The ABCs of Medication Assisted Treatment

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1 The ABCs of Medication Assisted Treatment J E F F R E Y Q U A M M E, E X E C U T I V E D I R E C T O R C O N N E C T I C U T C E R T I F I C A T I O N B O A R D

2 The ABCs of Medication Assisted Treatment Full Disclosure Medication Assisted Treatment is the standard of care for individuals with opioid use disorders. That being said, I am not an advocate for Medication Assisted Treatment specifically, but for recovery overall, by any route an individual chooses

3 The ABCs of Medication Assisted Treatment Goals for this morning Understand the basics of Opioid Use Disorders Define what Medication Assisted Treatment is Identify why medications may be necessary Identify medications used in the treatment of Opioid Use Disorders Challenge common myths associated with Medication Assisted Treatment

4 The ABCs of Medication Assisted Treatment WHY IS UNDERSTANDING OF MEDICATION ASSISTED TREATMENT FOR OPIOID USE DISORDERS IMPORTANT?

5 The ABCs of Medication Assisted Treatment SIMPLE: We are in the midst of a national opioid crisis! Approximately 500,000 to 650,000 active heroin users nationally 2700 overdose deaths 2.1 million people addicted to Rx opioids Overdose deaths QUADRUPLED in the 21 st century

6 The ABCs of Medication Assisted Treatment SIMPLE: We are in the midst of a national opioid crisis! Opioid Addiction has behavioral, cognitive, affective and NEUROBIOLOGICAL components. All must be addressed as a part of effective treatment We often treat the components we see, but what about the neurobiological?

7 The ABCs of Medication Assisted Treatment UNDERSTANDING OPIOID USE DISORDERS

8 The ABCs of Medication Assisted Treatment Commonly Abused Opioids Hydrocodone (Vicodin) Oxycodone (Percocet, OxyContin) Codeine Morphine Fentanyl Heroin

9 The ABCs of Medication Assisted Treatment Short Term Effects Long Term Effects

10 The ABCs of Medication Assisted Treatment Opioid Effects

11 The ABCs of Medication Assisted Treatment Opioid Dependence is a constant and ongoing cycle of use and withdrawal opioid use withdrawal

12 Why do people switch from pain pills to heroin? The ABCs of Medication Assisted Treatment

13 The ABCs of Medication Assisted Treatment MEDICATIONS USED TO TREAT OPIOID USE DISORDERS

14 The ABCs of Medication Assisted Treatment Opioids are naturally produced in our brain, they help us deal with every day pain. How does the brain handle opioids that come in from the outside (at higher doses than naturally created)??? For opioid use disorders, medication are often necessary to simply normalize brain function.

15 The ABCs of Medication Assisted Treatment Treatment statistics There is an average of 306,000 patients receiving methadone to treat opioid addiction per day in the United States In 2009, over 5.7 prescriptions for buprenorphine (suboxone/ subutex) were filled in the United States The numbers may fluctuate, but it s simple: We have a huge problem!

16 The ABCs of Medication Assisted Treatment Agonist Methadone Compounds that activate/ turn on opioid receptors and initiate the action potential of the receptor The more you take, the more effect you have Dispensed in licensed opioid treatment programs ONLY Buprenorphine Partial Agonist Compounds that partially turn on the receptor and block further activation They have what is called a ceiling effect there is a point where adding more doesn t increase effects (SUBOXONE, SUBUTEX, VIVITROL) Dispensed in doctor s offices*

17 The ABCs of Medication Assisted Treatment Naloxone (Narcan) Antagonists Compounds that block activation of receptors with no other effects. In essence they kick out other compounds that are in the receptor sites. Used to treat an opioid overdose only. Not an effective long term treatment. Available without a prescription in CT through pharmacies

18 The ABCs of Medication Assisted Treatment Common Buprenorphine Side Effects Blurred vision dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position drowsiness irregular, fast, slow, or shallow breathing relaxed and calm feeling shortness of breath sleepiness unusual tiredness or weakness

19 The ABCs of Medication Assisted Treatment Common Methadone Side Effects feeling anxious, nervous, or restless; sleep problems (insomnia); feeling weak or drowsy; dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite; or decreased sex drive, impotence, or difficulty having an orgasm.

20 The ABCs of Medication Assisted Treatment Important Reminders SAMHSA recommends a minimum of 2 years (at a stable dose) of methadone maintenance with a slow taper (often as long as stable) for those who CHOOSE to get off the medication. Methadone is best used for individuals with long term heroin use (IV) who have struggled with other treatment modalities

21 The ABCs of Medication Assisted Treatment Important Reminders Buprenorphine treatment is generally much shorter (SAMHSA identifies a total of months for most effective treatment) Better used to treat individuals without the long term history of IV use Less restrictive that methadone treatment

22 The ABCs of Medication Assisted Treatment Important Reminders Medication administration alone is not considered effective treatment. Psychosocial supports, counseling and other interventions are necessary. These medications are considered corrective, not curative, meaning they only work as long as someone is taking them Refer to them as medications, not drugs!

23 The ABCs of Medication Assisted Treatment Important Reminders MAT is scientifically supported by over 50 years of research and when followed according to guidelines, is THE MOST effective treatment for opioid use disorders An individual receiving MAT services has been screened by a physician who is responsible for the prescribing. When someone questions the need for a client to be on MAT, I always ask

24 What medical school did you graduate from? When did you get your medical license? The ABCs of Medication Assisted Treatment

25 The ABCs of Medication Assisted Treatment MYTHS AND MISPERCEPTIONS

26 The ABCs of Medication Assisted Treatment Name something negative often attributed to medication assisted treatment Survey Says

27 The ABCs of Medication Assisted Treatment 1. It s just trading one drug for another. 2. They are not abstinent. 3. It s not real recovery. 4. They aren t welcome in 12 step groups. 5. It rots your bones/teeth. 6. It burns holes in your brain. 7. It is not FDA approved.

28 The ABCs of Medication Assisted Treatment THE ISSUE THAT IS OFTEN HARDEST TO DEAL WITH

29 The ABCs of Medication Assisted Treatment Issues Related to Pregnancy and Childbirth Most recent news: Methadone treatment during pregnancy not child abuse. NJ Supreme Court December 2014

30 The ABCs of Medication Assisted Treatment Issues Related to Pregnancy and Childbirth Methadone is still considered the gold standard for treatment of pregnant women with opioid use disorders Referrals for treatment often come from OB/GYN offices Over 50 years of research on pregnancy, childbirth and longitudinal development Of course there are risks and issues, but they are calculated against other options Some use of buprenorphine, but no long term studies available

31 The ABCs of Medication Assisted Treatment IN CLOSING

32 The ABCs of Medication Assisted Treatment Medication Assisted Treatment is not perfect, but it does Improve survival Increase treatment retention Decrease illicit opioid use Decrease infectious diseases (Hepatitis and HIV) Decrease criminal activities Increase employment Improve overall birth outcomes with perinatal addicts Improves communities

33 The ABCs of Medication Assisted Treatment RESOURCES S A M H S A. G O V M E T H A D O N E A N D P R E G N A N C Y. C O M C R C. G O V A D V O C A T E S F O R P R E G N A N T W O M E N. O R G A C O G. O R G

34 The ABCs of Medication Assisted Treatment QUESTIONS? CONCERNS?

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