MEDICATION ASSISTED ADDICTION TREATMENT: Appropriate Use Louis E. Baxter, Sr., M.D., DFASAM Executive Medical Director-PAPNJ Assistant Clinical Professor Medicine Rutgers New Jersey Medical School DMHAS-Addiction Medicine Consultant American Society Addiction Medicine Past President American Board Addiction Medicine-Director 609-919-1660
Goals and Objectives The scope of a Full Treatment Plan FDA approved medication for SUDs Safe Medication in Pain and Psychiatric conditions The current status of MAT use in the Nation (~1/5 of treatment facilities)
Full Addiction Treatment is Detoxification Rehabilitation counseling (ASAM Criteria) Full Medical and Psychiatric Assessment Continuing Care (Medical, Psychiatric, and counseling) Psychosocial Assessment (legal, marital, & financial) 12 Step and Supportive Recovery MAT (Medication Assisted Therapies)
ASAM Criteria Short Version
Medication Assisted Therapies- FDA Approved Medications for detoxification Medications for maintenance Medications for Psychiatric Illnesses Medical Management of Pain
Medications for Detoxification Librium Alcohol and Benzodiazepine Detoxification Benzodiazepine & Phenobarbital Benzodiazepine detoxification Suboxone (Subutex) & Methadone Opiate Detoxification Clonidine & Naltrexone..Opiate detoxification Bromocryptine & Amantadine Stimulant Detoxification Welbutrin Cannabis Detoxification/Nicotine Chantix & Nicotine products Nicotine
Medications for Maintenance Buprenorphine.Opiate dependence Methadone. Opiate Dependence Acamprosate. Alcohol Dependence Naltexone. Alcohol and Opiate dependence Vivitrol... Alcohol and Opiate Dependence Disulfram. Alcohol Dependence Nicotine Replacement Nicotine Dependence
STATUS OF ALCOHOL TREAMENT More Treatment Options than ever before New medications and psychosocial approaches Guidelines for use of medications in actively using alcohol patients and patients in recovery Treatment in outpatient and primary care settings ASAM Levels I and II Medications help promote and sustain recovery Problem Less than 1/5 of facilities are using new pharmacotherapy (barriers?) Need to engage physicians and providers to move forward in pace with the new developments in alcohol treatment
Medications for Alcohol Dependence FDA Approved Disulfiram aversion therapy Oral Naltrexone reduction in craving Injectable Naltrexone compliance Acamprosate reduction in cravings, and prolonged withdrawal syndromes
Disadvantages of Medication Therapy Use in lieu of full treatment experience Burdensome regimes and side-effects may undermine commitment to recovery Poor medication selection must patient needs Premature discontinuation of medications ( need to match with patient s recovery status)
Adjunctive Medications Psychiatric Co-Morbidities SSRIs Affective Depressant Disorders Buspar.. Anxiety Disorders Benzodiazepines (Oxazepam, Librium, Klonopin) in special psychiatric cases (GAD, Panic Disorder, Agoraphobia) Phenothiazines... Affective Disorders (Schizophrenia) Lithium.. Major Depression Trazadone.. Insomnia Cymbalta Depression and pain Other Medications for Medical Problems under medical supervision
Patients with SUD and Pain NSAIDs. at maximum dosages ATC Methadone. In combination with NSAIDs Buprenorphine in combination with NSAIDs Cymbalta in combination buprenorphine & NSAIDS Neuroleptics in combination with other meds SSRIs. Have been shown to be useful Clonidine for neuropathic pain Clonazepam. For lancinating pain Baclofen..for central nervous system pain LONG Acting Narcotics. Medical supervision
TREATMENT ISSUES Mobile Medication Van 6 communities Needle Exchange Program Mobile Methadone and Buprenorphine New Drug Protocols Peer Review-Control Group Studies
Summary the Beginning Addiction treatment is growing up Pharmacotherapy has arrived Pharmacotherapy is not in lieu of traditional therapy Pharmacotherapy is an integral part of a full treatment experience Pharmacotherapy is not for everyone The need for pharmacotherapy should not lead to exclusion from treatment programs