Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal

Size: px
Start display at page:

Download "Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal"

Transcription

1 Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Roger Cicala, M. D. Assistant Medical Director Tennessee Physician s Wellness Program Step 1 Don t 1

2 It is legal in every state to taper a pain patient s medication slowly to avoid withdrawal symptoms. Unless you have special certification, in most states it is NOT legal to detoxify a substance abuser. There are gray areas and certain circumstances where a pain doctor will need to handle withdrawal including hospitalized patients, non abusing patients with physical dependence, patient requests, etc. Tapering versus Detoxification To use schedule II opiates for detoxification from opiate addiction, a special registration is required: (21 Code of Federal Regulation (a)). Drug Abuse Treatment Act of 2000 allows physicians to use schedule III agents to detoxify chemical dependent patients in an office setting, provided the physician qualifies for and obtains a waiver issued through the Substance Abuse and Mental Health Services (SAMHSA) and the DEA. ** ** State regulations may require further registration 2

3 Tapering when it is necessary to discontinue a pain patient's opioid therapy by tapering or weaning doses, there are no restrictions with respect to the drugs that may be used. This is not considered "detoxification" as it is applied to addiction treatment. Patricia Good, Chief of Policy Section, Office of Diversion and Control Opioid Withdrawal Symptoms Opiate craving Sweating Restlessness Nervousness Fatigue Rhinorrhea Dilated pupils Yawning Increased respiration Irritability Anxiety Dysphoria Piloerection Muscle twitching Headache Anorexia 3

4 Severe Opioid Withdrawal Symptoms Fever Tachycardia Cutaneous Hypersensitivity Hypertension Isomnia Hot/cold flashes Nausea Vomiting Bone pain Muscle Aches/spasms Abdominal Cramps Diarrhea Benzodiazepine / Sedative Withdrawal Symptoms Anxiety / Agitation Hypertension / Tachycardia Sensory Hypersensitivity Insomnia Confusion / Delerium Cramps / Hyperreflexia Seizures Nightmares Mania Tremor / Fasciculations Tinnitus / Dizziness Lethargy 4

5 Time Course of Withdrawal Onset proportional to T1/2 of agent, daily amount. Duration somewhat proportional to rate of receptor turnover. Duration somewhat proportional to T 1/2 of agent. Severity somewhat proportional to daily dose. Severity less proportional to duration of use. Sedative Hypnotic and Benzodiazepine Tapering 5

6 Sedative / Benzo Withdrawal Peak symptoms not for 3-6 days Duration of withdrawal 3-6 weeks Mentation may improve for more than 6 months. Secondary symptoms (insomnia, anxiety, etc.) may not normalize for a year. Symptom rebound occurs - it is not withdrawal. INSOMNIA - 1 year plan. Sedative / Benzo Withdrawal CAN BE FATAL!! Concurrent alcohol use / abuse in 1/3 of benzodiazepine dependent patients. Severity of withdrawal seems worse in females. Patients with abuse history, strong family history of abuse, concurrent daily alcohol, significant psychiatric issues are not candidates for tapering. 6

7 Benzodiazepine Tapering Dose reduced 10% to 20% every 2 weeks. If withdrawal Sxs occur hold at that level for 1 month. The final 20% should be tapered over a month. Benzodiazepine Cross Tapering Chlordiazepoxide, Clonazepan, Phenobarbital are most commonly used. Patient started on equivalent dose, may need to be increased until stable. Stable dose continued 1 week, then reduced 20% every 3 days. The last 25% of dose is removed over 2 weeks. Cross tapering is recommended for Alprazolam and Soma tapering - but rate of tapering may need to be slower. 7

8 Opioid Tapering Opioid Withdrawal Onset 6 hours (short acting) to 36 hours (methadone). Peak Sxs 12 hours (short) to 72 hours (long acting). Duration 5 to 14 days. Secondary withdrawal - episode of withdrawal symptoms lasting hours to a couple of days - may occur for 6 months. 8

9 Standard Opioid Tapering Minor withdrawal symptoms occur 10% dose reductions per day or 25% every 3 days usually tolerated well. Clonidine 0.2 mg q 4-6 hours markedly reduces withdrawal severity. Usually tapered over 10 to 14 days. Low dose benzodiazepines or TCAs may also be useful. Rapid Detoxification Naltrexone or Buprenorphine, with or without clonidine and benzodiazepine. Withdrawal symptoms are more pronounced than tapering on first day. Withdrawal process is quicker. Long acting partial agonist minimizes effect of opiate if patient cheats. 9

10 Buprenorphine Detoxification Not appropriate for high dose opioids: majority of patients at 60 mg Methadone per day will have withdrawal symptoms. Usually begin after 12 hours abstinence - patient in mild withdrawal. Begin with 2 mg dose SL, repeated every 2 hours to maximum 16 or even 32 mg first day.. Once stable dose is reached it is usually continued for 2 to 3 days Patient is then tapered over 2 to 3 weeks. May use adjunctive medications if needed. Buprenorphine Detoxification from Long Acting Opiates Taper to methadone 30 mg / day equivalent 24 hrs after last dose, give buprenorphine 2 mg Withdrawal symptoms present? Yes Give buprenorphine 2 mg Withdrawal symptoms continue? Yes Repeat dose up to maximum 8 mg/24 hrs No No Daily dose established Withdrawal symptoms relieved? No Manage withdrawal symptomatically Daily Yes dose established Increase to 16 mg / day on day 2 Adapted from H. Heit, M. D.; 10

11 11

Withdrawal Symptoms: How Long Do They Last?

Withdrawal Symptoms: How Long Do They Last? Withdrawal Symptoms: How Long Do They Last? Posted by First Step Medical Detox on November 24, 2015 When considering stopping drugs or alcohol, many addicts and alcoholics are concerned about the withdrawal

More information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

KAP Keys. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction

KAP Keys. For Physicians. Based on TIP 40 Clinical 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 Knowledge Application Program KAP Keys For Physicians Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine

More information

Benzodiazepines: A Model for Central Nervous System (CNS) Depressants

Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Objectives Summarize the basic mechanism by which benzodiazepines work in the brain. Describe two strategies for reducing and/or eliminating

More information

NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT

NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT Opioid dependence is a devastating and frequently fatal medical condition. It is a manifestation of addictive disorder

More information

Information for Pharmacists

Information for Pharmacists Page 43 by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. Information for Pharmacists SUBOXONE (buprenorphine HCl/naloxone HCl

More information

Guidance for Disease Management in Correctional Settings OPIOID DETOXIFICATION

Guidance for Disease Management in Correctional Settings OPIOID DETOXIFICATION 1145 W. Diversey Pkwy. 773-880-1460 Chicago, Illinois 60614 www.ncchc.org Guidance for Disease Management in Correctional Settings OPIOID DETOXIFICATION NCCHC issues guidance to assist correctional health

More information

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors

More information

CONTROLLED SUBSTANCE CONTRACT

CONTROLLED SUBSTANCE CONTRACT CONTROLLED SUBSTANCE CONTRACT The purpose of this contract is to protect my access to controlled substances and to protect our ability to prescribe for you. The long-term use of substances such as opiates

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT/FIT 2015 May 2015 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research

More information

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care Hull & East Riding Prescribing Committee Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care 1. BACKGROUND Patients who are physically dependent

More information

Medications Used in the Treatment of Addiction Developed by Randall Webber, MPH. Alcohol Withdrawal

Medications Used in the Treatment of Addiction Developed by Randall Webber, MPH. Alcohol Withdrawal Medications Used in the Treatment of Addiction Developed by Randall Webber, MPH Alcohol Withdrawal MEDICATION Long/intermediateacting benzodiazepines (e.g., chlordiazepoxide/ Librium, diazepam/valium)

More information

Opioid Agreement for Center for Pain Management S.C.

Opioid Agreement for Center for Pain Management S.C. Opioid Agreement for Center for Pain Management S.C. Patient Name: DOB: I am the patient named above. I have agreed to use pain medication as part of my treatment for chronic pain. I understand that these

More information

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern

More information

The CCB Science 2 Service Distance Learning Program

The CCB Science 2 Service Distance Learning Program S2S 2055 DETOXIFICATION Module 1 Post-Test 1. A common use of a biochemical marker is. a. to support or refute other information that leads to proper diagnosis b. for forensic purposes c. in detecting

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT Program May 2011 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 information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Alcohol Withdrawal Recognition and Treatment

Alcohol Withdrawal Recognition and Treatment Alcohol Withdrawal Recognition and Treatment Thomas Meyer BS EMS, MICP SREMSC Page 1 Purpose As EMTs a mantle of responsibility is placed upon you to ensure the safety and well-being of those in your charge

More information

Use of Buprenorphine in the Treatment of Opioid Addiction

Use of Buprenorphine in the Treatment of Opioid Addiction 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 Which of the following is an

More information

Benzodiazepine Detoxification and Reduction of Long term Use

Benzodiazepine Detoxification and Reduction of Long term Use Benzodiazepine Detoxification and Reduction of Long term Use Malcolm Lader 1 Model of general drug misuse and dependence. Tactical interventional options Social dimension Increasing breaking of social

More information

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA

More information

Update on Buprenorphine: Induction and Ongoing Care

Update on Buprenorphine: Induction and Ongoing Care Update on Buprenorphine: Induction and Ongoing Care Elizabeth F. Howell, M.D., DFAPA, FASAM Department of Psychiatry, University of Utah School of Medicine North Carolina Addiction Medicine Conference

More information

Medication Assisted Therapy and Pregnancy: An Introduction

Medication Assisted Therapy and Pregnancy: An Introduction Medication Assisted Therapy and Pregnancy: An Introduction Deborah A. Orr, Ph.D. The Center For Drug Free Living Adapted from the NIDA Blending Initiative Curriculum Presentation Objectives Define opioids

More information

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013 Hulpverleningsmodellen bij opiaatverslaving Frieda Matthys 6 juni 2013 Prevalence The average prevalence of problem opioid use among adults (15 64) is estimated at 0.41%, the equivalent of 1.4 million

More information

Program Assistance Letter

Program Assistance Letter Program Assistance Letter DOCUMENT NUMBER: 2004-01 DATE: December 5, 2003 DOCUMENT TITLE: Use of Buprenorphine in Health Center Substance Abuse Treatment Programs TO: All Bureau of Primary Health Care

More information

Medication-Assisted Treatment (MAT) & What It Means Long-Term Gary K. Byrd., M.Ed., MAC, CCS, CAMS Methadone is the Gold Standard for treatment of chronic heroin addiction Gary Byrd 2015 1 Gary Byrd 2015

More information

Residential Sub-Acute Detoxification Guidelines

Residential Sub-Acute Detoxification Guidelines I. Background Information A. Definition of Detoxification Residential Sub-Acute Detoxification Guidelines SAMSA s TIP #45, Detoxification and Substance Abuse Treatment: Treatment Improvement Protocols

More information

Downers/Depressants (pages 40-50)

Downers/Depressants (pages 40-50) Downers/Depressants (pages 40-50) Read pages 49-54, 59-60, and 78-79 of the booklet, Street Drugs. Pages 40-50 of the text. Narcotics: Prescription Origin: Southeast Asia, Southwest Asia, and in the Western

More information

Ohio Legislative Service Commission

Ohio Legislative Service Commission Ohio Legislative Service Commission Bill Analysis Brian D. Malachowsky H.B. 378 130th General Assembly () Reps. Smith and Sprague BILL SUMMARY Prohibits a physician from prescribing or personally furnishing

More information

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Children/Adolescents

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Children/Adolescents Medical Necessity In considering the appropriateness of any level of care, the four basic elements of Medical Necessity should be met: 1. A diagnosis as defined by standard diagnosis nomenclatures (DSM

More information

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health? Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY OF OPIATE USE Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months

More information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Mark Fisher Program Administrator State Opioid Treatment Adminstrator Kentucky Division of Behavioral Health OBJECTIVES Learn about types of opioids and

More information

Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED

Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED Dr. Karine Meador MD CCFP DABAM Assistant Director Inner City Health and Wellness Team Physician Addiction Recovery and Community Health (ARCH)

More information

Prescription Drug Addiction

Prescription Drug Addiction Prescription Drug Addiction Dr Gilbert Whitton FAChAM Clinical Director Drug & Alcohol Loddon Mallee Murray Medicare Local Deniliquin 14 th May 2014 Prescription Drug Addiction Overview History Benzodiazepines

More information

Identifying Neonatal Abstinence Syndrome (NAS) and Treatment Guidelines University of Iowa Children s Hospital -2/11/13

Identifying Neonatal Abstinence Syndrome (NAS) and Treatment Guidelines University of Iowa Children s Hospital -2/11/13 Identifying Neonatal Abstinence Syndrome (NAS) and Treatment Guidelines University of Iowa Children s Hospital -// What is Neonatal Abstinence Syndrome? Neonatal withdrawal after intrauterine exposure

More information

This module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists,

This module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists, BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module II Opioids 101 Goals for Module II This module reviews the following: Opioid addiction and the brain Descriptions

More information

Treatment of opioid use disorders

Treatment of opioid use disorders Treatment of opioid use disorders Gerardo Gonzalez, MD Associate Professor of Psychiatry Director, Division of Addiction Psychiatry Disclosures I have no financial conflicts to disclose I will review evidence

More information

What Is a Withdrawal Syndrome?

What Is a Withdrawal Syndrome? Chapter 8 What Is a Withdrawal Syndrome? T Well, I ve been 7 days without Vicodin after taking 10-18 pills per day for about 2 years. It was not fun. Sweats, bad stomach problems, depression, pain, and

More information

Heroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain?

Heroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain? Heroin Heroin is a synthetic opiate drug that is highly addictive. It is made from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears

More information

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health? Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

More information

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

Pain Medication Taper Regimen Time frame to taper off 30-60 days

Pain Medication Taper Regimen Time frame to taper off 30-60 days Pain Medication Taper Regimen Time frame to taper off 30-60 days Medication to taper Taper Regimen Comments Methadone Taper by no more than 25% Morphine Taper by no more than 25% Tramadol Taper by no more

More information

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings All-Ohio Conference 3/27/2015 Christina M. Delos Reyes, MD Medical Consultant,

More information

Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction

Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction March 3, 2008 By: David Rinaldo, Ph.D., Managing Partner, The Avisa Group In this FAQ What medications are currently

More information

Buprenorphine: what is it & why use it?

Buprenorphine: what is it & why use it? Buprenorphine: what is it & why use it? Dr Nicholas Lintzeris, MBBS, PhD, FAChAM Locum Consultant, Oaks Resource Centre, SLAM National Addiction Centre, Institute of Psychiatry Overview of presentation

More information

Naltrexone and Alcoholism Treatment Test

Naltrexone and Alcoholism Treatment Test Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score

More information

OTC Abuse. Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University

OTC Abuse. Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University OTC Abuse Dr. Eman Said Abd-Elkhalek Lecturer of Pharmacology & Toxicology Faculty of Pharmacy Mansoura University Opiates Abuse Opioids are a group of natural, partially synthetic, or synthetic drugs

More information

Benzodiazepines. And Sleeping Pills. Psychological Medicine

Benzodiazepines. And Sleeping Pills. Psychological Medicine Benzodiazepines And Sleeping Pills Psychological Medicine Introduction Benzodiazepines are a type of medication prescribed by doctors for its therapeutic actions in various conditions such as stress and

More information

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth I. II. Background A. AWS can occur in anyone who consumes alcohol B. Risk correlates

More information

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. This document can be made available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on 01224 551116 or 01224 552245. This controlled document

More information

Methadone treatment Information for service users Page

Methadone treatment Information for service users Page South London and Maudsley NHS Foundation Trust Methadone treatment Information for service users Page What can happen if I stop using heroin? If you are addicted to or dependent on heroin, you develop

More information

Prescription Drug Abuse

Prescription Drug Abuse Prescription Drug Abuse Introduction Most people take medicines only for the reasons their health care providers prescribe them. But millions of people around the world have used prescription drugs for

More information

Care Management Council submission date: August 2013. Contact Information

Care Management Council submission date: August 2013. Contact Information Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing

More information

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines

More information

UNIT VIII NARCOTIC ANALGESIA

UNIT VIII NARCOTIC ANALGESIA UNIT VIII NARCOTIC ANALGESIA Objective Review the definitions of Analgesic, Narcotic and Antagonistic. List characteristics of Opioid analgesics in terms of mechanism of action, indications for use and

More information

Detox Day. RCGP June 13 th 2006. Daphne Rumball Addictions Psychiatrist. Norfolk. Daphne Rumball RCGP Detox Day June 2006 1

Detox Day. RCGP June 13 th 2006. Daphne Rumball Addictions Psychiatrist. Norfolk. Daphne Rumball RCGP Detox Day June 2006 1 Detox Day RCGP June 13 th 2006 Daphne Rumball Addictions Psychiatrist Norfolk Daphne Rumball RCGP Detox Day June 2006 1 Scope of presentation Undertaking detox in the community A review of evidence and

More information

CONTROLLED SUBSTANCE (NARCOTIC) AGREEMENT

CONTROLLED SUBSTANCE (NARCOTIC) AGREEMENT George A. Frey, MD Zaki G. Ibrahim, MD Nicholas K. Olsen, DO Thomas C. Sanders, PA-C Kai F. Stobbe, PA-C Paul Smith, Administrator Swedish Plaza III 799 E. Hampden Avenue, Suite 500 Englewood, CO 80110-2776

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Non medical use of prescription medicines existing WHO advice

Non medical use of prescription medicines existing WHO advice Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations

More information

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 SUBOXONE /VIVITROL WEBINAR Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 WEBINAR INTRODUCTIONS Cynthia Parsons- Program Manager

More information

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone )

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Elinore F. McCance-Katz, M.D., Ph.D. Professor and Chair, Addiction Psychiatry Virginia Commonwealth University Neurobiology of Opiate

More information

WHAT YOU SHOULD KNOW ABOUT DETOX

WHAT YOU SHOULD KNOW ABOUT DETOX So I made it. I m on the other side. WHAT YOU SHOULD KNOW ABOUT DETOX My body has purged itself. Sure, it took help from staff, some vitamin shots, detox drugs and a lot of sickness to make the symptoms

More information

What is Methadone? Opioid Treatment Programs Today. Is Methadone Safe? Pain Clinics. Wisconsin OTPs. Methadone Maintenance Treatment 5/6/2013

What is Methadone? Opioid Treatment Programs Today. Is Methadone Safe? Pain Clinics. Wisconsin OTPs. Methadone Maintenance Treatment 5/6/2013 Methadone Maintenance Treatment Tanya Hiser, MS, LPC State Opioid Treatment Authority April 22, 2013 What is Methadone? Schedule II pharmaceutical opioid similar to Oxycodone or morphine. Binds to the

More information

How to Manage Adjustment of Psychiatric Drugs. Choosing an Agent. Psychotropic Agents

How to Manage Adjustment of Psychiatric Drugs. Choosing an Agent. Psychotropic Agents How to Manage Adjustment of Psychiatric Drugs Fredrick Astle PhD, APRN, PMHCNS-BC Clinical Associate Professor College of Nursing University of South Carolina Choosing an Agent Has the client ever been

More information

Financial Disclosures

Financial Disclosures Opioid Agonist Therapy: To Maintain or Not To Maintain - A Case Discussion PCSS-MAT American Psychiatric Association Drs. Ed Salsitz, John Renner, Timothy Fong April 14, 2015 Financial Disclosures Edwin

More information

One example: Chapman and Huygens, 1988, British Journal of Addiction

One example: Chapman and Huygens, 1988, British Journal of Addiction This is a fact in the treatment of alcohol and drug abuse: Patients who do well in treatment do well in any treatment and patients who do badly in treatment do badly in any treatment. One example: Chapman

More information

M a n a g i n g t h e P a i n Commonly used terms Ask the right questions LPN2009

M a n a g i n g t h e P a i n Commonly used terms Ask the right questions LPN2009 Improving pain management in addicted patients By Pamela J. Woods, RN, CEN, SANE-A, BSN Trauma Staff Development Specialist Marilynn Kyritsis Bartley, RN, MSN, FNP-C Trauma Advanced Practice Nurse Christiana

More information

Management of Opiate Dependence in the Outpatient Setting

Management of Opiate Dependence in the Outpatient Setting Management of Opiate Dependence in the Outpatient Setting Abigail Kay, M.D., M.A. Abigail.Kay@Jefferson.edu Please Note: I have no conflicts of interest Medical Director Narcotic Addiction Rehabilitation

More information

DrugFacts: Treatment Approaches for Drug Addiction

DrugFacts: Treatment Approaches for Drug Addiction DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please

More information

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped

More information

10/28/2014. Collecting the Raw Opium

10/28/2014. Collecting the Raw Opium Opioid Analgesics (or Narcotic Analgesics) We are moving on to a new category of drugs whose effects, superficially, may look similar to those of the CNS depressants, but the drugs are, in fact, a completely

More information

MEDICATION ABUSE IN OLDER ADULTS

MEDICATION ABUSE IN OLDER ADULTS MEDICATION ABUSE IN OLDER ADULTS Clifford Milo Singer, MD Adjunct Professor, University of Maine, Orono ME Chief, Division of Geriatric Mental Health and Neuropsychiatry The Acadia Hospital and Eastern

More information

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM 3 rd Quarter 2015 BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM Introduction Benzodiazepines, sometimes called "benzos",

More information

Joanna L. Starrels. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VIII, 2003-2004. A. Study Purpose and Rationale

Joanna L. Starrels. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VIII, 2003-2004. A. Study Purpose and Rationale Outpatient Treatment of Opiate Dependence with Sublingual Buprenorphine/Naloxone versus Methadone Maintenance: a Randomized Trial of Alternative Treatments in Real Life Settings Joanna L. Starrels A. Study

More information

Prescribing and Tapering Benzodiazepines

Prescribing and Tapering Benzodiazepines E-Resource October, 2014 Prescribing and Tapering Benzodiazepines The use of benzodiazepines has grown over time and evidence has shown that long term use of these drugs has very little benefit with many

More information

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting ANCILLARY STABILIZATION AND WITHDRAWAL The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting About CASAColumbia A science-based, multidisciplinary organization Focused on transforming

More information

Methadone. Buprenorphine 10/9/2015

Methadone. Buprenorphine 10/9/2015 Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious

More information

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within

More information

Opioid Treatment Services, Office-Based Opioid Treatment

Opioid Treatment Services, Office-Based Opioid Treatment Optum 1 By United Behavioral Health U.S. Behavioral Health Plan, California Doing Business as OptumHealth Behavioral Solutions of California ( OHBS-CA ) 2015 Level of Care Guidelines Opioid Treatment Services,

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Pik-Sai Yung, M.D. Staff Psychiatrist Center for Counseling at Walton Background and Rationale Alprazolam is

More information

Opioid overdose can occur when a patient misunderstands the directions

Opioid overdose can occur when a patient misunderstands the directions Facts About Opioid Overdose How Does an Overdose Occur? Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription

More information

Prescription Drugs: Abuse and Addiction

Prescription Drugs: Abuse and Addiction EAP Drug Free Workplace Newsletter March 2014 Prescription Drugs: Abuse and Addiction What are some of the commonly abused prescription drugs? Although many prescription drugs can be abused or misused,

More information

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School OPIOIDS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ July 24, 2013

More information

Ambulatory Intoxication and Withdrawal Management: A Clinical Monograph

Ambulatory Intoxication and Withdrawal Management: A Clinical Monograph Ambulatory Intoxication and Withdrawal Management: A Clinical Monograph Revised December 2014 1 Table of Contents I. Ambulatory Intoxication and Withdrawal Management... 3 II. Evaluation and Assessment

More information

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal Background 1 Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Alyssa Cavanaugh, PharmD PGY1 Pharmacy Resident Children s Hospital of Michigan **The speaker has no actual or

More information

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1 Treatment and Interventions for

More information

Benzodiazepines. Understanding psychiatric medications. Information for consumers, families and friends. Titles in the

Benzodiazepines. Understanding psychiatric medications. Information for consumers, families and friends. Titles in the Titles in the Understanding psychiatric medications series include: Antidepressants Antipsychotics Benzodiazepines Mood Stabilizers Understanding psychiatric medications Benzodiazepines For more information

More information

Oxford Health NHS Foundation Trust. A guide to Opioid Detoxification

Oxford Health NHS Foundation Trust. A guide to Opioid Detoxification Oxford Health NHS Foundation Trust A guide to Opioid Detoxification If you re considering detox, congratulations. You have obviously been visualising a drug free life and planning your future goals. Detox

More information

Use of Pharmacotherapies by Substance Abuse Treatment Facilities

Use of Pharmacotherapies by Substance Abuse Treatment Facilities Use of Pharmacotherapies by Substance Abuse Treatment Facilities Cathie E. Alderks, PhD Substance Abuse and Mental Health Services Administration Department of Health and Human Services November 2007 1

More information

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D. Opiate Substitution Therapy for Opiate Dependence Alan Shein, M.D. OH #1-1 STATISTICS Prevalence of Specific Drug Abuse and Vulnerability to Develop Addictions National Household Survey and Related Surveys

More information

Substance Abuse Protracted Withdrawal. Kate Speck, PhD, MAC, LADC

Substance Abuse Protracted Withdrawal. Kate Speck, PhD, MAC, LADC Substance Abuse Protracted Withdrawal Kate Speck, PhD, MAC, LADC 1 Overview 1. Acute and Protracted Withdrawal 2. Withdrawal Potential 3. Recovery Reinforcers 2 Addiction Addiction is a primary, chronic,

More information

Science and Treatment Prescription Drug Addiction Treatment. Karen Miotto, M.D. David Geffen School of Medicine kmiotto@mednet.ucla.

Science and Treatment Prescription Drug Addiction Treatment. Karen Miotto, M.D. David Geffen School of Medicine kmiotto@mednet.ucla. Science and Treatment Prescription Drug Addiction Treatment Karen Miotto, M.D. David Geffen School of Medicine kmiotto@mednet.ucla.edu Presentation Objectives Examine drugs: effects, toxicities, withdrawal

More information

It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.

It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose. MEDICATION GUIDE VIVITROL (viv-i-trol) (naltrexone for extended-release injectable suspension) Read this Medication Guide before you start receiving VIVITROL injections and each time you receive an injection.

More information

Substance Abuse Treatment Admissions for Abuse of Benzodiazepines

Substance Abuse Treatment Admissions for Abuse of Benzodiazepines Treatment Episode Data Set The TEDS Report June 2, 2011 Substance Abuse Treatment Admissions for Abuse of Benzodiazepines Benzodiazepines are a class of central nervous system depressant drugs that are

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call the

More information

Withdrawal symptoms in long term sedation exposure of pediatric intensive care patients

Withdrawal symptoms in long term sedation exposure of pediatric intensive care patients CLINICAL PRACTICE Withdrawal symptoms in long term sedation exposure of pediatric intensive care patients Susanne Kotz University Medical Center Hamburg-Eppendorf, Germany Correspondence: Susanne Kotz.

More information

Reintegration. Recovery. Medication-Assisted Treatment for Alcohol Dependence. Reintegration. Resilience

Reintegration. Recovery. Medication-Assisted Treatment for Alcohol Dependence. Reintegration. Resilience Reintegration Recovery Medication-Assisted Treatment for Alcohol Dependence Reintegration Resilience 02 How do you free yourself from the stress and risks of alcohol dependence? Most people cannot do it

More information