health May 8, 2014 Joshua Lee, Disclosures
More informationExtended-Release Naltrexone for Opioid Relapse Prevention
Extended-Release Naltrexone for Opioid Relapse Prevention 1.NYU SOM; Bellevue Hospital Center 2.Brown Univ. 3. Friends Research Institute 4. Columbia Univ. 5. Univ. Pennsylvania 6. Univ. Virginia Funding:
More informationShawn A. Ryan MD, MBA President & Chief Medical Officer Board Certified, Addiction Medicine
[Patient-focused, evidence-based addiction treatment] Shawn A. Ryan MD, MBA President & Chief Medical Officer Board Certified, Addiction Medicine BrightView Health All Rights Reserved www.brightviewhealth.com
More informationLatest Research on Addiction and Treatment
Latest Research on Addiction and Treatment Joshua D Lee MD MSc joshua.lee@nyumc.org / @DrJoshuaDLee Associate Professor NYU School of Medicine, Department of Population Health Disclosures, LeeJD Grants:
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 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 informationWHEN & HOW TO GET STARTED
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences XR-NALTREXONE for the Treatment of OPIOID USE DISORDER: WHEN & HOW TO GET STARTED Matt Iles-Shih, MD Acting Assistant
More informationNaltrexone for Opioid Use Disorder. A Project RAMP Resource Adam J. Gordon, MD MPH FACP DFASAM CMRO December 2017
Naltrexone for Opioid Use Disorder A Project RAMP Resource Adam J. Gordon, MD MPH FACP DFASAM CMRO December 2017 LEARNING OBJECTIVES Be able to inform patients regarding the use and latest literature of
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 informationLong-Acting Injectables: Pharmacological Information
Long-Acting Injectables: Pharmacological Information J Code/ J2315 INJECTION NALTREXONE DEPOT FORM 1 MG Injection, naltrexone, depot form, 1 mg [Vivitrol ] VIVITROL (naltrexone for extended-release injectable
More informationIt s Not Just One More Thing! Overcoming Obstacles for Buprenorphine Treatment by Residents, Faculty and Programs
It s Not Just One More Thing! Overcoming Obstacles for Buprenorphine Treatment by Residents, Faculty and Programs Ken Saffier, MD Maureen Strohm, MD May 7, 2017 Disclosures Ken Saffier, MD, has nothing
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 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 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 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 Objectives Review Full Opioid
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 informationOpioid Use Disorder Treatment Initiation in Diverse Settings
Opioid Use Disorder Treatment Initiation in Diverse Settings Sarah Wakeman, MD, FASAM Medical Director, Mass General Substance Use Disorder Initiative Assistant Professor, Harvard Medical School Disclosures
More informationPCSS Guidance. Monitoring of Liver Function Tests in Patients Receiving Naltrexone or Extended-Release Naltrexone
PCSS Guidance Topic: Original Author: Edited by: Monitoring of Liver Function Tests in Patients Receiving Naltrexone or Extended-Release Naltrexone Sandra A. Springer, M.D. (September 1, 2014; 1 st revision
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 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 informationLong term treatment for opioid dependence Antagonist therapy
Long term treatment for opioid dependence Antagonist therapy Treatment of Opioid Dependence Antagonist treatment Naltrexone Naltrexone (NTX) synthesized in 1965 Eliminate drug carving and prevent relapse
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 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 informationDr Alistair Dunn. General Practitioner Whangarei
Dr Alistair Dunn General Practitioner Whangarei 1982 Temgesic = Buprenorphine Sublingual opiate analgesic 0.2 mg Popular drug of abuse 1991 Temgesic NX = Bup & Nalxone Nalxone added to deter abuse 1999
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 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 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 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 informationRECONSTITUTION, DOSING AND ADMINISTRATION
Prescribing Information can be found within this document CORRECT RECONSTITUTION FOR SC AND IV ADMINISTRATION VELCADE (bortezomib) 3.5 mg powder for solution for injection is available for intravenous
More informationHealth Systems and Addiction: Provider Issues
Health Systems and Addiction: Provider Issues The Emerging Roles of Primary Care Patrick G. O Connor MD, MPH Dan and Amanda Adams Professor of General Medicine Chief, General Internal Medicine Yale University
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 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 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 informationSustained-release preparations of naltrexone for the treatment of alcohol and opioid dependence: current status
Sustained-release preparations of naltrexone for the treatment of alcohol and opioid dependence: current status Linda R. Gowing, Discipline of Pharmacology, University of Adelaide Sarah Larney, National
More informationEXTENDED-NALTREXONE for the Treatment of OPIOID USE DISORDER:
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences EXTENDED-NALTREXONE for the Treatment of OPIOID USE DISORDER: September 13, 2018 Matt Iles-Shih, MD Acknowledgement:
More informationVirginia Opioid Addiction ECHO*
Virginia Opioid Addiction ECHO* Project ECHO: July 27th *ECHO: Extension of Community Healthcare Outcomes Agenda Agenda Agenda Introductions Clinical Director Administrative Medical Director ECHO Hubs
More informationDISCLOSURES MANAGEMENT OF OPIOID USE DISORDERS LECTURE COVERS. SUDs ARE IMPORTANT. I have nothing to declare
MANAGEMENT OF OPIOID USE DISORDERS DISCLOSURES Marc A Schuckit Distinguished Professor of Psychiatry, UCSD Medical School I have nothing to declare SUDs ARE IMPORTANT Affect > 20% of your patients Are
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 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 informationApproaches to Treatment of Youth with Opioid Addiction
Approaches to Treatment of Youth with Opioid Addiction Marc Fishman MD Mountain Manor Treatment Center Johns Hopkins University What should we do with this case? 17 M Onset prescription opioids 15, progressing
More information4/5/2018 MEDICATION ASSISTED TREATMENT FOR OPIOID USE DISORDERS OBJECTIVES DEFINITION OF ADDICTION APRIL 11, 2018 RITU BHATNAGAR, M.D., M.P.H.
MEDICATION ASSISTED TREATMENT FOR OPIOID USE DISORDERS APRIL 11, 2018 RITU BHATNAGAR, M.D., M.P.H. MEDICAL DIRECTOR, UNITYPOINT HEALTH MERITER/ NEWSTART ADJUNCT PROFESSOR, UNIVERSITY OF WISCONSIN MADISON
More informationVIVITROL (naltrexone for extended-release injectable suspension) A µ-opioid Receptor Antagonist
MECHANISM OF ACTION VIVITROL (naltrexone for extended-release injectable suspension) A µ-opioid Receptor Antagonist VIVITROL is indicated for prevention of relapse to opioid dependence, following opioid
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 informationMeeting the Need Doing more to help address the crisis of opioid and alcohol dependence
Opioid Dependence Newsletter Series MeetingTheNeed.CurrentPsychiatry.com INDICATIONS VIVITROL is indicated for: Treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient
More informationLinkage and Retention in Care for Vulnerable Populations. Lisa R. Metsch Columbia University
Linkage and Retention in Care for Vulnerable Populations Lisa R. Metsch Columbia University No Financial Disclosures or Conflicts Study data presented here are supported by National Institutes on Drug
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 informationTHE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE. Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept.
THE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept. Public Health disclosures Dr. Martin has no conflict of interest to disclose.
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 informationSafe Practices and Action Items
Safe Practices and Action Items Karen F Marlowe, Pharm D, BCPS Certified Pain Educator Auburn University Harrison School of Pharmacy University of South Alabama School of Medicine Case Study A 58 year
More informationGuidance For The Use Of Naltrexone In The Maintenance Of Abstinence in Formerly Opioid Dependent Adults By Clinicians Working Within NHS Grampian
Title: Identifier: Guidance For The Use Of Naltrexone In The Maintenance Of Abstinence in Formerly Opioid Dependent Adults By Clinicians Working Within NHS Grampian NHSG/Guide/NHSG_NaltexMA_885 Replaces:
More informationTreatment of Youth Opioid Addiction: Approaches to a Modern Epidemic. What should we do with this case? Heroin Addiction History
Treatment of Youth Opioid Addiction: Approaches to a Modern Epidemic What should we do with this case? 17 M Onset prescription opioids 15, progressing to daily use with withdrawal within 8 months Onset
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 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 informationExtended-Release Naltrexone for Opioid Relapse Prevention Among Community Criminal Justice Participants
Extended-Release Naltrexone for Opioid Relapse Prevention Among Community Criminal Justice Participants JD Lee 1, PD Friedmann 2, TW Kinlock 3, EV Nunes 4, CP O Brien 5 1. New York University School of
More informationResponding to the Opioid Epidemic
Responding to the Opioid Epidemic Jessica Gray, MD Addiction Medicine Fellow Boston Medical Center ROME New England August 17, 2017 Disclosures for Jessica Gray, MD No conflicts Learning Objectives Describe
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 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 informationThe Opioid Crisis: What Can Physicians Do About It?
The Opioid Crisis: What Can Physicians Do About It? Richard S. Schottenfeld, M.D. Professor and Chair, Department of Psychiatry and Behavioral Sciences 2018 Louis J. Kolodner Memorial Lecture Disclosures
More informationMedication Assisted Treatment for Opioid Use Disorders and Veteran Populations
Medication Assisted Treatment for Opioid Use Disorders and Veteran Populations Kamala Greene Genece, Ph.D. VP, Clinical Director Phoenix Houses of New York Benjamin R. Nordstrom, M.D., Ph.D. President
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 informationMETHADONE TO BUPRENORPHINE TRANSFERS TRANSITIONING FROM METHADONE MAINTENANCE TO BUPRENORPHINE/NALOXONE
METHADONE TO BUPRENORPHINE TRANSFERS TRANSITIONING FROM METHADONE MAINTENANCE TO BUPRENORPHINE/NALOXONE Work with methadone clinic staff to coordinate the methadone taper, with the transition to buprenorphine/naloxone:
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 informationOpioid Stewardship and Managing the Opioid Crisis: A Health-Care Perspective
Opioid Stewardship and Managing the Opioid Crisis: A Health-Care Perspective February 13, 2018 Frank Vocci, PhD New Therapies on the Horizon The planners, editors, faculty and reviewers of this activity
More informationArizona s Opioid Epidemic
Arizona s Opioid Epidemic Rise in Heroin Addiction and the Dangers of Fentanyl Sara Salek, MD Chief Medical Officer Shana Malone, MS Clinical Initiatives Project Manager 1 Disclosures None The National
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 informationArtesunate 60 mg for injection WHOPAR part 3 November 2015 (Guilin Pharmaceutical Co., Ltd.), MA051 PATIENT INFORMATION LEAFLET
PATIENT INFORMATION LEAFLET 1 PATIENT INFORMATION LEAFLET: INFORMATION FOR THE USER Artesun 60mg * Artesunate 60 mg for injection and sodium bicarbonate injection 50 mg/ml (1ml) and sodium chloride injection
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 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 informationDidactic Series. Opioid Dependence and HIV Care. Theo Katsivas, MD MAS, AAHIVS Associate Clinical Professor Owen Clinic, UCSD 10/25/2018
Didactic Series Opioid Dependence and HIV Care Theo Katsivas, MD MAS, AAHIVS Associate Clinical Professor Owen Clinic, UCSD 10/25/2018 Physicians: This activity has been planned and implemented in accordance
More informationCAM2038 A new liquid-lipid crystal depot buprenorphine: A dose-ranging suite of weekly and monthly subcutaneous depot injections
CAM2038 A new liquid-lipid crystal depot buprenorphine: A dose-ranging suite of weekly and monthly subcutaneous depot injections Dr. Fredrik Tiberg Assoc. Prof. President & CEO, Head R&D, Camurus Lund,
More informationDISCLAIMER. Original Effective Date: 6/23/14. Subject: Vivitrol (naltrexone for extended-release injectable suspension) Policy Number: MCP-177
Subject: Vivitrol (naltrexone for extended-release injectable suspension) Policy Number: MCP-177 Original Effective Date: 6/23/14 Revision Date(s): Review Date(s): 12/16/15; 9/15/2016; 6/22/2017 DISCLAIMER
More informationAdvancing Addiction Science to Address the Opioid Crisis
Advancing Addiction Science to Address the Opioid Crisis National Institute on Drug Abuse Bringing the full power of science to bear on drug abuse and addiction Nora D. Volkow, M.D. Director National Institute
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 informationScreening, Diagnosis, and Medication Assisted Treatment for Alcohol Use Disorders
Psychiatry and Addictions Case Conference Screening, Diagnosis, and Medication Assisted Treatment for Alcohol Use Disorders MARK DUNCAN, MD Acting Assistant Professor, Co-lead University of Washington
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 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 informationVivitrol/Suboxone. Comparison Study Summary
Vivitrol/Suboxone Comparison Study Summary Lee, J. D., Nunes, E. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S., & King, J. (2017). Comparative effectiveness of extended-release naltrexone versus
More informationPrescribing Framework for Naltrexone in Relapse Prevention (Opioid Dependence)
Hull & East Riding Prescribing Committee Prescribing Framework for Naltrexone in Relapse Prevention (Opioid Dependence) Patients Name: Unit Number: Patients Address:.. G.P s Name:.. Communication We agree
More informationInjectable extended-release naltrexone for the prevention of relapse to opioid dependence following opioid detoxification
Review Injectable extended-release naltrexone for the prevention of relapse to opioid dependence following opioid detoxification Evgeny Krupitsky* Practice points Injectable extended-release naltrexone
More information